Fetal Effects of Untreated Versus SSRI-Treated Maternal Depression

The goal of this thesis is to better understand the outcomes of both treated and untreated maternal depression on fetal development and birth defects. We focus on a class of antidepressant drugs known as selective serotonin reuptake inhibitors (SSRIs). We hope to gain insight into how these effects might carry on into childhood and adolescent years. While research shows there are potentially significant consequences for the fetus in both treated and untreated scenarios, it remains unclear whether depression itself or SSRIs play the larger role in the outcomes of children born from these women. We begin with a general history of depression and the introduction of SSRIs, followed by a review of the physiology of depression and SSRI treatment. We then narrow our focus to the history of maternal depression, SSRI usage in pregnant women, and potential risk factors. Following this, we analyze studies on the effects of depression and SSRI usage on the fetus and at birth, paying careful attention to the cortisol pathway that results from depression itself and the biochemical effects that SSRIs have on embryogenesis and fetal development. While there is limited research on the long-term effects of fetal exposure to SSRI-treated and untreated maternal depression, one of the aims of this thesis is to understand the potential risks for children throughout their developmental years and into adolescence. Therefore, we also researched the effects of depression and SSRI use in children and adolescents themselves, comparing this information to the effects of both SSRI-treated and untreated maternal depression. We believe there is sufficient evidence of causal connections involving cortisol (in untreated depression) and SSRIs (in pharmacologically treated depression) to warrant caution regarding the use of SSRIs in a clinical setting. We suggest alternative treatments for depression such as Cognitive Behavioral Therapy (CBT), which have been shown to be effective, and which have very little chance for harm. Notably, such treatments can be of real benefit regardless of the underlying biological, psychological, and social causes of depression. Finally, we conclude by suggesting some preventative treatments for maternal depression. While we do not believe the use of SSRIs needs to be completely avoided in the case of maternal depression, we believe that better practitioner education in preventing depression could go a long way in making them unnecessary in most cases.