There’s an interesting study in the British Medical Journal (August 2013). It’s called Use of antidepressants near delivery and risk of postpartum hemorrhage: cohort study of low income women in the United States, and it was written by Kristin Palmsten et al.
The study examined nationwide Medicaid data from 2000-2007, and followed 106,000 pregnant women aged 12-55 who had been given a “diagnosis” of a mood or anxiety disorder.
The women were categorized into four mutually exclusive groups on the basis of information obtained from Medicaid’s pharmacy dispensing data. The criterion for categorization was exposure to SRI’s or to Non-SRI’s and the groupings were:
Current exposure (at delivery date)
Recent exposure (1-30 days prior to delivery)
Past exposure (1-5 months prior to delivery)
“All types of selective serotonin reuptake inhibitors available for analysis and venlafaxine, a serotonin norepinephrine reuptake inhibitor, were significantly associated with postpartum hemorrhage.”
“Compared with no exposure, women with current exposure to serotonin reuptake inhibitors had a 1.47-fold increased risk of postpartum hemorrhage…and women with current non-serotonin reuptake inhibitor exposure had a 1.39-fold increased risk…”
A total of 14,205 women (13.4% of the total) had been taking SRI’s or N-SRI’s at the time of delivery. An additional 19,473 women (18.3% of the total) had taken SRI’s or N-SRI’s in the previous five months. Adding these numbers, we can see that a staggering 31% of the women had taken these drugs in the last five months of their pregnancy.
This was a cohort study, not a randomized controlled trial. The researchers drew from the data base information on all women who were pregnant and had a “diagnosis” of mood disorder or anxiety disorder. Then they checked antidepressant use against postpartum hemorrhage. It is possible that the individuals who were taking the pills were also positive for some unmonitored risk factor, and that it was this unknown factor that was causing the excessive hemorrhaging.
However, given that postpartum hemorrhaging is one of the very serious complications of delivery (sometimes leading to the death of the woman), the results of the cohort study should at the very least be a cause for concern. Of equal concern is the fact that almost a third of the women had taken these drugs during the last five months of their pregnancies.
In the late 80’s/early 90’s, I worked in the chemical dependency field. At that time, we were seeing a fairly marked increase in the numbers of people coming into treatment units for cocaine addiction. It was said at the time that dire poverty and unemployment in the inner cities were driving the increase in cocaine use. In other words, people’s lives were so wretched that they were turning to cocaine for some kind of chemical relief. I have no way of verifying this information, but it does have a measure of plausibility, and was widely accepted at the time.
With regards to the present research, it is noteworthy that all of the women in the study were poor. (Medicaid eligibility is assessed on need.) Pregnancy, childbirth, and childcare, on average, represent a greater burden for poor women than for their more affluent counterparts. It is well within the realm of possibility that many of these women were having difficulty coping and had mixed feelings at the prospect of bringing a new baby into their world. It is possible that they were turning to pharmaceutical products for the same reasons that the cocaine addicts turned to cocaine: to find temporary chemical relief from the burdens of poverty and its entailments. Psychiatry, of course, won’t countenance this possibility, but rather clings to its inane notion that each of these women has a brain illness, that the drugs are necessary – even life-saving –, and that their benefits outweigh the risks!
So here’s the question: Is there any essential difference between a poor, unemployed victim of inner-city blight taking cocaine as a temporary relief to feelings of despair on the one hand, and a poor, pregnant woman taking an SRI to alleviate her negative feelings on the other? This question is particularly pertinent, in that the method of action of cocaine and these pharmaceutical products is essentially similar (inhibition of neurotransmitter reuptake).