Antidepressants and spontaneous abortion.

On the cover of the July 13, 2010 issue of CMAJ was the heading, “Use of antidepressants in pregnancy increases the risk of spontaneous abortion.” The findings in the related research article by Nakhai-Pour and colleagues are based solely on prescription drugs. No estimate was done of actual compliance with the medications. If a woman was aware that she was pregnant, the likelihood of her taking the medication might be lower. Patients sometimes fill a prescription but then decide against taking it. Medical contact for antidepressant therapy might be associated with pregnancy testing, making women more aware that vaginal bleeding might be a sign of spontaneous abortion. What can be said is that filling a prescription for an antidepressant is associated with an increase in clinically detected spontaneous abortions.