Kudos toThe Houston Press, who recently did a story spotlighting the tragic story of a a local family and the use of Paxil during pregnancy, "Baby Blues: Lisa Collins took the Paxil her doctor prescribed. There was supposed to be no problem with continuing it during her pregnancy. But it turns out, there was, giving a human face to the ongoing debate over the use of SSRI antidepressants during pregnancy.

This is the kind of reporting we need on complex issues like pharmaceutical use during pregnancy - beyond the sound byte and dense enough in content to provide readers with actual take-away information!

Lisa Collins' family's suit is the first in the nation to get a trial date for a suit against Paxil manufacturer GlaxoSmithKline - set for next summer. Problems with Paxil and birth defects started to creep into the professional and public consciousness when a 2005 study published in The Teratology Society reported women who took Paxil were more likely to have infants with birth defects such as omphalocele, in which the intestines or other abdominal organs protrude from the navel, and craniosynostosis, the early closing of one or more of the sutures of an infant's head, resulting in malformation of the skull as well as mental retardation and blindness. A subsequent study published in The New England Journal of Medicine suggested that taking Paxil after 20 weeks of pregnancy greatly increases the risk of persistent pulomonary hypertension in babies.

The Houston Press reporter writes, "These studies and several others still awaiting publication would seem to offer ample proof that SSRIs and pregnancy should not mix. But many doctors remain unconvinced," going on to quote the research-physicians who worked on these studies, who point out that much of the data we have is limited, and the findings inconclusive, on the broader issue of the safety of SSRI antidepresants during pregnancy.

Which, as I have argued many a time before, is the sad truth of where things stand. We now know that Paxil is out of bounds for pregnant women. It's no longer being prescribed to these patients. But the risk vs. benefit analysis for other SSRIs still remains an issue for informed - often anguished - decision-making between a pregnant woman with depression and the physicians treating her. (Choose your doctors very carefully, and never be afraid to make a switch when you have concerns! As for the insurance cos., don't hesitate to give 'em hell when it counts.)

Just as there may be some risks from some SSRI's during some stages of pregnancy, there are also very real and serious consequences of untreated depression that impact both baby and mother. Thousands of pregnant women with depression - including myself - have experienced health benefits from SSRI medication, finding it absolutely necessary for mental and physical health during pregnancy. But our decisions have never, ever been easy. We have worried endlessly, and we have been thankful when we gave birth to healthy, beautiful babies and were ourselves healthy enough to care for them.

Is the solution to return to tricyclic antidepressants - those developed in the 1970s and (to date, anyway) not found to cause birth defects? I don't know. None of us knows - not even our doctors, not even the FDA (whose relationships with pharmaceutical firms have greatly diminished our trust in the agency's role as a public "protector").

We need to demand more research and better research in this area! And we need to each take personal responsibility as a partner in our own care, weighing the risks and benefits of any medication very carefully, while also exploring as many non-invasive strategies for supporting emotional wellness as possible. For some of us, exercise, yoga, meditation, changes in the diet, more rest, targeted stress reduction, etc. can be a valuable therapeutic boost, should we make the decision to limit or wean off antidepressants during pregnancy.

We need to keep pushing, and pushing hard, for more transperancy and accountability from pharmaceutical makers, policymakers, and the media who covers these issues.