Antidepressants and Neural Tube Defects

What are neural tube defects?

Neural tube defects (NTDs) are birth defects of the brain and spinal cord. During the third and fourth week of pregnancy the embryonic neural tube develops and begins to close, forming what will become the central nervous system (brain and spinal cord). When the neural tube of an embryo fails to close completely, an NTD occurs.

There are different types of neural tube defects that occur at different stages of neural tube development. Spina bifida and anencephaly are two examples of NTDs.

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Spina bifida forms, symptoms and complications

Spina bifida occurs when the tube that forms the spinal cord and spine fails to properly fuse and the bones of the spine (vertebrae) do not completely close around the spinal cord. Spina bifida may be closed (covered by skin) or open (the skin does not cover the defect). There are different types of spina bifida with different complications ranging from mild back pain to severe physical and mental disabilities.

• Spina bifida occulta: Also called hidden spina bifida, spina bifida occulta is a less severe form of spina bifida. In occulta spina bifida, there is a very small split in the vertebrae that protect the spinal cord.This congenital defect is not harmless however, since studies suggest it can lead to severe back pain and can affects normal bowel or urinary function. Symptoms also include a dimple in the skin, a lipoma or a birthmark at the site of the lesion.

• Meningocele: This type of spina bifida occurs when the membranes that protect the spinal cord (meninges) protrude through the vertebral column. This cerebrospinal fluid may collect within a sac that may be visible as a bulge on the lower back. Meningocele is considered a moderate form of spina bifida. Some infants born with meningocele may be asymptomatic while others may suffer from incomplete paralysis and urinary/bowel dysfunction. Treatment for meningocele may involve surgery, especially if the defect is not covered by skin.

• Myelomeningocele: Also known as cleft spine, myelomeningocele is the most severe type of spina bifida. This defect occurs when the spinal cord protrudes through an opening in the spine, leaving the spinal cord and meninges (protective coating of the spinal cord) vulnerable to damage. Myelomeningocele can lead to paralysis in parts of the body underneath the opening. This type of spina bifida can also lead to bowel and urinary dysfunction, meningitis (a life threatening infection), hydrocephalus (extra fluid in the brain) and tethered cord syndrome. Although surgery cannot correct the defect, surgical treatment is usually required to close the opening in the back and prevent infection to an infant’s spinal cord. Physical and psychological therapy may be needed to help a child deal with the physical and emotional hardships associated with myelomeningocele.

Anencephaly

Anencephaly is a neural tube defect that occurs when the head end of the neural tube does not form properly. The incomplete closure of the “cephalic” or head end of the neural tube prevents a large portion of the brain from developing, particularly the forebrain and cerebrum. Anencephaly is a fatal congenital defect with affected infants being either stillborn or dying shortly after birth.

There is no treatment and no cure for fetal anencephaly.

Causes of neural tube defects

Research has shown that taking antidepressants during pregnancy can affect the developing fetus in many negative ways. A 2007 study in the New England Journal of Medicine found a link between the use of certain antidepressants during pregnancy and a higher risk of the NTD anencephaly.