Until recently, the prevailing thinking was that women were “protected” from psychiatric illnesses like clinical depression when they were pregnant. It was considered to be a time of emotional well-being – you know, that “glow” and all – and pregnant women, fearing the effects of medication on their babies, were often encouraged to discontinue use of anti-depressants.
But recent studies have shown that women who have been diagnosed with clinical depression and who discontinue anti-depressant medication during their pregnancies are at strong risk for relapse. Research has also shown that depression during pregnancy may heighten the risk of premature birth, fetal distress, neonatal behavioral differences and the development of postpartum depression. What’s more, the research into the effects of anti-depression medications taken by pregnant women on their babies has been encouraging, though it is ongoing and the potential risks should be given serious consideration. Nevertheless, there’s been a great awareness of the importance of the impact of depression on both mother and baby, and a growing inclination to ensure that clinically depressed pregnant women get the help they need – and continue medication when necessary.
Of course, all the anti-depressants are not equal. The Mayo Clinic warns that “few medications have been proved safe without question during pregnancy” but add that “overall, the risk of birth defects and other problems for babies of mothers who take antidepressants during pregnancy is very low.” The site also includes a helpful table laying out the relative risks associated with many commonly prescribed medications and advising readers which to consider and which to avoid. Paxil, when taken by a mother in the first trimester, for instance, has been found to increase the risk of fetal heart defects and to have other negative effects; consequently, the American Congress of Obstetricians and Gynecologists recommends that women who are pregnant or planning to become pregnant avoid it, when possible. The ACOG also recommends that the use of selective serotonin reuptake inhibitors (SSRIs), such as Prozac, and selective norepinephrine reuptake inhibitors, such as Cymbalta, for the treatment of depression during pregnancy be considered on an individual basis, weighing the risks and benefits. The AAP advises similarly, saying: “Drug treatment is indicated if psychotherapy is inadequate or inappropriate for the patient’s severity of illness. Once a decision to offer pharmacotherapy is made, important factors in drug selection for the mother include efficacy of the drugs available, the anticipated response of the individual patient, and the overall toxicity profile of the drug for the mother and the fetus.”
The upshot? Talk to your doctor. If your depression is mild, you and your physician may decide to eschew antidepressants and manage your symptoms with support groups, counseling and other forms of therapy. But if you experience or have a history of severe depression, you may decide that the risk of a relapse outweighs the risks of taking antidepressants during your pregnancy. Whichever choice you determine is right for you, remember: Neither you or your baby has to suffer.