By Heather Hatfield
Reviewed By Cynthia Haines
With pregnancy comes joy, excitement, baby showers, and the wonder of a new life. But for some, pregnancy is clouded by depression, a condition that puts not only the mother at risk, but the child as well.
"During pregnancy, doctors try to keep women off antidepressants unless they have severe depression or if they have a history of relapsing if taken off antidepressants in the past," says Victoria Hendrick, MD. "Instead, other interventions, like psychotherapy, are used to help reduce the need for an antidepressant.
Not Treating is Risky
But if the depression is so bad that a pregnant woman is not eating or gaining weight, for instance, then it needs to be treated as aggressively as possible."
For women at risk for depression during pregnancy -- those who have battled major depression in the past or who experienced depression during a previous pregnancy -- the news is good: The risk associated with the use of antidepressants during pregnancy is small.
But what should be considered when deciding whether or not to take an antidepressant, or to try other therapies first? And, what research is available to help put an expectant mom's mind at ease?
"For mild or moderate depression, I'd rather use psychotherapy or group therapy than antidepressants," says Hendrick, assistant professor in the department of psychiatry and bio-behavioral sciences at UCLA.
But for pregnant women with major depression, the risk of a relapse after stopping antidepressant medication is greater than the risks posed by treating it with medication.
"If health behaviors are not good because of the depression, that could have a negative impact," says Hendrick. "If a woman is not eating, not sleeping, feeling stressed or anxious -- these could have an adverse impact on a developing fetus. And obviously, suicidal feelings are another adverse risk associated with depression."
Untreated depression can interfere with a woman's ability to care for herself, impair nutrition, increase the use of tobacco, alcohol, and drugs, lead to premature labor and low birth-weight babies, and interfere with bonding feelings with an unborn child.
Untreated major depression during pregnancy may also cause infants to have an increased sensitivity to stress.
In cases of major depression, Hendrick explains to WebMD, women need both psychotherapy and antidepressant medication.
"The more multidisciplinary the treatment, the more likely they are to get better," says Hendrick. "Using both therapy and medication greatly increases a woman's chance of seeing an improvement in her symptoms."
Antidepressants Generally Safe
When the symptoms of depression warrant psychotherapy as well as antidepressant medication, the good news is that certain drugs can help treat depression with little to no risk to an unborn child.
"There is no evidence to suggest that taking antidepressants during pregnancy comes with a risk of congenital defects, and that's reassuring," says Hendrick. "But it is important to keep in mind that we cannot say for sure that antidepressants are 100% safe to take during pregnancy."
According to a study published in the American Journal of Psychiatry, women who took antidepressant drugs throughout their pregnancies -- both selective serotonin reuptake inhibitors (SSRIs) such as Prozac and Zoloft and tricyclic antidepressants -- had children with normal pre-school and early-school development.
Data also suggested that, on the other hand, depressed, untreated pregnant women and those suffering from long-term depression or multiple episodes of depression can have children with behavioral problems and delayed cognitive and language development.
A concern associated with medical treatment of depressed women during pregnancy is the possible increase risk of premature labor. A review of medical records showed women treated with SSRIs during pregnancy had a higher risk of delivering their babies early, before 36 weeks, according to a study published in the American Journal of Psychiatry.
But the women in this study who were treated with another class of antidepressants known as tricyclics had no increased risk of premature birth. Researchers stressed the risk associated with SSRIs is not overwhelming enough to warrant women not take antidepressants if their condition requires medication. Also reassuring is that the study showed no risk of birth defects associated with SSRIs.
An additional concern is whether a newborn baby whose mother took antidepressants during pregnancy will suffer from symptoms of withdrawal.
"While the SSRIs, such as Zoloft, Prozac and Paxil, are unlikely to cause a major birth defect, several, including Prozac and Paxil, have been reported to increase the risk of withdrawal symptoms in the newly born child, especially if they are used in the third trimester," says C. Neill Epperson, MD, assistant professor of psychiatry and obstetrics/gynecology at Yale University School of Medicine.
Studies that assessed the risk of SSRIs taken during pregnancy showed that Paxil could cause withdrawal symptoms, such as jitteriness, vomiting, and irritability, in infants. But researchers noted the cause of the symptoms is not entirely clear: They were not able to say definitively whether the symptoms were a result of withdrawal, the toxicity of the drugs, or another unknown factor.
The last area of concern comes when a mother gives birth and decides to breastfeed her baby while on antidepressants. Here, the news is very promising.
"Breastfeeding has been well researched in terms of antidepressants, "Hendrick tells WebMD. "And the results of research show that breastfeeding women shouldn't be told they have to stop taking an antidepressant to breastfeed."
Hendrick explains that babies are very sensitive to their mothers' moods, and there is a great deal of evidence that suggests a mother's mood can impact the child.
"The mother should not remain depressed for both her benefit and the baby's," he says. "Antidepressants can be helpful, and the exposure to a baby through breast milk is so minute, there is no reason to not take them if they would be helpful."
Weighing Benefits and Risks
"Have a discussion with your doctor about the risk and benefits about being on an antidepressant if you are pregnant," says Epperson. "If you can be off a medication, of course you should be, but if you can't -- and a lot of women can't -- then antidepressants can help."
With both psychotherapy and antidepressants, a pregnant woman can overcome depression and enjoy the birth of her child, and be assured that the risk that antidepressants pose to her child is small.
Originally published June 9, 2003.
Medically updated February 2005.
SOURCES: C. Neill Epperson, assistant professor of psychiatry and obstetrics/gynecology, Yale University School of Medicine. Victoria Hendrick, MD, assistant professor, department of psychiatry and biobehavioral sciences, UCLA. University of Dartmouth Patient Education. WebMD Medical News: "A Mother's Dilemma: Using Antidepressants During Pregnancy." WebMD Medical News: "Antidepressants Linked to Premature Birth." WebMD Medical News: "Depression Drugs OK During Pregnancy." Medscape: "Antidepressants During Pregnancy: Researchers Assess Safety of Prenatal Exposure to SSRIs." WebMD Medical Reference in collaboration with The Cleveland Clinic: "Depression in Pregnancy."
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