Pregnancy and Depression
I have been getting questions and comments from visitors concerned about the effects of antidepressants and psychotropic medications on pregnancy. Thus, I’ve been keeping a watchful eye on new research information published on this concern.
In the August 2007 issue of the American Journal of Psychiatry was a medical education article called, “Antenatal Depression: Navigating the Treatment Dilemmas” by Dr. Marlene P. Freeman, M.D. Dr. Freeman described 2 patient case studies - a 35-year old professional woman with major depression whose illness relapsed when she discontinued her meds after becoming pregnant. Another was a 24-year old mother who became clinical depressed 20 weeks into her pregnancy. Both women posed concerns for the doctor because of the need to weigh the potential risks to the fetus from medication side effects and the risks to the mothers from not receiving medication treatment for their bipolar disorder or depression.
As of this writing, I was able to access the entire article online here. Please feel free to check it out for yourself; however, the article is very technical since it’s geared towards doctors. Dr. Freeman’s conclusions, based on her Summary and Recommendations section, are as follows:
Summary and Recommendations
- Doctors should choose treatment based on how severe the patient’s symptoms are, the patient’s mental health history, and the patient’s preferences in selecting treatment.
- In women with mild depression, nonpharmacological (i.e. non medication) approaches may be useful first-choice treatments.
- In women with moderate to severe depression or a history of previous postpartum depression or recurrent major depression, antidepressants should be strongly considered, alone or in combination with nonpharmacological treatment.
- The risks of antidepressant exposure to the baby are unclear, although some studies have suggested the potential for risks such as cardiac teratogenicity with paroxetine (brand name Paxil or Seroxat, manufactured by GlaxoSmithKline); persistent pulmonary hypertension of the newborn and other adverse outcomes with SSRIs; and preterm birth and lower gestational age at birth with antidepressants in general.
Source: Am J Psychiatry 164:1162-1165, August 2007
doi: 10.1176/appi.ajp.2007.07020341
© 2007 American Psychiatric Association
So what happened to the two women in the article?
The 35-year old professional woman ultimately chose not the be on medication therapy during the course of her pregnancy. Instead, she relied on a dietary supplement alternative, which did not appear to work to improve her depression. She did, however, decide to stop breastfeeding 2 months after delivering her baby to begin medication therapy and experienced full remission from her major depression. Her baby was born normal.
The 24-year old mother and her husband made the decision together that she would start antidepressant therapy, as they both agreed that the risk of not getting treatment for her depression outweighed the potential risk to the baby, especially when she was beginning to feel antagonistic toward her unborn baby. She responded well to antidepressant therapy and also began psychotherapy. She began to feel excited about her baby.
Moral of the stories - When you are pregnant and have a history of depression or begin to experience clinical depression, work with your doctor to discuss all your options as well as your concerns. Your decision will be a very personal one, and the more love and support and accurate information you have about the risks and the benefits of medication treatment for your depression, the better you will be equipped to make the decision that makes the most sense for you during this exciting and challenging time.
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