It's a myth that pregnancy is usually one of the happiest times of a woman's life. Sure, many are delighted to be pregnant; but at least 14 percent of pregnant women are depressed during pregnancy. Pregnancy, in fact, is now recognized as one of the highest risk periods for mental illness among women.
Experts continue to debate how to help pregnant women who are depressed. Now there are a couple of recent studies that could be reassuring to women who opt to take antidepressants during pregnancy.
The question of how to treat the condition is critical because research does show there are some risks to a baby from taking medication. And many women do take antidepressants: One study found that approximately 13 percent of women took an antidepressant at some time during their pregnancy.
But not treating the depression isn't a good option, either. Other research shows that depression in pregnancy can lead to less-healthy babies, including those born weighing less. And depressed mothers may struggle to take care of an infant. If mom and baby don't bond well, the effects on children can be significant and long-term.
It's a tough dilemma, for women and their doctors. Which is why, in 2009, the American College of Obstetricians and Gynecologists joined with the American Psychiatric Assocation to put out guidelines to help, though they basically concluded that the decision is a matter of individual preference. "Both depression symptoms and the use of antidepressant medications during pregnancy have been associated with negative consequences for the newborn," the recommendations noted. These, they said, included babies that are more irritable, less active and attentive, and who show fewer facial expressions than infants born to moms without depression. The report went on to say that some research has linked antidepressants during pregnancy to heart problems, lower birthweight, malformations, and hypertension in babies.
Three years after these recommendations appeared and women and their doctors still have to weigh the pros and cons of taking medication during pregnancy, says Dr. Linda Chaudron, a psychiatrist and expert on pregnancy and depression. But there is a growing amount of information that should help women with depression choose the best course for themselves and their babies.
A new study of women taking antidepressants during pregnancy, published in the journal Acta Psychiatrica Scandinavica, found that the risk of the baby having a major malformation is small. However, up to 30 percent of newborns exposed to antidepressants have something called "neonatal adaptation syndrome," which includes insomnia, agitation, jitteriness, poor feeding, poor temperature control, crying, and/or seizures. In comparison, about ten percent of infants not exposed to antidepressants have this condition, according to researchers at the University of Massachusetts Medical School.
A different—and a bit more heartening—study, published recently in the Journal of the American Medical Association, found that the use of antidepressants in pregnancy does not increase the risk of stillbirth. This should help women and their doctors when they're talking about the best treatment, Chaudron told TakePart.
"The information just keeps evolving. Data keeps coming out, which is great, but it makes the answers less simple," says Chaudron, the senior associate dean for diversity and a professor of psychiatry at the University of Rochester, in New York. "I like to use the word 'informed.' I think our patients and providers are becoming more informed and conversant about the risks and benefits. Twenty years ago we said, 'we just don't know the risks.' Today we have more nuanced, more subtle information."
Chaudron cautions women to be flexible about treatment decisions because pregnancy lasts a long time. "There is no right answer for the whole year of pregnancy," she says, including the post-partum period. "What I try to do is monitor the patient: 'How are you doing off the medication? Let's get you through the first trimester and see how you're doing. Maybe you'll need to go back on the medication later.' It's got to be give-and-take and a constant dialogue."
If you're thinking about becoming pregnant and dealing with a mental health disorder, be sure to talk to your doctor about how to manage your illness during the nine months and beyond, Chaudron says. "A moment of crisis is not when you want to decide," whether or not to go off your meds, she explains. "It's better to do that ahead of time. [So if] X, Y or Z happens, I understand the risks and benefits of my medication and I'm going back on it."
Non-medication treatment options are also available, and family and social support are important in managing pregnancy and a mental illness, adds Chaudron. But, she cautions: "Pregnancy is totally unpredictable. That is important for women to understand. If they miscarry, for example, they may link it to a decision they made. But these things happen, regardless. Pregnancy in and of itself is not without risk."
Do you think the benefits of treating depression during pregnancy outweigh the risks? Did you use an antidepressant while pregnant, or would you?
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Shari Roan is an award-winning health writer based in Southern California. She is the author of three books on health and science subjects.
- Family Health