Women commonly suffer depression during the childbearing years - it’s well known that depression occurs postnatally in many women. But depression can also occur at any time before or during pregnancy. As depression is potentially life threatening it should NEVER go untreated.
Treatment for depression often involves counselling or talk therapy, but sometimes antidepressants are also needed. This poses a problem for women who have been depressed and wish to fall pregnant and for women who develop depression during pregnancy. Should they suffer untreated depression in order to avoid taking medications during pregnancy? Or should medication be continued throughout pregnancy thus causing potential problems to the baby?
Let’s look at some options when talking therapy is not enough and antidepressants are needed:
1. Postponing pregnancy until depression is resolved and medication no longer needed.
This seems the “safest” option for the baby, but there are problems with this approach. Pregnancy may need to be postponed for up to two years as it can take six months to stabilise on the antidepressant, 6-12 months of maintenance medication, and another six months to withdraw fully. But by this time women can find it harder to get pregnant because their fertility has fallen, especially if they are over 35.
2. Withdrawing antidepressants before pregnancy.
This also seems safe for the baby. Unfortunately, however, there is a high risk of relapse during the pregnancy and then it can be very difficult getting the depression under control again. Many women end up suffering unnecessarily for the rest of the pregnancy.
3. Continuing or starting antidepressants during pregnancy.
This is best from the depression point of view. However, sometimes newborns whose mothers took antidepressants known as selective serotonin reuptake inhibitors (eg Prozac, Zoloft, Aropax) can have withdrawal symptoms like agitation, poor feeding and sleepiness for a few days. Reducing the dose at the end of the pregnancy may avoid this. To date, there are no reports of antidepressant related birth defects and research suggests children whose mothers took fluoxetine (Prozac) during pregnancy have no added risk of behavioural, neurological, or developmental problems by age five. St John’s Wort is not recommended during pregnancy.
4. Leaving depression and/or anxiety untreated during pregnancy.
There are many risks with leaving depression untreated, not least of which is suicide. The babies are at risk of being undernourished in the womb, they risk delayed development at eight months, and they risk more behavioural and emotional problems at four years than other children.
So in conclusion, to date evidence suggests there is more risk to the mother and child from untreated depression than there is from taking antidepressants. However while taking antidepressants in pregnancy seems safe, they should only be rescribed when absolutely necessary. The final decision needs to be made by the woman herself in consultation with her doctor (GP, psychiatrist, obstetrician, or all three). If you think you may be depressed, don’t hesitate to discuss this with your doctor.
Please note: this article does not replace medical advice.
For further information on antidepressants in pregnancy see http://www.bcrmh.com/index.htm and http://www.motherisk.org or contact Mothersafe at the Royal Hospital for Women in Randwick on 02 9382 6539 or 1800 647 848
References:
Australian Adverse Drug Reactions Bulletin Volume 22, Number 4, August 2003
The American Journal of Psychiatry 2002;159:1889-95
The Safety of Herbal Medicinal Products UK Medicines Control Agency www.mca.gov.uk
The Journal of Child Psychology and Psychiatry 2003;44:1025-36
The Journal of Child Psychology and Psychiatry 2003;44:810-18
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