Conventional advice used to steer pregnant women away from antidepressant drugs, but new research suggests there may be more risk to the child if the mother's depression isn't treated during pregnancy. When Canadian researchers looked at children born to women who took antidepressant drugs all the way through their pregnancies, they found that all of the children had normal pre-school and early-school development. What’s more, the new findings apply to the older tricyclic antidepressants as well as to the newer selective serotonin reuptake inhibitors (SSRIs) such as Prozac (fluoxetine HCl). The study appears in a recent issue of the American Journal of Psychiatry. The new findings, however, do not state that all pregnant women who have a bout of the blues should necessarily take medication, experts stress. “Generally speaking, it’s a very individualized decision and there is no absolute answer,” says reproductive psychiatrist Catherine Birndorf, M.D., the program director of the Payne Whitney Women's Program at New York Weill Cornell Medical Center, and an assistant professor of psychiatry at Weill Medical College of Cornell University, in New York City and White Plains. When making a decision about treatment, “We consider the risk of exposure to fetus versus the risk of untreated depression to the mother,” Dr. Birndorf says. “It may not be advisable for a pregnant woman who takes medication and has a history of severe recurrent depression to come off medication while pregnant.” “If someone comes to me because their primary care doctor put them on [the SSRI] Zoloft (sertraline HCL), I ask if they think they could live without this medication and if they say ‘yes’, it may merit a trial off the medication. And if they are not doing well, I will put them back on it,” Dr. Birndorf says. The SSRIs are relatively safe, she says, but before any medication is used, she usually tries non-pharmacological interventions such as increased therapy or support groups to modify the illness or stress. “If a pregnant woman is experiencing severe depression, there is no reason that she should stop taking her medication because antidepressants are relatively safe around the birth and seven years out,” Dr. Birndorf explains. What’s more, recent data suggests that untreated maternal depression may lead to premature delivery and low birth weight babies. Why? “If you are depressed, you may not be able to care for yourself,” Dr. Birndorf explains. “This compromises prenatal care. You don’t take vitamins and don’t comply with appointments and then after pregnancy, you may have difficulty bonding with baby.” In addition, she says, mothers who are depressed may self-medicate with drugs and alcohol, already known to have devastating effects on the fetus. Alex M. Joanow, D.O., of the Horizon Family Medical Group in Orange County, says, “If there is a chronic problem of underlying depression, we typically make the decision to continue therapy under the auspices of joint management between an obstetrician and psychiatrist.” Dr. Joanow adds, “It is more of a gray area when [an unmedicated] pregnant woman comes in with signs and symptoms of depression with or without a past history of depression. We do know that it is far more damaging to an infant if the mother is not okay during pregnancy and afterwards.” The bottom line, he says, is to weigh the benefits and risks of prescribing medications. “As long as you take care of the patient or mother appropriately, the risk-benefit will always work in the baby’s favor,” Dr. Joanow says. “Obstetricians are often the primary care doctors for women, and when a women goes through the hormonal changes of pregnancy, we try to spend an enormous amount of time looking for signs and symptoms of depression and her ability to handle the hormonal, physical and emotional changes of pregnancy. “Pregnancy is a huge life change and the end result of having a baby is a tremendous life change — socially, financially and in every aspect of life. We look to see if a woman is having an appropriate response to those changes,” Dr. Joanow says.
Take-Home Points • Antidepressants are safe for mother and child during pregnancy. • Untreated depression is far more dangerous to both mother and child. • There is no one-size-fits-all answer. All cases are evaluated on an individual basis. • Talk to your obstetrician if you are pregnant and experiencing symptoms of depression. He or she can refer you to a mental health professional.