Deciding whether to take antidepressants during pregnancy is a complex and deeply personal choice. 1 in 10 pregnant individuals experience depression, according to the U.S. Centers for Disease Control and Prevention (CDC). This statistic only accounts for those who seek treatment.
These medicines help with depression, but you might worry about how they affect your baby. We’ll explain the risks and benefits in this blog. Every pregnancy is different, so it’s important to work closely with your doctor. Although experts advise against some antidepressants, many are considered safe for pregnant women compared to untreated depression. This means the dangers of not treating depression may be worse than the risks of the medications.
Getting a good diagnosis
The first step to treating depression is to get a sound diagnosis, but that can be challenging for doctors treating pregnant women.
To diagnose depression, doctors will ask you a series of questions similar to the following:
- Have you been pregnant before?
- Was there a time when you weren’t depressed?
- How does this feeling compare to how you felt during a previous pregnancy?
Understanding the need for treatment
Before considering treatment options, it’s important for you to understand the risks of not treating depression. Many pregnant women with untreated depression don’t get enough prenatal care, good nutrition, or sleep. They may also be more likely to smoke, drink, or use drugs, which can lead to premature birth, low birthweight, and post-delivery complications.
What treatments are recommended?
Treatment for pregnant women – as for non-pregnant woman – will depend on numerous factors including the severity of the depression, the strength of a patient’s support network and her comfort level with different kinds of therapies.
For mild to moderate depression, especially for first-time episodes, the first line treatment is typically psychotherapy.
There are also situations in which antidepressants are recommended for patients with mild to moderate depression. An estimated 15% percent of pregnant women fill prescriptions for antidepressants, according to 2013 data compiled by the CDC.
Research into risks is not definitive
Unborn babies can be exposed to antidepressants through the placenta and amniotic fluid, posing a concern for many pregnant women. Research on the effects of antidepressants on babies is limited because ethical research protocols do not allow for experimenting on pregnant women.
As a result, the available information is based on reports from patients after pregnancy. In addition, the studies conducted can only demonstrate associations, not direct cause-and-effect relationships, between antidepressant use and fetal issues.
Concerns about birth defects
For certain antidepressants, some of the concerns raised by research have persisted across multiple studies and may be worth considering when you consult with your doctor about treatment for depression.
Selective serotonin reuptake inhibitors (SSRIs) are far and away the most commonly prescribed antidepressants for pregnant women, just as they are in the population at large. Most SSRIs are considered lower-risk for use by pregnant women, and the most frequently used SSRI, sertraline, is believed to present minimal concerns. But two SSRIs in particular – fluoxetine and, to a greater extent, paroxetine – have raised some red flags.
Most doctors prefer not to prescribe paroxetine to pregnant women. But in some cases, the benefits of effectively treating depression may outweigh potential risks to the baby.
Some research also links tricyclic antidepressants (TCAs), particularly clomipramine, to fetal heart defects, but that risk is considered to be low with most studies not showing a link. TCAs are not commonly used as a first line treatment in pregnant women.
Other antidepressant-related worries
Using certain medications known as SSRIs and TCAs during pregnancy may increase the risk of preterm delivery. These medications are also associated with causing mild jitteriness and irritability in newborns if taken late in pregnancy, but these symptoms usually go away within two weeks after birth. Additionally, taking paroxetine, certain serotonin and norepinephrine reuptake inhibitors (such as duloxetine or venlafaxine), and TCAs at the time of delivery can potentially lead to postpartum hemorrhage in the mother.
Stay consistent in your treatment
All in all, experts agree that pregnant women with depression should not avoid treatment out of concern over the potential effects on an unborn child, since those effects are not clearly understood. Regardless of the method used, the key is to stick to a treatment that works and only change or taper off treatment under the supervision of a mental health professional.
After all, you’ll need to be at the top of your game and able to weather a host of new stressors when it comes time to deliver your baby – and when you have a new little one at home. Asking for help to take care of your mental health is one of the bravest things you can do for yourself.
Find an OB/GYN
At HCA Florida Healthcare, we’re your partner in care, from family-centered labor and delivery services to maternity tours and classes.
As one of the largest healthcare providers in the state, our extensive network is home to everyone from OB/GYNs and midwives to high-risk pregnancy doctors and neonatologists. Find an OB/GYN near you.
