Depression Medication Linked to Gestational Hypertension

Currently SSRI’s (selective serotonin reuptake inhibitors) are commonly prescribed during pregnancy for those who have been previously responsive to SSRI’s and those who have severe depression or anxiety. A March 2009 study in the American Journal of Psychiatry reported increased incidence of gestational hypertension and preeclampsia in women who took SSRI’s during the last trimester of pregnancy.

Should pregnant women take depression medications? This is a complicated question and requires an individual assessment of the woman’s needs. The risks of taking depression medication have to be weighed against the risks of not taking it. We know that some drugs can cause birth defects especially if taken during the first trimester. Some babies experience medication withdrawal after birth if their mothers took antidepressants during pregnancy. On the other hand, we also know that untreated depression during pregnancy carries its own risk to the baby such as preterm labor, smaller head size and lower birth weight. Also, babies born to untreated, anxious, depressed mothers are more difficult to soothe and may have slowed motor development.

So what’s a woman to do? I tend to be on the conservative side of the spectrum with regards to avoiding medication if at all possible, especially during the first trimester when the baby’s organs are forming. However, I think the general trend has been to use SSRI’s even in mild cases of depression. There are definitely women who cannot continue the rest of their pregnancy off depression medication without putting their life and the life of their unborn baby at risk. In general the findings seen in this study should make us give more consideration as to which women should continue on depression medication throughout their pregnancy and which ones should continue off depression medication and be monitored closely.

How Long Until Antidepressants Work?

We in psychiatry have always said it took 3-4 weeks for an antidepressant to show a clinical effect. Those who showed improvement in the first 2 weeks were thought to be having a placebo effect. In the past 2 years, there have studies that have shown that patients can have a “real” response to antidpressants as early as 1 week after starting the medication.

When Lexapro became available in 2002, pharmaceutical reps said it was supposed to show effect in the first week.  At that time, that was the first antidepressant that made that claim.  I find the literature still unclear about what is an expected response time.  This is probably because there are other factors such as lack of support, ongoing stressors, variability in how drugs are metabolized that affect response time.

Also, another source of confusion may be in how we define “working”.  A clinical response is not the same as a full recovery, so a person may experience some lifting of their depressed mood in the first week, but still have considerable irritability, insomnia, anxiety, etc. for several more weeks.  Bottom line, I think the current literature supports early responses in the first week as being real and possible, but we still need to give the medications 4-6 weeks at a therapeutic dose to show a full response.