Depression During Pregnancy May Warrant Medication
Ground-breaking new guidelines issued by two national physician groups state that while talk therapy alone is considered the best treatment for pregnant women who suffer from depression, in severe cases use of medication is warranted despite potential risk to the developing fetus. Nearly one in four U.S. women experience episodes of depression during pregnancy, 13% of whom are prescribed antidepressant medications. Until now, doctors have lacked coherent professional guidelines to guide pregnant patients in weighing the risks of various treatment procedures for depression during pregnancy.
Based on a study of medical practices between 1999 and 2003, the new guidelines, which were jointly issued by the American Psychiatric Association and the American College of Obstetricians and Gynecologists, stress that talk therapy alone remains the preferred treatment for pregnant women suffering from depression. However, the guidelines go further, stating that in cases of recurrent depression or suicidal inclinations, prescription of antidepressant medication to augment talk therapy should be considered.
The guidelines point out that the danger of limiting treatment for severe depression and under-treating the mother may in certain cases outweigh the risk of subjecting the developing fetus to antidepressant drugs. Babies exposed to antidepressant drugs in the womb can be born prematurely or with low birth weights. Some antidepressants given in late pregnancy can cause more serious, potentially life-threatening problems during the first two weeks of life. The new guidelines, however, recognize the greater risk of poor nutrition and prenatal care that often results from untreated depression and the increased risk to both mother and fetus from possible suicide.
Physicians praised the new guidelines for clearly encouraging obstetricians to screen pregnant patients for signs of depression and for clarifying the role of psychiatrists in caring for pregnant women suffering from depression. “This is a very exciting time in obstetrics and psychiatry, a golden opportunity for us to really make a difference in the lives of women and their children,” UCLA psychiatrist Vivien Burt told the Los Angeles Times.
Physicians from both specialties expect the new guidelines to result in better medical are for women and their unborn children during pregnancy, with obs screening patients for depression and referring those who exhibit symptoms to psychiatrists for treatment.
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.
Obesity Worsens Risk of Birth Defects with Antidepressant Use in Pregancy
Two studies published in the New England Journal of Medicine in June 2007 reported on the risks of birth defects when women took selective serotonin-reuptake inhibitors (SSRIs) during pregnancy (sources: Louik, C et. al NEJM Volume 356:2675-2683 June 28, 2007 Number 26 and Alwan S. et al. NEJM Volume 356:2684-2692 June 28, 2007 Number 26). Both articles conclude that SSRIs taken during the first trimester of pregnancy increase the risk of certain birth defects, but the increased risk was considered to be small. Given that untreated depression carries its own risks to the unborn baby, the researchers were said to have considered these finding reassuring in terms of weighing the risks and benefits of treating depressed women during pregnancy.
Further analysis of their data showed that women with a body mass index of 30 and greater showed an even further increase in risk defects. For example, obesity plus SSRI use resulted in 3.5 times greater chance of certain heart defects and 5.9 greater chance of certain cranial defects. These numbers were in comparison to non-obese women taking SSRIs.
We don’t know why having more body fat makes a difference, but we do know SSRIs are absorbed more quickly in fat. Thus, it would stand to reason that perhaps more drug is absorbed and/or retained and this may amplify the effects of the drugs.
Women taking antidepressants and considering getting pregnant should consult with their doctor about whether to continue on the medication during pregnancy.
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