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.