Depression during Pregnancy
Ever since I was diagnosed with depression, I dreaded the day when I became pregnant. Most antidepressants are in a class of drugs that are considered unsafe for the fetus in a variety of ways. I always planned to go off my antidepressants when I became pregnant, and was positive that I would spend the entire pregnancy depressed. The day I found out I was pregnant, I called my psychopharmacologist by prior arrangement, and he instructed me in how to wean myself off my meds. I was extremely apprehensive, but knew I had to do it for the baby’s sake.
Imagine how pleased and surprised I was when day after day went by with no change in mood. It was as though I was still on my meds and they were working perfectly. During the whole pregnancy I had not one moment of depression. It was a huge relief. Of course, as soon as I gave birth to my son, I went right back on my meds (I was not breastfeeding) as I was concerned about postpartum depression.
I was extremely lucky. According to a recent study just published in the Journal of the American Medical Association, pregnant women run a high risk of slipping back into depression when they stop taking their antidepressants. Sixty-five percent of the study participants who went off their antidepressants became depressed.
On the other hand, women in the study who stayed on their antidepressants also became depressed – twenty-six percent. What it all comes down to for me is that we still don’t know enough about the correlation between hormones and depression in women, and each case is wholly individual. If you are planning to get pregnant and have a history of depression, you need to integrate that into your medical care.
• Make sure your OB/GYN and your psychiatrist or psychopharmacologist consult together at least once during your pregnancy.
• Consider starting therapy or, if you are already in therapy, schedule more sessions.
• Make sure your doctors are aware of this study, as there is a long-held belief in the medical community that women with a history of depression are shielded from it during pregnancy due to the presence of hormones.
As a final note, the decision as to whether to go off antidepressants during pregnancy is wholly individual, as the severity of the woman’s depression is one of the factors that has to be considered. I have never been suicidal, so I knew that my actual risk of being without my antidepressants was relatively low. Anyone who has been suicidal in the past needs to keep that in mind as it is as much of a risk factor in terms of the baby’s health as staying on antidepressants.
When Words Are Not Enough: The Woman’s Prescription for Depression and Anxiety by Valerie Davis Raskin, M.D. contains a good discussion of the pros and cons of antidepressants during pregnancy. She also has a great book on postpartum depression with Karen Kleiman, This Isn’t What I Expected: Overcoming Postpartum Depression