Depression is difficult enough, but for pregnant women, it can present additional problems. Most antidepressant medications are classified to be FDA pregnancy category C or D. Category C means that animal studies have shown an adverse effect and there are no adequate and well-controlled studies in pregnant women or that animal studies have been conducted and there are no adequate and well-controlled studies in pregnant women. Category D means that studies, adequate well-controlled or observational, in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy may outweigh the potential risk. Neither of these are attractive to pregnant women; they're very worrisome.
Things are no less worrisome and confusing after the baby is born. Nobody can really say whether it's safe for the baby to breast feed while the mother is taking antidepressants. Most antidepressants are labeled as "safety unknown" or "probably safe." A few are labeled as "safe," but most women worry about those too.
Two recent studies are reporting on the prevalence of depression and treatment for depression during and after pregnancy.
"Large proportions of low-income, urban mothers attending WCC visits experience MDD (major depressive disorder) or MnDD (minor depressive disorder) during the postpartum year. The EPDS (Edinburgh Postnatal Depression Scale), BDI-II (Beck Depression Inventory II), and PDSS (Postpartum Depression Screening Scale) have high accuracy in identifying depression, but cutoff scores may need to be altered to identify depression more accurately among urban, low-income mothers."5
The Chaudron study involved 198 mothers going for well-child care visits with their infants, aged 0 to 14 months. The mothers completed a psychiatric diagnostic interview and were assessed with the three screening tools mentioned above -- the Edinburgh Postnatal Depression Scale, the Beck Depression Inventory II, and the Postpartum Depression Screening Scale. Of those 198 mothers, 56% met the criteria for MDD (37%) or MnDD (19%) at some time between two and 14 weeks after delivery. Chaudron commented: