In an ideal world, the only decisions a mom-to-be would have to make during pregnancy would be what stroller to buy and what to call her little one. But in reality, pregnant women are faced with countless decisions, including those related to their own mental health. In fact, between 14 and 23 percent of women will experience some symptoms of depression during pregnancy, according to the American College of Obstetricians and Gynecologists.
Deciding whether to take antidepressants during pregnancy is a tough call. I’ve been there myself. The problem with making that call is that there are so many factors to consider and so much contradictory research out there.
More research is needed
A study published in the Journal of the American Medical Association in April 2017 found that antidepressant use during early pregnancy doesn’t increase a child’s risk of developing autism or attention deficit hyperactivity disorder (conditions previously linked with the medication). The study also found that antidepressant use wasn’t linked to reduced mental growth. However, the researchers said the risk for premature birth was slightly higher — about 1.3 times.
However, a later study, published in the British Medical Journal in July 2017, found that children exposed to antidepressants during pregnancy are at a slightly higher risk of autism than children not exposed to antidepressants during pregnancy. But the researchers stressed that the absolute risk of autism is small, so the results should not be considered alarming; yet, their findings still contradict the earlier study.
Another issue is whether the problematic factor is antidepressants or the presence of maternal depression itself. A study of Danish women published in an International Journal of Obstetrics and Gynecology in 2015, for instance, found that undiagnosed depression in mothers while pregnant seemed to be linked to problematic behavior in children, not antidepressant use itself.
It seems that all we can take away from the most recent research is that while maternal antidepressant use poses some potential risks to the unborn child and their health in later life, we don’t know exactly what those risks are, nor what actually happens in the brains of fetuses and newborns who’ve been exposed to SSRIs (selective serotonin reuptake inhibitors, the most commonly prescribed drug to manage depression and/or anxiety-related conditions). A study published in the journal Cerebral Cortex in 2017 study found “subtle abnormalities” in the brains of exposed newborns, but didn’t explain exactly what those were.
Making the decision
So if, after decades of studies that evaluated the impact of SSRIs in pregnancy, the jury is still out, what should pregnant women do?
“Generally speaking, SSRIs and some of the older antidepressants are considered the safest, though all medications that cross the placental barrier confer some risk,” Cory Walker, M.D., medical director of the psychiatric and assessment service at the Menninger Clinic in Houston, Texas, told HealthCentral via email.
According to Dr. Walker, the safest antidepressants include sertraline, citalopram, fluoxetine, amitriptyline, nortriptyline, and bupropion.
“When I’ve collaborated with obstetricians on treating depression, they tend to prefer sertraline,” she says.
Every woman who has depression during her pregnancy should assess the risks and benefits of taking antidepressants with her health care providers.
“You should discuss with both your obstetrician and psychiatrist the severity of your depression, your history of depression severity, other therapy means that may be appropriate, and any which have failed,” psychiatrist and author of “The Power of Different: The Link Between Disorder and Genius,” Dr. Gail Saltz, M.D., told HealthCentral via email.
The severity of maternal depression is key to any assessment of the risks and benefits of taking antidepressants during pregnancy.
“Depression is a serious illness which affects not only the mother’s mood, but her ability to eat appropriately, sleep appropriately, and move around, which all affect the health of the baby,” says Dr. Saltz. “Serious major depression also carries the risk of suicide.”
One study, published in JAMA Psychiatry in August 2016, found that untreated depression during pregnancy is associated with an increased risk for preterm birth and low birth weight. Other studies have suggested that babies born to mothers with untreated maternal depression may be less active, show less attention and be more agitated than babies born to mothers without a mood disorder.
“If a pregnant woman has moderate to severe depression and/or is having suicidal ideation, the risk of not taking medication exceeds the risk of taking medication,” says Dr. Walker. However, if a pregnant woman is suffering from mild to moderate depression, there are many alternatives to antidepressant medication, including exercise, an optimized diet low in processed foods and high in fresh, unprocessed foods and lean protein, plenty of sleep, individual psychotherapy, support groups, and light therapy.
The bottom line
Ultimately, balancing the risks and benefits of using antidepressants during pregnancy is a difficult decision, but one no woman should make alone. Raise your concerns with your doctor, rely on your support system, and you’ll make the right decision for you and your child.
See more helpful articles:
Anxiety During Pregnancy
What You Need to Know about Postpartum and Perinatal Mood Disorder
How to Deal with a Depression Relapse