Anti-Depressants and Pregnancy

Even though many don’t want to talk about it, depression is a very common problem---major depression affects 20% of American women at some point in their lives. So when a woman becomes pregnant, is it safe to take an antidepressant? The answer may not be so clear. There have been three major studies on antidepressants during pregnancy in the past week.

Pregnant women who take anti-depressants to battle depression during pregnancy should be careful. . There have been three major studies on antidepressants during pregnancy in the past week. One points out the risk of not using an antidepressant in those who need it, while the other two discuss two risks associated with their use during pregnancy, one of which is relatively rare, but life-threatening.

"I would only take it if it was necessary with the doctor’s supervision always." Maria Mercado has always made sure she doesn’t take any medications that would harm her unborn twin boys. Now, while Maria doesn’t suffer from depression, many women do--up to 10% of women will experience depression during pregnancy.

In these patients, is it safe and reasonable to use the widely used class of antidepressants called SSRI’s---drugs like Prozac and Paxil. And is it even needed? It was once thought that the high levels of female hormones during pregnancy "protected" women from depression. But the latest research, looking at pregnant women who stopped their antidepressants, suggests this is not the case.

Dr. Jennifer Wu, OB-GYN at Lenox Hill Hospital, says, "It appears women in pregnancy experience the same relapse rate as women who are not pregnant so we think perhaps the hormones are not protective and that women need to continue their treatment for depression during pregnancy often times." But are there risks associated with these medications to the unborn baby? And how severe are they?

One study in the archives of pediatrics and adolescent medicine says that almost a third of newborn infants whose mothers took antidepressants during pregnancy experienced a type of drug withdrawal syndrome shortly after birth. However, ob-gyn Dr. Douglas moss downplays the importance of this so called abstinence syndrome in neonates. He says, "They’re jittery they’re anxious but it is a temporary thing it has no long term sequelae and it’s really insignificant."

But another newly identified syndrome worsened by SSRI’s is; it’s called PPHN--persistent pulmonary hypertension of the newborn. Around one in a 100 babies born to moms who use an SSRI will develop it. The condition carries a high death rate. Still, the disease is rare, and these experts believe, the risks associated with depression—like suicide-- are much greater, especially after discontinuing medication.

"When using any medication during pregnancy the risk and the benefits need to be weighed. There are certain patients for whom depression is very debilitating they nave frequent relapses, off medication, they really do need a medication throughout pregnancy," says Dr. Wu. "Most people, in New York and other cities, who are on antidepressants need to be on them. And those are patients you don’t want to stop at any time," Dr. Moss adds.

The most likely women to have depression during pregnancy have a personal or family history of depression. Dr. Wu recommends discussing with your doctor about the risks and benefits of taking the medication during pregnancy, but does say, you should not conceive until you are on a stable dose of antidepressant.