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Antidepressant Use During Pregnancy for Depression

by Katlyn Joy | November 29, 2012 1:17 PM
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Depression during pregnancy is a tricky topic for mothers and their physicians. There are risks and benefits on both sides of the equations. While certain drugs are definitely off-limits for pregnant women due to risks of fetal harm, the risks of depression can be quite serious as well to the mother, which in turn is risky to the unborn child by proxy.

First understand depression and its role in a woman's pregnancy. While it was once thought that pregnancy hormones naturally lifted depression in pregnancy, that premise has since been disproven. Indeed a woman with a history of depression may well suffer from depression, even possibly intensified depression during pregnancy.

The hormone swings, the increasing demands on her body and energy, the emotional impact of expecting a baby and all the myriad changes that come as a result can create stress which in turn increases depressive symptoms. Also, women with a history of depression are at increased risk for postpartum depression which can be quite serious. Some women have a rebound of symptoms when off medication for depression.

Depression is not a yes or no condition. It is more of a spectrum disorder. One woman may experience cyclical symptoms, while another has had years of non-stop symptoms. A woman may have mild symptoms that are generally treated well with cognitive or talk therapy and healthy lifestyle choices, while another experiences intense depression without pharmaceutical treatment.

Each woman along with her health providers, which may also include a therapist or psychologist, will need to assess a woman's condition and treatment options. The decision to treat with medications will need to take a woman's unique symptoms, severity of symptoms, history of depression into account. The bottom line will be to make a decision based on all the factors and then chose the course which poses the least risks and offers the most benefits to mother and child.

Factors to consider include the risks. No drug is known to be absolutely safe to a growing fetus, but there are some that are safer than others. Paxil or paroxetine is believed to cause heart defects. MAOI's are thought to raise blood pressure in mothers, and limit fetal growth so neither of these drug or drug families are good choices for pregnant or breastfeeding moms.

An early study showed risks of limb malformation with tricyclic antidepressants, but the results did not show in later studies so the jury is out there. Another risk is possible with drugs such as citalopram, sertraline, and fluoxetine causing lung problems in newborns. While the risk is rare, it is serious. This occurs when the drugs are taken during the last half of pregnancy. Another rare but serious risk shown in some studies is for heart defects involving the septum.

While these risks are unlikely to happen to you or your child should you take these drugs, the risks cannot be brushed aside entirely either. You need to understand exactly what the risks are and what you feel comfortable with.

The risks of not taking antidepressants will depend on your particular depression. If there is a risk of you not eating well, becoming isolated or increasingly depressed to the point of self-harm, or if you may self-medicate with drugs or alcohol, your child would be at risk as well.

If you decide to stop taking antidepressants during pregnancy, you may experience SSRI discontinuation symptoms. These include flu-like symptoms, like nausea, vomiting and chills, irritability, depression symptoms rebounding or anxiety. If you stop during pregnancy, your baby may also experience some withdrawal symptoms. This may include jitteriness or irritability.

After talking to your health care providers, you may decide to take a medication with a relatively low risk profile such as Wellbutrin, Celexa, Zoloft, Prozac, or others. You may want to adjust your dosage instead.

If your symptoms are mild, you may want to work with a counselor in cognitive therapy, try meditation, relaxation exercises, massage, acupuncture and other wellness strategies including eating healthy and exercising regularly.

Always be vigilant about your moods and well-being and seek help as soon as you feel yourself slipping in any way. You need to be proactive in taking care of yourself. While your baby's health is priority, you must remember that baby's health begins with mama's. If you are unwell, your baby will suffer as well.


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