Should Pregant Women Take Antidepressants?

It is a simple decision for a pregnant woman to forgo things like cold medicine, caffeine or alcohol in order to protect their baby from potentially harmful substances. The effects of those decisions are short term and not harmful to either mother or child. However, almost 20% of pregnant woman experience clinical depression. Left untreated clinical depression can be deadly. There are several options available to treat depression, including psychotherapy, medications, bright light therapy and combinations of these.**[see note]

A study published in the April issue of Pharmacotherapy analyzes the choices available to patients and their doctors. This particular study evaluated the results of several other studies that focused on newer antidepressants; selective serotonin reuptake inhibitors (SSRIs) and seratonin norepinephiren reuptake inhibitors. While “information is available on the safety of antidepressant use during pregnancy it is limited by the small size of most trials and by trial designs that often did not use mothers with depression as control subjects and could not, for ethical reasons, be randomized and double blinded.” That paucity makes the decision whether or not to use medication to treat depression during pregnancy that much more difficult. Pregnant women “are subject to the same adverse consequences of depression as are non-pregnant women, including social withdrawal and even suicide.”

Untreated clinical depression during pregnancy has been associated with preeclampsia, miscarriages, and premature labor. “In addition, pregnant women with depression are less likely to attend regular obstetric visits and may have lower than normal weight gain, may lack compliance with prenatal care, and may be more likely to smoke, drink alcohol, or use cocaine.”

While data about the gestational pharmacotherapy is sparce, most of the data is encouraging. For example, “preliminary evidence suggests that SSRI exposure in utero does not have significant long-term effects on cognition or behavior.” Doctors and women should weigh several factors to decide on a treatment plan including the severity of the depression and the preferences of the mother.

**Electoconvulsive therapy is another option, however, it is only used when other therapies have failed to provide relief.