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.

Visiting The Emergency Room

No one likes to go to the emergency room. That’s understandable. For one thing, the fact that you are there means that you have a problem that you cannot deal with on your own. Not only that, but you get to pay someone else an exorbitant amount of money at the same time. It is also irritating waiting centuries for your turn, I mean, hours for your turn. I have figured something out; when the staff take you straight back to an exam room instead of making you wait 4 hours, this is NOT a sign of good service. Customer service is not a high priority for emergency room personnel. That doesn’t mean that they will go out of their way to inconvenience you. It means that they have bigger fish to fry. Let me reiterate, going straight back to an exam room is BAD.

Almost 10 years ago, my six year old son had a chest cold. All of the sudden, he started complaining about stomach pain. My internal “Red Alert” lights started flashing, so I took him down to the ER. It wasn’t a busy night, and we made it to the triage nurse within 10 minutes. She took his pulse and blood pressure and also tested his O2sats (blood oxygen saturation levels) which turned out to be 87. She said, “Why don’t you two come on back?” Then the ER staff were all doing something for my son. It wasn’t dramatic like on TV, but they were definitely scurrying. I was confused because I didn’t think it was all that bad. After all, an 87 is a B+, right? In a word, no. But I’m still not a doctor, so I don’t know why and don’t care all that much. I do know that my son had actually pneumonia, not just a head cold.

Two years ago, my other son was getting his nightly (high blood pressure) medicine ready when he spilled the bottle. So, he picked all the pills up. After he picked them all up, because he had been in the process of taking his medicine to begin with, he proceeded to swallow the entire handful. Over doses are nothing to trifle with, so we headed straight to the ER. Thank God that he told me right away! When we got to the hospital, I told the nurse what we were there for, and we headed straight back to an exam room. We spent the next two nights in the hospital.

Last June, I fell at work and broke my left elbow, badly. Or, depending on your point of view, I did a very good job breaking it. I arrived at the hospital in an ambulance. Once I got there, my wheelchair was parked in the waiting room and I waited over an hour and a half to be seen. That is not a long wait, all things considered, but it is far from a straight shot to the doctor! I was definitely injured, but the fact that I was waiting to go back told me that I was not in imminent danger.

I am not talking about the aberrational situations where people have died because they should have been seen earlier. That is a whole other topic. For the average Joe, waiting in the ER for treatment can be torture. You depend on the staff to end the interminable wait and so you analyze them, like a hunter stalking prey. From your point of view they flirt, fight, and gossip instead of discernibly treating patients. At times like this, remember waiting is good.