Is it safe to take antidepressants through pregnancy?

Yes

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by Piper Wilson

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There is a beauty surrounding a pregnant woman that attracts attention from people. She is nurturing a gift to the world of hope, untapped potential and promise. People often discard normal boundaries when faced with a pregnant woman. Many women tell stories of complete strangers touching them, asking intrusive and personal questions about everything from conception to plans for labor.

Pregnant women are bombarded with unasked and often unwanted advice from family, friends, co-workers and even complete strangers. In addition, the media inundates women with conflicting messages about the best way to have a healthy baby. For example, studies about caffeine intake have "suggested that a high caffeine intake could lead to lower average birth weights of as much as 100g to 200g and an increased chance of preterm babies, others found no such connection between caffeine and problems with fetal development."

It would be uncomfortable, but survivable for a pregnant woman to forgo cold medicine for her baby's health. Her nose will be runnier, but that is short term and ultimately not harmful to either mother or child. However, almost 20% of pregnant woman experience clinical depression. "While the term "depression" is commonly used to describe a temporary mood when one "feels blue", clinical depression is a serious illness that involves the body, mood, and thoughts that cannot simply be willed or wished away. It can be a disabling disease that affects a person's work life, school life, sleeping and eating habits, and ability to enjoy the activities they normally would."

In spite of the seriousness of clinical depression, it is still a common misconception that depression is just a passing mood. Individuals seeking treatment are often looked at with disdain by society. They are viewed as weak or overly-sensitive. Their suffering is not recognized for what it is; it is seen as trivial.

Left untreated clinical depression can be deadly. In 1997, suicide was the 8th leading cause of death in the United States. That is more than double the amount of deaths attributable to AIDS. A diagnosis of AIDS is always a terminal one. Depressed people do not always commit suicide, but that potential is always very real. "Depressed pregnant women are less likely to eat and sleep well and more likely to neglect personal hygiene and to smoke and drink alcohol. They are less likely to seek prenatal care or to adhere to medical recommendations. In addition to personal suffering and disability, these women might be at risk of harming themselves or even committing suicide. " In addition, these women are more likely to abuse drugs or alcohol.

Fortunately, depression is very treatable. There are several options available, including psychotherapy, medications, bright light therapy and various combinations of these. Electoconvulsive therapy is another option, however, it is only used when other therapies have failed to provide relief.

A study published in the April issue of Pharmacotherapy analyzed 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."

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. It would be nice if women could just "pull themselves up by their boot straps" and not need to take antidepressants during pregnancy, but the reality is that antidepressants can mean the difference between life and death for both mother and child.

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