Many women who take antidepressants for depression are concerned when they become pregnant, and rightfully so. Taking antidepressants during pregnancy may cause risks to the baby, but so does stopping the antidepressants. This situation is one that does not have a one-size-fits-all solution. The March of Dimes urges pregnant women with depression to work with a team that includes their healthcare providers, mental health professionals and their baby's future healthcare providers to decide on the best course of action.
Significance
As many as one out of five women suffer from the symptoms of depression during pregnancy, according to the March of Dimes. Many of these women are unable to deal with their depression on their own and need the help of antidepressant medication. Not taking antidepressant medication during pregnancy may put these women and their babies at risk. Depressed pregnant women are at greater risk for poor prenatal care, high blood pressure, poor weight gain, unhealthy eating habits, the use of drugs or alcohol and even suicide. They are also more likely to give birth to babies who are premature or have low birth-weight, explains the March of Dimes. They are less able to care and bond with their babies after birth, as well.
Considerations
Although women typically consider the direct risks to the baby first, they should also consider a number of other factors when deciding whether or not to continue with their antidepressant medication. Even if the antidepressant does not cause any harm during the pregnancy itself, the baby may experience temporary withdrawal symptoms from the antidepressant at birth, including the jitters or irritability. Tapering off the dosages towards the end of pregnancy can help prevent these withdrawal symptoms in the baby, but this strategy increases the risk of the new mother suffering from post-partum depression. Pregnant women should consider doing this only under the careful monitoring of a doctor.
Some pregnant women also consider switching to a "safer" antidepressant medication during pregnancy, but this also has risks. The new medication may not work as effectively for the woman and may trigger a depression relapse. It also may trigger new side effects for both the mother and baby. Although switching medications may be necessary despite these risks, pregnant women should always discuss these issues with a doctor before making changes.
Women who decide to stop antidepressant medications completely should be aware than doing so may cause withdrawal symptoms. The withdrawal symptoms for SSRI antidepressant medications may include chills, insomnia, anxiety, irritability, chills and nausea and vomiting. In addition, the National Institute of Mental Health states that pregnant women who stop antidepressant medications are five times more likely to experience a depression relapse as those who continue taking the medications.
Misconceptions
What is true for one antidepressant is not true for all antidepressants. For example, one specific brand or type of antidepressant may be safe during pregnancy, but that does not mean all similar antidepressants are safe. Each individual antidepressant medication has its own specific risks and benefits. Pregnant women need to be careful not to make blanket assumptions about antidepressants in general. They need to consider the risks of their own specific antidepressant medications.
Alternatives
Women who decide to stop taking antidepressants during pregnancy may benefit from other treatments for depression. Individual counseling and support groups can benefit many depressed women, especially those with mild cases of depression. In fact, psychotherapy can be just as effective as medication in some cases, states Marjorie Greenfield, M.D. and expert contributor to DrSpock.com. Pregnant women should talk to their doctor or a mental health professional about alternative treatments that may work best for them based upon their specific needs.
Warning
Pregnancy can be an emotional and overwhelming time for many women. Reporting suicidal thoughts immediately is essential, regardless of whether a pregnant woman stays on her antidepressant medication, switches to a new one or goes off antidepressant medication completely. Family members and friends of pregnant women who stop taking antidepressants or switch to a new medication, in particular, should also carefully monitor the woman for signs of suicidal thoughts or behavior.
References
- Mayo Clinic: Antidepressants: Safe During Pregnancy?
- March of Dimes: Depression During Pregnancy
- National Institute of Mental Health: Stopping Antidepressant Use While Pregnant May Pose Risks
- Dr. Spock: Antidepressants During Pregnancy
- American Congress of Obstetricians and Gynecologists: ACOG Issues Opinion on SSRI Antidepressant Use During Pregnancy
