The American Congress of Obstetricians and Gynecologists reports that between 14 and 23 percent of pregnant women will experience depression during their pregnancy. Depression can be treated in one of two ways--through "talk" therapy, or through medication. Medications can increase the risk of complications, so women should work closely with their doctors to find the safest, most effective depression treatment for themselves and their unborn child.
Antidepressants
There are two kinds of antidepressants that serve as safe alternatives for use by pregnant women--selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). Both help improve mood by boosting the amount of certain neurotransmitters in the brain. Although reasonably safe, they both do come with the risk of complications, so the appropriateness of these medications may vary among pregnant women.
The SSRIs that may be considered for use during pregnancy are fluoxetine, sertraline, and citalopram. Another well-known SSRI called paroxetine should be avoided by pregnant women because it has been linked to an increased risk of fetal heart defects in newborns whose mothers took it during their first trimester. Though results have been somewhat mixed, SSRIs may increase the risk slightly for other complications, as well. These include an increased risk of birth defects in newborns whose mothers took SSRIs during the first trimester, a slight increase in the rate of miscarriage, and the presence of withdrawal symptoms such as tremors, irritability, convulsions and increased crying in newborns whose mothers took SSRIs near the end of the pregnancy. A very rare but serious breathing problem called persistent pulmonary hypertension may also be more likely to develop among babies whose mothers took SSRIs during the second half of their pregnancy.
Tricyclic Antidepressants (TCAs) that are considered safe for use among pregnant women include amitriptyline and nortriptyline. While some studies have suggested these drugs may increase the risk for limb malformation in the fetus, these concerns have not been validated in more recent studies.
Bupropion
Bupropion is an atypical antidepressant, meaning it's in a class by itself. It works by balancing the amounts of the neurotransmitters dopamine and norepinephrine in the brain. Available research indicates there is no significant increase in miscarriage among pregnant women taking bupropion beyond the rates observed in those taking an SSRI or tricyclic drug during pregnancy. There have been mixed results regarding the potential for heart malformations in babies of women taking bupropion during the first trimester. Overall, bupropion is thought to be a good alternative for pregnant women who have not responded to other antidepressants.
"Talk" Therapy
Pregnant women may also consider "talk" therapy as an option for treating depression. Unlike medication, therapy has the advantage of eliminating the potential health risk to the fetus. Still, research suggests that pregnant women who both receive medication and participate in therapy may see the biggest improvement in their depression. Further, the type of therapy may also play a role. A review published in the March 2006 issue of "Research on Social Work Practice" supports this, finding that medication alone or in combination with cognitive-behavioral therapy, group therapy or interpersonal therapy may be most effective in treating depression among women who are pregnant.
References
- ACOG: Depression During Pregnancy
- Baby Center: safety of antidepressants during pregnancy
- "Research on Social Work Practice;" Treating Depression during Pregnancy and the Postpartum: A Preliminary Meta-analysis; Sarah E. Bledsoe and Nancy K. Grote; 2006
