Anti-depressants During Pregnancy

by Pregnancy.org Staff

choosing a treatmentRecently our news feeds have been flooded with bad news about pregnancy and anti-depressants. If you're depressed and expecting a baby, finding a treatment can feel like a balancing act over hot coals.

1 in 10 moms-to-be are depressed during their pregnancy or the postpartum period according to the American College of Obstetricians and Gynecologists. Moms express their concerns over the research that weighs the negative impacts of suffering from depression versus the risks of moms taking anti-depressants (which can affect the developing or breastfeeding baby).

"After my father passed away I was put on an antidepressant. When I got pregnant I was very concerned about my developing baby and the effects of the medicine. But thinking of going off the medication...that was scary, too! I dreaded the hormonal depression compounded by depression from being off the meds." ~Shellie, Pregnancy.org member

Tip: Each woman's individual medical history and circumstances will determine the best course for her personal treatment. We encourage you to work with a trusted physician and counselor as you consider treatment options.

Are You Depressed?

The first step is to figure out whether your symptoms are connected to depression, postpartum depression, or "baby blues." More information is available for you in these related articles:

Depression During Pregnancy
Postpartum Baby Blues
Postpartum Depression: Debunking Denial

Once you've received a diagnosis of depression or postpartum depression, the next course of action is deciding what treatment to use. Each choice will have varying possible risks for mom and/or baby.

Untreated Depression

Some pregnant or breastfeeding moms try to deny they're depressed or that anything's wrong. Ignoring real depression is not a viable choice. There's nothing shameful about having this condition. You're not alone.

The risks:
• Moms who aren't sleeping, eating and gaining enough weight, or alternatively, overeating and gaining too much weight -- can deny a baby of proper nutrients needed for proper growth and development.

• Your negative moods could also have an effect on your growing son or daughter's brains. The "sad" or "anxious" chemical in your bloodstream moves to your baby's bloodstream via the placenta. The developing brain takes these signals and makes the changes to prepare your baby for life in a stressful world.

• Your baby might be born too soon. Women who are depressed have twice the risk of preterm delivery as opposed to pregnant women who aren't. Scientists suspect that the chemistry of depression during early pregnancy could possibly interfere with placental development and function.

• Stress on your body can lead to higher blood pressure which increases the risk of toxemia. Stress can also pave the way for other challenges such as anxiety, fears, overwhelming sadness, and even thoughts of suicide.

Traditional Treatments and Lifestyle Changes

"It's essential that pregnant moms recognize that option of "no treatment" might also harm both you and your baby," clinical phychologist, Shoshana Bennet shares. "Pregnant women and their families, including those not yet born, no longer need to suffer from depression."

Could changing your diet, making exercise a regular part of your day or going to bed earlier ease your depression? Many moms-to-be claim to feel better after trying. Here are our suggestions:

Frequently eat healthy meals and snacks. Keeping your blood sugar levels even can balance your mood.
Up your omega-3's. Eating the right kinds of fats minimizes your risk for depression, during and after pregnancy. Avocados, olives, salmon and flax seed contain omega 3's, but it's hard to get enough just from foods during pregnancy. If your prenatal vitamin contains under 3000mg, you might want to ask your midwife or doctor about taking a supplement.
Drink more water. Water's important for your mental health. Dehydration can cause anxiety, so bring along your water bottle and sip on it all day.
Take a hike. The American College of Gynecologists recommends 30 minutes of moderate exercise a day during pregnancy. Expectant moms who exercise have less depressive symptoms than mom who do not. Are you on bedrest? Talk with your provider and put together a routine to keep your muscles tones and your mood elevated.

Therapy is an important part of treatment. Research demonstrates that working with a therapist helps. These professionals can provide support and compassion and help you consider other resources for your well-being. Even if you don't have a mood disorder, but are at high risk for one, you might want to be proactive and check in every now and then during your pregnancy just for peace of mind.

Medication for Depression

If you're suffering clinical depression, you might be prescribed medication deemed "safe" during pregnancy (and/or breastfeeding). According to a study published in the Canadian Medical Association Journal, almost 4% of pregnant women take anti-depressants at some point during the first trimester. Some of the most common include selective serotonin reuptake inhibitors (SSRIs), especially Paxil, Prozac, Zoloft, Luvox, or Celexa, and an SNRI, Effexor, or their generic forms.

Risks:
While the overall risks of birth defects or other problems to mom/baby are low, these risks should be carefully considered by doctor and patient.

  • Expectant moms taking certain anti-depressants have a 68% increase in risk of early pregnancy loss
  • When taken in early pregnancy, some increased risk of fetal heart defects
  • When taken late in pregnancy, some association with birth defects of the heart, brain, and abdominal organs
  • Low increased risk of limb malformations
  • Increased chance of preterm labor
  • Slight association with a grave lung problem in newborns known as persistent pulmonary hypertension of the newborn (PPHN)
  • Rare cases of infant deaths might be related to use of Effexor during pregnancy
  • Newborns may experience withdrawal symptoms (irritable and overly nervous) shortly after birth
  • New studies suggest anti-depressants during pregnancy increase rates of autism, ADHD, or other learning disabilities

There is a large variety of options, dosages, and prescriptive treatments available. There are those that could be safer for your body and better choices for your circumstances. We still strongly suggest talking with your personal healthcare provider, researching your choices, and make the best choice for you and your baby.

Alternative Treatments

Pregnant patients diagnosed with mild to moderate depression may be able to explore alternative therapy options to decrease risks and improve their overall mental, emotional, and physical well-being. This non-exhaustive list includes:

  • Counseling / physiotherapy
  • Relaxation or meditation techniques
  • Aromatherapy
  • Massage therapy
  • Acupuncture or reflexology
  • Biofeedback
  • Herbal remedies
  • Exercise regimes
  • Yoga
  • Hypnosis / guided imagery
  • Music therapy
  • Chiropractic treatment

Risks:
These options are not effective in dealing with more serious forms of depression and could pose a greater risk for those patients than going untreated.

If you or a loved one is diagnosed with depression seek help. It isn't a sign of "weakness" or mean that you're failing as an expectant or new mom. The best gift you can give your child and yourself is a healthy mom -- physically and mentally!

What have been your challenges? Tell us in the comments!

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