Treating Depression in Pregnancy: What’s New?

Depression in Pregnancy

You just found out you are pregnant, so you may be anticipating the joy of pregnancy. But did you know that according to the American College of Obstetrics and Gynecology (ACOG), depression is one of the most frequent complications of pregnancy? In fact, over 50 percent of women report an increase in symptoms of depression or anxiety during their pregnancies.

You could be at higher risk for depression during pregnancy if you have had depression in the past. Other risk factors include a family history of depression and stress during your pregnancy. Stress could be due to relationship problems, lack of support, or worries over financial issues.

The greatest danger of depression during pregnancy is ignoring it. Depression can be devastating for you, your baby, and your family. Depression during pregnancy has been linked to poor nutrition, smoking, drinking, suicide, premature labor, and babies that are underweight, less active, and less attentive.

Studies suggest that many pregnant women ignore symptoms of depression and many of their care givers miss the diagnosis. What’s new as of this spring is ACOG recommendations for health care providers. They suggest that all pregnant women be screened for depression at least once with a standardized screening exam. Women who are diagnosed with depression should be treated, and if necessary, referred to a behavioral health specialist.

How to Treat Depression in Pregnancy
The need to do a better job of diagnosing depression in pregnancy is not controversial. How to treat serious depression in pregnancy is controversial. If you have mild to moderate depression, you may be treated with psychotherapy (talk therapy) given by a mental health provider. More serious depression may require a combination of psychotherapy and an antidepressant.

Herein lies the controversy. The most common, safe, and effective antidepressants used during pregnancy are selective serotonin reuptake inhibitors (SSRIs). But some SSRIs have been linked to birth defects including heart and lung problems. So how do you balance the risks versus benefits?

Two New Studies
A study published last month in the American Journal of Psychiatry, analyzed data from over 800,000 births. They compared women who were diagnosed with depression and treated with an SSRI to women who were diagnosed with depression and were not treated with an SSRI.

Among the findings was some surprising support for SSRI use. The women treated with SSRIs had a 16 percent lower risk of preterm birth and a 50 percent lower risk of very preterm birth compared to the women with untreated depression. The untreated women also had a higher rate of C-section deliveries than the treated women. On the other side, there was evidence that babies born to the mothers on SSRIs were more likely to have breathing issues and longer stays for hospital neonatal care.

In another study released this summer in the British Medical Journal, almost 18,000 mothers of infants with birth defects were compared with almost 10,000 mothers of infants without birth defects. The study was designed to find out if five SSRI’s used early in pregnancy might be linked to birth defects.

The good news is that for three of the SSRIs (Celexa, Lexapro, and Zoloft) there was no association with birth defects. The bad news is that for two of the SSRI’s (Paxil and Prozac) the risk for birth defects was about three times higher than normal. It is important to note that even with the increased risk, the likelihood that a baby who was exposed to these products will develop a birth defect is still extremely low.

Bottom Line
Depression during pregnancy is serious business. Do not ignore the symptoms and do not assume you can’t be treated. Choosing to take an SSRI to treat depression is a decision that only you and your health care provider can make after weighing all the risks and benefits. Here are the symptoms to talk to your health care provider about:

  • Increased sadness
  • Changes in sleep or eating habits
  • Loss of interest in activity
  • High anxiety
  • Frightening thoughts
  • Feeling guilty or worthless
  • Thoughts of death or suicide

Suicide related to depression kills more women during pregnancy than bleeding or toxemia of pregnancy. If you have thoughts of harming yourself, you are experiencing a medical emergency. Get help right away.

You may also want to read the following related post in The Pulse: Some Antidepressants Might Be Safer To Use In Pregnancy Than Others, A New Study Suggests.

Christopher Iliades
Dr. Chris Iliades is a medical doctor with 20 years of experience in clinical medicine and clinical research. Chris has been a full time medical writer and journalist since 2004. His byline appears in over 1,000 articles online including EverydayHealth, The Clinical Advisor, and Healthgrades. He has also written for print media including Cruising World Magazine, MD News, and The Johns Hopkins Children's Center Magazine. Chris lives with his wife and close to his three children and four grandchildren in the Boston area.

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