Antidepressants During Pregnancy: Yes, No or Maybe
I recently read a magazine article in The New York Times written by Andrew Solomon, and titled, “The Secret Sadness of Depression.” Perhaps you read it, too. The story’s subtitle was: “Pregnant women often fear taking the antidepressants they rely on. But not treating their mental illness can be just as dangerous.”
The article covered a topic that frequently arises in my therapeutic sessions with patients. And, because there is no definitive answer of the short or long-term effects of pregnant women taking antidepressants, the question continues to puzzle us.
In my mind, it comes down to a risk-benefit analysis between patient and mental health provider. As with any medication, there are some (yet at times only minimal) risks. However, in some cases, like the one profiled in the article, these types of medications might have been life saving.
If pressed, I’d have to come down on the side of this statement by one of the experts cited, “Untreated depression can take a heavy toll; this isn’t a matter of being depressed for nine months, but of a potential escalation that can result in a lifetime of struggle.”
The tragedy examined in the magazine article involved Mary, a 37-year-old woman who had struggled with depression for much of her life — a fact few of her friends or colleagues knew. Prior to pregnancy, she had dealt with her depression with a combination of therapy and antidepressant and antianxiety medications.
Although Mary was delighted when she learned she was pregnant, she expected the experience to be blissful. And because she had read about the potential danger for a growing fetus with a mother’s use of antidepressants, she opted to discontinue her use of the medication.
Despite being monitored by a psychiatric nurse practitioner, Mary couldn’t shake the idea that something was wrong with the fetus. She spiraled downward, until finally near the end of her fifth month of pregnancy, she resumed taking antidepressants. But, it may have been too late, for at six and a half months pregnant, she jumped to her death.
The question for her medical team was: if Mary had stayed on her medications without a break, or even gone back on them sooner, would she have survived? However, this is an impossible question to answer.
The positive effect of this story is its spotlight on a condition known as antenatal depression, or depression suffered during pregnancy, which affects up to 15 percent of expectant women. The author says, “For more than half of the women who develop postpartum depression, the condition is simply an escalation of pre-existing depression; addressing the antenatal problem would ameliorate the postpartum one.”
He goes on to say, “We have not acknowledged how appropriately anxiety-ridden pregnancy is, how traumatic the change in identity that accompanies prospective motherhood can be.”
Gratefully, studies on the effects of antidepressants on the fetus are numerous and ongoing. Perhaps at some point, there will be definitive evidence to help patients and medical personnel make an informed decision regarding their use during pregnancy.
But currently, I will reiterate my beginning comments: this is a decision to be made between patient and their mental health provider. And to keep in mind, not treating mental illness can be life threatening and a dangerous choice.
The Post-Postpartum Depression Blog 