Many women across the U.S. battle depression on a daily basis. Depressive and anxiety disorders affect 7.1% and 19.1%, respectively, of the US adult populations annually and disproportionately affect reproductive-aged women. Treatment of depression may include psychotherapy (talk therapy), antidepressant medications, or a combination of both. Approximately 7% of US reproductive-aged women report being prescribed or using an antidepressant. There are many types of antidepressants that vary on mechanism of action, side effect profile, and safety during pregnancy.
A healthy mother is important for a healthy pregnancy and baby. Deciding to continue or stop using antidepressants during pregnancy is one of the hardest decisions a woman must make. The decision to use antidepressants during pregnancy is based on the balance of risk and benefits. Untreated depression can have harmful effects on both the mother and the baby. But, taking antidepressants while pregnant may increase the risk of problems for the baby.
While doctors don’t believe antidepressants cause birth defects, it’s still possible for them to affect the baby. It’s important for a mother and her doctor to know the risks. American College of Obstetricians and Gynecologists (ACOG) recommends the following:
- Avoiding Paroxetine use during pregnancy. Fetal echocardiography should be considered if a woman takes paroxetine in early pregnancy due to some studies showing an increased risk of cardiac defects in babies.
- The use of a single medication at higher dosages over the use of multiple psychotropic medications
- Treatment with SSRIs, SNRIs, or both should be individualized
Although studies suggest that most selective serotonin reuptake inhibitors (SSRIs) do not increase the risk of birth defects, there are two important conditions to discuss. About 30% of babies whose mothers take SSRIs will experience neonatal adaptation syndrome, which can cause increased jitteriness, irritability and respiratory distress (difficulty breathing), among other symptoms. However, doctors aren’t sure whether this effect is due to the baby’s withdrawal from the SSRI after birth or exposure to the drug itself before birth. In addition, SSRIs have a possible association with an increased risk for persistent pulmonary hypertension (PPHN) in the baby which results in significant breathing difficulties for the infant and has a 10-20% mortality rate.
Importantly, untreated mental illness itself poses risks to a developing fetus. A woman who is depressed is less likely to get good prenatal care and increases the risk of engaging in unhealthy or dangerous behaviors, like smoking and substance abuse. Babies of depressed moms have higher levels of a hormone called cortisol which can contribute to a baby’s risk of developing depression, anxiety, and behavioral disorders later in life. Untreated depression in pregnancy raises risks for babies including:
- Premature birth
- Low birth weight
- Less growth in the womb
- Other problems after birth
In addition, untreated depression also raises the risk of postpartum depression and trouble bonding with the baby. Signs of depression during pregnancy include:
- Depressed mood most of the day, nearly every day
- Loss of interest in work or other activities
- Feeling guilty, hopeless, or worthless
- Sleeping more than normal or having trouble sleeping
- Loss of appetite, losing weight, or eating much more than normal and gaining weight
- Feeling very tired or without energy
- Having trouble paying attention, concentrating, or making decisions
- Being restless or slowed down in a way that others notice
- Thinking about death or suicide
Women should balance their mental health needs with a healthy pregnancy. Untreated depression during pregnancy is also one of the strongest risk factors for the development of postpartum depression (PPD). It is important to note that postpartum depression has potentially devastating consequences including suicide and infanticide. In addition to pharmacological management, psychotherapy and self-care can be a useful way to help the mother’s mood and overall health. Self-care options include:
- Make time for activities that you enjoy
- Start or continue physical therapy
- Eat a healthy diet
- Ask people in your life for help, such as a spouse or partner, parents, other family members or friends
- Talk with and spend time with loved ones
- Work on healthy sleep habits
There are important resources available for both education and help lines including:
- Postpartum Support International – nonemergency helpline for support, information, or referrals to mental health professionals during or after pregnancy
- 800-944-4773
- 988 Suicide & Crisis Lifeline – Free help from trained counselors by phone or live online chat. Available 24 hours a day, 7 days a week, 365 days a year.
- 988
- National Maternal Mental Health Hotline – Free, confidential hotline for pregnant and new moms in English and Spanish.
- 1-833-TLC-MAMA (1-833-852-6262)
REFERENCES:
Armstrong, Carrie. “ACOG Guidelines on Psychiatric Medication Use during Pregnancy and Lactation.” American Family Physician, vol. 78, no. 6, 15 Sept. 2008, pp. 772–778, www.aafp.org/pubs/afp/issues/2008/0915/p772.html.
“Anxiety and Pregnancy.” Www.acog.org, www.acog.org/womens-health/faqs/anxiety-and-pregnancy.
“Depression during Pregnancy.” Www.acog.org, www.acog.org/womens-health/faqs/depression-during-pregnancy.
Health, MGH Center for Women’s Mental. “ACOG Opinion on SSRI Use during Pregnancy.” MGH Center for Women’s Mental Health, 12 Nov. 2007, womensmentalhealth.org/posts/acog-opinion-on-ssri-use-during-pregnancy/.
Mayo Clinic. “Antidepressants: Safe during Pregnancy?” Mayo Clinic, 2018, www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/antidepressants/art-20046420.
“Treatment and Management of Mental Health Conditions during Pregnancy and Postpartum.” Www.acog.org, June 2023, www.acog.org/clinical/clinical-guidance/clinical-practice-guideline/articles/2023/06/treatment-and-management-of-mental-health-conditions-during-pregnancy-and-postpartum.
“Safety of SSRIs in Pregnancy.” Obstetrics & Gynecology, vol. 113, no. 5, May 2009, pp. 1162–1167, https://doi.org/10.1097/01.aog.0000347992.68280.b8.
Anderson, Kayla N., et al. “Maternal Use of Specific Antidepressant Medications during Early Pregnancy and the Risk of Selected Birth Defects.” JAMA Psychiatry, vol. 77, no. 12, 5 Aug. 2020, https://doi.org/10.1001/jamapsychiatry.2020.2453.
Faye Athey
Faye Athey is a 3rd year student at Saint James School of Medicine. She is married to her husband for 2 years who is currently completing his residency in Emergency Medicine at BSW Temple, TX. She is currently completing her psychiatric rotation at TTBH under the supervision of Dr. German Corso and interested in pursuing Internal Medicine.