Depression cases are on the increase in pregnant women, and antidepressants are an effective way of treating symptoms.
Medium to large doses of antidepressant medication taken during pregnancy may pose a risk to the health of the fetus, a recent study has found.
Experts recommend that you take the lowest effective dosage of antidepressant medicine when you are pregnant, but that the chances of depression ultimately outweigh your unborn child's risks.
If, at some stage during your pregnancy, you are struggling with depression and anxiety, realize that you are not alone. A study conducted by the Journal of Obstetrics and Gynecology found that among women arriving at the hospital to give birth, the incidence of depression is at an all-time high of over 28 women per thousand.
In an attempt to relieve symptoms of depression and anxiety, physicians usually prescribe antidepressants known as SSRIs, or Selective Serotonin Reuptake Inhibitors, to both non-pregnant and pregnant women. In general, during pregnancy, most of these medications are commonly used and considered safe.
But a recent study shows that when SSRIs are used at medium and high doses during the third trimester of pregnancy, there could be increased risks to the fetus.
During Pregnancy Depression
Depression is a normal and treatable condition even during pregnancy that can be managed through the use of antidepressant medication. Even if you have never experienced depression or anxiety before, it's still better to talk to your doctor if you notice signs or suspect something isn't right. When you're about to be responsible for a little person who will rely on you for everything, self-care has never been more important than now.
So don't hesitate to bring it up, because it's a good idea to start it earlier rather than later to protect your own mental health if your doctor thinks you'd benefit from an antidepressant. Not sure if you're suffering from depression? Below, as stated by the Centers for Disease Control and Prevention, we have described some of the more common symptoms of depression:
Getting a sad, nervous, or "empty" mood that lasts
Feelings of pessimism or hopelessness
Feelings of guilt, lack of worth, or helplessness
Irritability or restlessness thoughts
Loss of Strength
Concentration issues, remembering information, and making decisions
Difficulty falling asleep or over-sleeping
Overeating or lack of hunger
Suicidal thoughts or attempts at suicide
Aches or pains that with medication do not get better
Risks of Antidepressants being used while pregnant
The use of antidepressants during pregnancy has been widely deemed safe in recent years, with most antidepressants marked as Class B or C products (both relatively safe during pregnancy).
However, a report released by the Official Journal of the American Academy of Pediatrics in the June 2020 edition of Pediatrics found that the chances of fetal respiratory failure and preterm birth are increased with high-dose maternal use of antidepressant drugs in the third trimester.
Although that sounds alarming, it's still not time to panic. The research was performed to analyze the frequency of these findings based on dosage and timing of antidepressant usage, rather than uncovering unique and unknown threats to the fetus.
Not surprisingly, the results showed that the greatest risks to an unborn baby were associated with the high doses used during the entire nine months. But even then, the risks are low and if you really need it, this new knowledge shouldn't change your mind about taking an antidepressant.
"These risks are real, but they should be weighed against the risk of untreated depression in the mother, which could cause a much worse outcome than respiratory distress and potential preterm birth in the fetus," Zaher Merhi, MD, a board-certified OB-GYN and fertility specialist at the New Hope Fertility Center in New York, says.
Risks of Depression of the Perinatal
In an ideal world, in the months before you start trying to get pregnant, you might consider tapering off your antidepressant medicine. Of course, if you want to keep the symptoms at bay, it is just not possible.
"Women with a history of mental health conditions are generally likely to experience worsening symptoms during pregnancy," says Community Psychiatry psychiatrist Pavan Madan, MD.
It is also understood that untreated mental health conditions pose serious risks to the mother and fetus. Women with untreated anxiety may have a higher risk of problems with the mother's blood pressure, fetal growth limits, and increased risks during childbirth and postpartum periods.
Pavan Madan, MD —
Other dangers include everyday challenges, such as lacking the energy to get through the day, let alone suffering from morning sickness, constant tiredness, and all the other not-so-glamorous signs of pregnancy.
"A depressed mother may find it difficult to take care of herself. She may be more likely to suffer with a lack of energy or an unhealthy diet, or may self-medicate herself with illicit drugs, smoking, or consuming alcohol in some cases. Of course, all these factors will do serious damage to her unborn baby, more than the minute risks of taking antidepressants during pregnancy, Merhi says.
Treating and Managing During Pregnancy Depression
So how do you decide whether to continue or try to stop taking your medicine for nine months? This question has no simple response. Allie Shapiro, a psychologist with Community Psychiatry, says the answer to the question is the most critical consideration: will I be stable off medication?
As well as your medication background, the answer depends on a variety of factors. Whether or not you can take treatment during pregnancy, the severity of your anxiety also determines, she says. Do you feel like you can manage without them? "Exercise, support groups, yoga, meditation, behavioral therapy, and acupuncture are some non-medication therapies," Merhi suggests.
But if you really can't be at your best without taking an antidepressant on a regular basis, you can still mitigate the risk of potential harm to your baby by taking the lowest effective dosage and, if possible, sticking to one drug instead of two or more.
The lower the dose of medication, the safer it is for the baby, in line with the findings set out in the June 2020 study. Also, the fewer drugs a mom takes, the better it is. Instead of taking two or three drugs, it is safer to use one drug at a dose that controls depression.
Zaher Merhi, MD —
And if you haven't found a prescription you're comfortable with yet, consider moving to an antidepressant that is considered safer for maternity usage. Along with Cymbalta and Effexor, the Mayo Clinic lists Celexa and Zoloft as two of the better medications to try.
One that's not advised? Paxil, better known as Paroxetine. Several studies have shown that taking Paxil is associated with an increased risk of congenital heart defects during the first trimester of pregnancy. Paxil is especially difficult to wean off, so if you are taking Paxil and are considering becoming pregnant, consult early on with your doctor to decide if adjusting your prescription could be helpful.
What it means to you
The risk of harming your unborn baby from taking an antidepressant during pregnancy is still low, regardless of what trimester you're in or how high your dosage is. Your own health is vital to your unborn baby's health, and that includes both mental health and physical health.
A closer look at the link between particular SSRIs and birth defects (CDC)
Risk Reduction for Birth Defects (AOG)