Depression during pregnancy

Depression affects approximately 10 to 15 % of pregnant women.  Sometimes symptoms may be difficult to differentiate from normal changes of pregnancy.  Symptoms of depression include depressed mood, irritability, feeling no pleasure, weight changes, appetite and sleep changes, loss of energy, feelings of guilt or worthlessness, agitation or suicidal thoughts.  Depression during pregnancy can be caused by increased stress, decreased social support, poor maternal weight gain, smoking, alcohol and drug use.  Untreated depression in pregnant women is associated with an increase in negative pregnancy outcomes such as premature birth, low birth weight infants, poor fetal growth or other complications during the pregnancy. 

Antidepressants:  Are they safe?

Overall antidepressants are safe to use during pregnancy or while breastfeeding and their use has not been shown to cause birth defects with the exception of paroxetine (Paxil) which has been found in some studies to cause heart defects in the fetus and therefore should be avoided in pregnancy.  Several studies have suggested that managing depression in pregnancy is beneficial for neonatal outcomes. The selective serotonin reuptake inhibitors (SSRIs) are the most widely studied and most frequently used antidepressants in pregnancy.  Patients with depression can be managed during pregnancy with or without medication but those with more significant depression will need to continue their medications during pregnancy to prevent relapse of their illness which occurs in about 70 percent of those who discontinue their medication.  Each patient is evaluated individually and should discuss their situation with their doctor.  Currently available data suggests that use of SSRIs during late pregnancy is associated with an increased risk for neonatal complications (jitteriness, gastrointestinal symptoms, irritability, decreased muscle tone, seizures, mild respiratory distress) and probably pulmonary hypertension.  The neonatal complications are temporary and rarely require treatment.  Pulmonary hypertension also appears to be a rare occurrence.  The neonatal symptoms should be discussed with the patient and the potential risks of the medications can be balanced against the effects of untreated maternal depression on the individual patient and her family.

by:  Tameeka Law, M.D.

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