Pregnant women run the same risk of depression as do women who are not pregnant. It may be difficult to diagnose because changes in appetite and sleep patterns normally occur during pregnancy. So other symptoms need to be assessed - such as lack of interest in the pregnancy, preoccupation with guilt feelings, an inability to enjoy anything including once-favorite pastimes, and suicidal thoughts. In addition, a woman's risk factors for depression need to be evaluated. These would include a previous depression, a family history of depression, marital problems, unwanted pregnancy, and financial problems.
In an ideal world, the decision about whether or not a woman should take an antidepressant would have been discussed prior to conception. However one cannot precisely predict who will become depressed. And it frequently happens that a woman will conceive while taking an antidepressant. What is the danger to the growing fetus?
The answer is - we don't really know what dangers antidepressants pose for fetuses and newborns, but we do know that the fetus is most vulnerable during the first 12 weeks when the organs (including the brain and the nervous system) are forming. Frequently women don't realize that they are pregnant during this sensitive time.
The FDA has classified most antidepressants as being in Category C - meaning there's not enough data and that "risk cannot be ruled out." On the other hand, there is no evidence implicating tricylic antidepressants (TCA's - Tofranil/imipramine, Pamelor/nortriptyline, etc.), fluoxetine (Prozac), or the newer serotonin reuptake inhibitors (SSRI's - Celexa, Lexapro, etc.) as major causes of birth defects.
These factors all need to be considered, along with the risk of no treatment for the depression. Some women experience a marked decrease (rather than increase) in appetite when depressed. Pregnant women's depressions have been associated with lower birth weight, smaller head conference, and pre-term delivery.
If a woman conceives while taking an antidepressant, should she discontinue the medication? The same factors come into play, as well as the high rate of relapse when antidepressants are discontinued.
The bottom line is that a woman should discuss these issues with her obstetrician and her psychiatrist.
In my practice, one of my young patients decided to continue taking her antidepressant during her pregnancy. I kept close tabs on her and stayed in touch with her obstetrician. She did well and her baby was perfectly healthy.
If a woman has had a mild episode of depression, she would probably do well with psychotherapy (In the future, I will write about types of psychotherapy). One of my patients decided to taper off her medication prior to conceiving. During this time, we worked together in therapy and continued to do so until the baby was born. Again, both mother and baby are in good health.
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