Some psychiatrists are advising women to cease taking antidepressants when they become pregnant, saying they “have a natural high when pregnant”.
Only recently have doctors begun to recognize that pregnant women are just as likely to be depressed as their non-pregnant peers. Studies suggest that more than 10% of pregnant women experience depression; or hundreds of thousands each year.
A study published last month of 201 pregnant women with a history of major depression found that 68% of those who stopped their antidepressant relapsed, compared with only 26% of those who stayed on their drugs. Lead author Lee Cohen, a Harvard psychiatrist, says his team is trying to figure out why some women did not relapse after ceasing their antidepressants.
Though doctors worried about antidepressants’ effects on the fetus, little consideration was given to untreated depression’s effect on mother and child.
“Going off a medication during pregnancy may be for some women a far greater risk than staying on,” says Margaret Howard, a psychologist with Women & Infants Hospital in Providence.
Recent research suggests that depressed pregnant women are more likely to deliver too early or develop preeclampsia. “There are potentially risks on both sides of the fence,” says University of Michigan psychiatrist Sheila Marcus. “You really have to look at the severity of the maternal illness, the desire of the mother, the medicine you’re thinking about using.”
For some pregnant women, talk therapy and exercise can relieve depression without drugs, she says.
Research about the safety of selective serotonin reuptake inhibitors (SSRIs) like Paxil and Prozac during pregnancy has resulted in mixed conclusions. A study out last month concluded that women taking Celexa, Paxil, Zoloft, or Prozac during the second half of their pregnancy were six times more likely to deliver a baby with a rare but potentially fatal heart and lung condition.
At a press conference about these findings, FDA official Sandra Kweder said the agency might ask SSRI manufacturers to add a new warning to their labels. Kweder emphasized, however, that the risk of the condition is still only about 1% in women who take SSRIs later in pregnancy.
Preliminary data from two other studies suggests that mothers taking Paxil early in pregnancy are 1 ½ to 2 times more likely to give birth to babies born with a heart defect than babies in the general population, where the risk of such defects is about 1%. That finding spurred the FDA in December to reclassify Paxil from pregnancy category C, meaning pregnant women should be cautious with using it, to category D, meaning there is evidence of risk to human fetuses.
And some research has suggested that babies born to mothers on SSRIs may have temporary withdrawal symptoms, and that some non-drug treatments for depression during pregnancy, such as light therapy and yoga, may help depressed pregnant women.