To take or not to take: Debate arises on antidepressants during pregnancy

WASHINGTON — Expectant moms usually go to great lengths to protect their babies. They give up smoking and wine and watch what they eat. But do those who take pills for depression need to give up their medications?

There are advocates for and against the use of antidepressants during pregnancy. Some say these drugs up the risk of birth defects, while others believe untreated depression is far more dangerous to both mother and child. 

“I think that these decisions have to be made very carefully and on a case by case basis,” says Dr. Jennifer Payne, director of the Women’s Mood Disorders Center at Johns Hopkins Medicine.

She points to a recent study published in JAMA — the Journal of the American Medical Association — that shows the risk of breathing problems in babies born to mothers on antidepressants is much less than earlier believed.

Other research has raised red flags, including a report released last year by Johns Hopkins that spoke of an apparent link between the drug Paxil and an increased risk of autism in boys.

Payne says overall, though, the risks from taking these drugs are not that great. And she points to literature focusing on the risk of untreated depression during and after pregnancy.

She says women with untreated depression are more likely to have premature or low weight babies, and for some there is the increased risk of suicide and bodily harm. There is also the likelihood of post-partum depression, which can have a decided impact on a child.

“When moms have babies, they spend a lot of time stimulating them and talking to them and holding them and nurturing them. And all that has effects on the development of IQ and language and behavior,” Payne says.

She says a team approach is needed to help these women, involving mental health providers, obstetricians and supportive family and friends. Each patient needs to be advised of the risks and the benefits of taking antidepressants during pregnancy.

A big problem is women who unilaterally stop taking their medication. Payne says she has seen it in her psychiatric practice, and makes a point to be proactive.

“For these women, I make sure I have explained everything and then I offer to follow them very closely so that if they get into big trouble, I am right there to help them get better.”

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