There’s a lot to grapple with during pregnancy — eating right, taking prenatal vitamins, monitoring your health and becoming a regular at your obstetrician’s office. For some, pregnancy may not be all bright and shiny, a social media aesthetic of pastels and positivity.
Depression during pregnancy is a common complication, affecting between 10% and 20% of pregnancies in the U.S., according to a 2020 review in the Cleveland Clinic Journal of Medicine. But it’s also treatable.
Pregnancy and Depression
Pregnant women carry an increased risk of depression for several reasons, including:
— Hormonal changes.
— The stress of decision-making and preparing for childbirth.
— Working a job during pregnancy.
— Increased risk of intimate partner violence.
To help mitigate this risk, the American College of Obstetricians and Gynecologists recommends that all pregnant and postpartum women are screened for depression. This screening is also part of a Healthy People 2030 initiative to improve overall public health.
The medical community favors multiple depression screening tools, including the Edinburgh Postnatal Depression Scale. The EPDS asks participants to rate the truthfulness of phrases regarding their emotional well-being: “I have looked forward with enjoyment to things” or “I have been anxious or worried for no good reason.”
If you are one of the hundreds of thousands of pregnant women diagnosed with depression, you have several options for treatment during your pregnancy.
[READ A Patient’s Guide to Depression]
Which Antidepressant Medications Are Safe in Pregnancy?
You can take antidepressants while pregnant. There are several classes of medications available, including:
— Selective serotonin reuptake inhibitors, or SSRIs, like Zoloft. These medications increase the levels of serotonin, also known as the “happiness hormone” in the brain. SSRIs are usually the first-line treatment, and Zoloft in pregnancy is frequently prescribed.
— Serotonin and norepinephrine reuptake inhibitors, or SNRIs, like Cymbalta. SNRIs increase serotonin and norepinephrine, a neurotransmitter (chemical messenger in the body) associated with emotional regulation.
— Tricyclic antidepressants like amitriptyline. These medications increase both serotonin and norepinephrine but use a different mechanism than SNRIs.
— Norepinephrine and dopamine reuptake inhibitors, or NDRIs, like bupropion. NDRIs increase norepinephrine and dopamine, known as the “feel-good” neurotransmitter.
Each type of antidepressant works differently and comes with its pros, cons and side effects, such as headaches, dizziness, loss of appetite, diarrhea and constipation.
“Non-pharmacological options may appeal to some women due to concerns over medication safety during gestation or personal preferences,” adds Dr. Laura Purdy, a board-certified family medicine physician based in Nashville, Tennessee.
Alternative treatment options for mild depressive symptoms can include support groups, cognitive behavioral therapy or even light therapy.
Whether you’re going the medication route or trying other treatment avenues, Purdy says that any treatment should be tailored to your specific wants and needs. So, make sure you speak with your provider about the ideal option for your situation.
[READ: Mental Health Support Groups: Pros & Cons.]
Risks of Taking Antidepressants While Pregnant
Every medication and treatment comes with a degree of risk. For antidepressants during pregnancy, these risks can be boiled down to three types:
— Developmental defects.
— Pregnancy and delivery complications.
— Neonatal withdrawal symptoms.
Developmental defects
Pregnant women may be concerned about the risk of miscarriage
, stillbirth, congenital heart defects, autism spectrum disorder and neurological delay related to taking antidepressants during pregnancy.
“Research suggests a slightly increased risk for developmental and neurological defects among newborns of mothers taking antidepressant drugs during gestation — specifically during the first trimester — but any increases should still be seen against risks from untreated depression during gestation,” Purdy says.
In other words, it may be better to take the medication than not treat your depression while you’re pregnant.
Still, there are some antidepressants that you should steer clear of completely, such as monoamine oxidase inhibitors, or MAOIs. These medications work by increasing norepinephrine, serotonin and dopamine. This might sound similar to the other antidepressant drug classes typically considered safe during pregnancy (such as the ones above). MAOIs, though, have been shown to cause pregnancy and fetal development complications.
Other medications, such as Paxil (an SSRI) and Venlafaxine (an SNRI), have also been correlated with possible poor outcomes in fetal development and are not prescribed as much as, say, Zoloft.
On the other hand, there is little research showing that other SSRI medications, including Zoloft, have adverse effects on fetal development and newborn outcomes. Most research, including a 2018 systematic review in BMC Medicine, shows that the risk of a negative outcome in fetal development is minuscule. This risk, however, can only be entirely ruled out once more research has been conducted (more on that later).
Pregnancy and delivery complications
According to Kristin Mallon, a certified nurse midwife in Hackensack, New Jersey, there is a slightly increased risk of some pregnancy and delivery complications when antidepressants are part of the pregnancy equation. These risks include postpartum hemorrhage, preterm labor and high blood pressure.
Neonatal withdrawal symptoms
Although more studies need to be completed, there is some evidence — including this 2021 study in Psychotherapy and Psychosomatics — that neonates exposed to antidepressants in utero might experience some withdrawal symptoms after birth. These symptoms include low blood sugar, difficulty breathing or rapid heart rate. In these cases, the baby may need an extended hospital stay, including a possible NICU admission for more intense observation.
[READ: Checklist for Choosing a Maternity Hospital.]
The Benefits of Taking Antidepressants in Pregnancy
Taking care of your mental health while also ensuring the safety of your pregnancy is a careful balance.
The benefits of taking antidepressants while pregnant include:
— Lowered risk of suicidal ideation.
— Decreased delivery complications.
Lowered risk of suicidal ideation
One of the biggest concerns of depression in pregnancy is the risk of suicidal thoughts. Suicide
is the leading cause of death for pregnant women and those up to one year into postpartum, according to a 2021 systematic review in Frontiers in Psychiatry.
Mental health screenings, such as those mentioned above, and antidepressant prescriptions are a harm reduction action endorsed by many obstetric providers. The threat of suicidal thoughts or actions often overshadows the small risk of complications during pregnancy and birth due to antidepressants.
Decreased delivery complications
Untreated depression during pregnancy can come with another risk: A stress hormone, cortisol, is prevalent in depression and can cross the placental barrier. This stress may cause preterm labor and newborns smaller than average for their gestational age.
“The known benefits of taking an antidepressant in pregnancy include an enhanced quality of life, relief from anxiety and depression, better nutrition, less substance abuse and better adherence to prenatal care,” Mallon adds.
When to Start and Wean Off Antidepressants
Medical providers may prescribe antidepressants at any point during a pregnancy. Mallon notes that providers sometimes avoid prescribing in the first trimester if the mother is not at risk for depression complications.
“This is the time of embryologic development and organogenesis (when organs are being formed), but it is not necessary to avoid antidepressants during this time,” she adds.
Thinking about weaning off an antidepressant? You should always do so under medical guidance, Mallon says. If weaning isn’t done correctly, you can experience withdrawal symptoms, such as nausea, upset stomach or difficulty with sleep that typically last a couple of weeks. A medical provider also needs to determine if weaning off the medication is safe, as a major depressive episode can potentially harm both mom and baby, Mallon adds.
More Studies Are Needed
Over time, clinical practices are likely to shift as medical professionals continue to track data and outcomes of antidepressants during pregnancy.
“More long-term studies need to be conducted,” Mallon explains.
Most studies are focused on the period of pregnancy and the neonatal and infant period. There is still a lack of studies focusing on the long-term impact of antidepressants in utero on neurodevelopment and behavior.
Basically, it’s challenging to survey a double-blind, randomized controlled trial, the gold standard in medical studies, because of the ethics behind conducting tests on pregnant women. However, there is still a push in the medical community for pregnant women to be more represented in clinical studies.
Informed Consent Is Key
Informed consent is when a patient gets all the information necessary on risks, benefits and alternative treatments and then gives their permission on how they would like to move forward. Purdy adds that informed consent is essential for patients to understand all potential advantages and drawbacks of treatment, including potential fetus risks measured against untreated depression risks.
Having a good relationship with your medical provider is imperative, and you shouldn’t feel like your provider is unwilling to discuss the risks or benefits of any treatment for depression. As a patient, you deserve to be active in determining your pregnancy care, especially regarding your mental health.
More from U.S. News
Apps to Support Your Mental Health
Tips to Support Someone Struggling With Mental Health
What to Pack in Your Hospital Bag When You’re Expecting
Can You Take Antidepressants While Pregnant? originally appeared on usnews.com
