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Depression and Antidepressants in Pregnancy
I have decided not to have children, yes, in large part due to the bipolar disorder.
We know people with a parent with bipolar disorder have a 50 percent chance of have another serious psychiatric disorder and first-degree relatives of people with bipolar I have a seven times greater chance of developing bipolar I than the general population.
In other words, it’s a coin toss as to whether my child would have a serious mental illness. I’m not willing to toss that coin. Moreover I know how much work it is to manage my illness and that effort would make me less than the mother I believe a child deserves.
But, of course, this is each person’s decision and when going into a pregnancy it’s important to know the risks.
Depression, Bipolar, and Pregnancy
Pregnancy hormones were once thought to protect a woman against depression, but we now know this isn’t true—about 18 percent of women experience depression during pregnancy. Depression treatment during pregnancy is actually very important as depression can lead to low birth weight, premature birth, preeclampsia, or other problems for the baby. Moreover, depression during pregnancy can lead to significant post-partum depression and those with bipolar disorder are at greater risk for post-partum psychosis, which can endanger the lives of the mother and child.
Antidepressants in Pregnancy
The decision as to whether to take any kind of medication during therapy is something that needs to be made considering the risks versus the benefits of treatment. Most doctors agree that, overall, it is better to treat the depression with antidepressants (when appropriate) during pregnancy rather than let the depression stand.
However, this doesn’t mean there are not risks. According to the Mayo Clinic:
- Tricyclic antidepressants (TCAs): early studies suggested a risk of limb malformation with TCAs but this finding has not been replicated in more recent research.
- Selective serotonin reuptake inhibitors (SSRIs): some are generally considered safe, including: citalopram (Celexa), fluoxetine (Prozac) and sertraline (Zoloft). Paroxetine (Paxil) is generally discouraged during pregnancy as it has been related to fetal heart defects when taken during the first trimester.
- Monoamine oxidase inhibitors (MAOIs): generally not recommended as they can limit fetal growth and aggravate high blood pressure.
Additionally, if you take antidepressants during the last trimester a baby may experience discontinuation symptoms (withdrawal) at birth. Tapering the dosage at the end of pregnancy is not recommended and doesn’t appear to help.
Antidepressants and Pregnancy – A Recent Study
Two recent studies looked at SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs) and norepinephrine reuptake inhibitors (NRIs) and their association with the most severe fetal complications. According to a Psychiatric Times article, these studies found:
- Some studies show a correlation between SSRIs and birth defects but this finding has not been consistent.
- Postnatal adaptation syndrome (PNAS) occurs in up to 30 percent of neonates who are exposed to antidepressants during the final trimester but it has been found to be transient and generally resolved within a few days.
- “. . . we do not recommend discontinuing SSRIs in pregnant women because of the risk of PPHN . . . the overall data on SSRI use in pregnancies is reassuring. SSRIs are considered to be relatively safe for use during pregnancy and the postpartum period.”
Deciding on Antidepressant Use During Pregnancy
It’s no easy task deciding on medication use during pregnancy but the best thing to do is to talk to your healthcare provider before getting pregnant and make a plan. Experts recommend using the lowest effective medication dose possible, avoiding polypharmacy (multiple medications) and maximizing evidence-based nonpharmacological treatments.