Pregnant Women

Most women who take antidepressants stop taking them when they get pregnant.

Women who come to Dr. Anna Glezer, an assistant clinical professor who straddles the psychology and obstetrics and gynecology departments at the University of California, San Francisco, often say their previous doctors told them they weren’t comfortable prescribing the drugs during pregnancy.

Glezer believes it’s better for for women with moderate to severe depression — not just a fleeting case of the blues — to take antidepressants in the commonly prescribed class of selective serotonin reuptake inhibitors (SSRIs) than to leave their depression untreated.

“Certainly for moderate to severe depression, I’ve been encouraging women to try medication and have been prescribing medication, particularly first-line SSRIs, as treatment because more and more data does come out saying that these are safe,” Glezer said.

Two new studies published in BJOG, an international journal of obstetrics and gynecology, back Glezer’s view that SSRIs are safe for women to take during pregnancy, especially when weighed against the risks of untreated depression.

One of the studies examined whether children of mothers who had taken SSRIs during pregnancy developed motor skills at appropriate ages.

It found that Norwegian 3-year-olds whose mothers had taken SSRIs for a prolonged period had developed motor skills slightly after their peers but still within a time frame considered normal.

Women with untreated depression are more likely to engage in less healthy behaviors — whether it’s fewer prenatal appointments, poor nutrition, [or] substance use.
Dr. Anna Glezer, University of California, San Francisco

A second study looked for behavioral problems in 7-year-old Danish children whose mothers took SSRIs during pregnancy. It concluded that untreated depression in pregnant women presented a bigger risk for children’s development than antidepressants.

Each study included roughly 50,000 women.

John Thorp, the deputy editor of BJOG, described the studies as more compelling evidence that a woman’s depression shouldn’t wait for treatment until after the baby is born.

“While there are some increased risks, the evidence so far seems to be that the risks of untreated depression outweigh the risks of taking them,” Thorp wrote in a note that appeared with the studies.

Read More: The Dangers of Abruptly Stopping Antidepressants »

Pills Aren’t the Only Risk for Baby When Mom’s Depressed

It’s easy to single out prescription drugs as a risk to a developing fetus or a breast-feeding child. But a mother’s depression can also put a baby at risk.

Recent research suggests that a mother’s mental health during pregnancy influences the fetus through epigenetic mechanisms, or the ways in which genes turn on and off.

But depression also affects the baby in more familiar ways, by making it harder for a woman to make good decisions.

SSRIs and Pregnancy

“There’s definitely the biological effects of the depression on the developing fetus,” Glezer said. “There’s also the fact that women with untreated depression are more likely to engage in less healthy behaviors — whether it’s fewer prenatal appointments, poor nutrition, substance use, et cetera, and there’s the effect of those individual consequences.”

A depressed mom is less likely to provide top-notch care to her baby in the months after birth, and that can affect the child over the long term.

Interactions with parents cue a baby’s brain to wire itself in a particular way. If a mother doesn’t have the emotional energy to engage in those interactions, the baby’s brain may not develop normally.

“That’s when infants can become securely versus insecurely versus anxiously attached to mom, and that kind of sets them up for their emotional health moving forward,” Glezer said.

Read More: Depression During Pregnancy Increases a Child’s Risk of Mood Disorders »

Don’t Assume Antidepressants Are Bad

These challenges don’t mean that children of depressed mothers are doomed. But they do mean that mothers-to-be shouldn’t assume that avoiding antidepressants is the best thing they can do for their children.

That’s especially important because many women become depressed while they are pregnant. In the ballpark of 15 percent of pregnant women meet the criteria for clinical depression.

“Depression is a condition that can be triggered by an environmental stressor and pregnancy is a hell of an environmental stressor,” Glezer said. “I think there are a lot of women struggling through mild to severe pregnancy-related depression and not getting treatment, so I would encourage them to do their best to try to recognize these symptoms as depression and to seek out treatment.”

Treatment for depression doesn’t have to mean antidepressants. It can also mean talk therapy or exercise.

Read More: Drugs to Avoid During Pregnancy »

Questions About SSRIs for Teens

The news on SSRIs isn’t all good, though.

An analysis and an editorial published by the journal BMJ suggest that the early industry-sponsored studies that set forth that depressed adolescents could safely take the SSRI paroxetine (Paxil) were flawed.

A skeptical second look at the data reveals that thoughts of suicide were much more common among teens taking the drug than among those taking a placebo.

When severity of depression was compared, paroxetine was barely more effective than the sugar pill.