Antidepressants and Pregnancy

Depression is a common affliction among women in general, and pregnant women are no exception. According to the Women's Mental Health Program at Loyola University Health System, between 12 to 20 percent of pregnant women suffer from depression, and many cases may go undiagnosed.

Many women are concerned about taking antidepressants while pregnant, for fear of harming their unborn child. Studies show, however, that there is no evidence that antidepressants cause any serious problems, and suggest that leaving depression or anxiety untreated during pregnancy may actually have negative effects.

Many studies in the last few years have shown no increase in the incidence of birth defects, behavioral problems, learning disabilities, mental retardation, pre-term labor, or low birth weight with women who take selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Paxil, and Zoloft during their pregnancy.

However, if depression or anxiety is left untreated during pregnancy, there is an increased likelihood of preterm labor, premature delivery, low-birth weight, and small head circumference. Untreated depression can also inhibit a woman's ability to care for herself; impair her nutrition; lead to an increase in her use of tobacco, alcohol, and drugs; and interfere with her ability to bond with the child.

Depression during pregnancy is also a strong risk factor for postpartum depression. Women in the United States have a higher incidence of postpartum depression than any other country in the world. This is believed to be caused by shorter maternity leave in this country, women feeling pressured to return to work quickly to help with the family income, fragile support systems, and parents and other family members living far away. Other risk factors for postpartum depression include being a single mother, an unwanted pregnancy, a history of depression and anxiety, and having a child with special needs.

Depression is a serious condition that affects many women. If you are suffering from depression, talk to your doctor about getting treatment. Group therapy and one-on-one counseling with a psychotherapist are also great medication-free ways to deal with depression. Getting proper treatment is important for your health, and the health of your baby.

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Postpartum Depression

Postpartum depression is moderate to severe depression in a woman after she has given birth. It may occur soon after delivery or up to a year later. Most of the time, it occurs within the first 3 months after delivery.

Causes, incidence, and risk factors

Women commonly have mood changes during pregnancy, especially after delivery. These mood changes may be caused by changes in hormone levels. Many non-hormonal factors may also affect mood during this period:

• Changes in your body from pregnancy and delivery
• Changes in work and social relationships
• Having less time and freedom for yourself
• Lack of sleep
• Worries about your ability as a mother

Feelings of anxiety, irritation, tearfulness, and restlessness are common in the week or two after pregnancy. These feelings are often called the postpartum or "baby blues." These symptoms almost always go away soon, without the need for treatment.

Postpartum depression may occur when the baby blues do not fade away or when signs of depression start 1 or more months after childbirth.

You may have a higher chance of postpartum depression if you:

• Are under age 20
• Currently abuse alcohol, take illegal substances, or smoke (these also cause serious medical health risks for the baby)
• Did not plan the pregnancy, or had mixed feelings about the pregnancy
• Had depression, bipolar disorder (for example, manic depression), or an anxiety disorder before your pregnancy, or with a previous pregnancy
• Had a stressful event during the pregnancy or delivery, including personal illness, death or illness of a loved one, a difficult or emergency delivery, premature delivery, or illness or birth defect in the baby
• Have a close family member who has had depression or anxiety
• Have a poor relationship with your significant other or are single
• Have financial problems (low income, inadequate housing)
• Have little support from family, friends, or your significant other

Symptoms

The symptoms of postpartum depression are the same as the symptoms of depression that occurs at other times in life. Along with a sad or depressed mood, you may have some of the following symptoms:

• Agitation or irritability
• Changes in appetite
• Feelings of worthlessness or guilt
• Feeling withdrawn or unconnected
• Lack of pleasure or interest in most or all activities
• Loss of concentration
• Loss of energy
• Problems doing tasks at home or work
• Negative feelings toward the baby
• Significant anxiety
• Thoughts of death or suicide
• Trouble sleeping

A mother with postpartum depression may also:

• Be unable to care for herself or her baby
• Be afraid to be alone with her baby
• Have negative feelings toward the baby or even think about harming the baby (Although these feelings are scary, they are almost never acted on. Still you should tell your doctor about them right away.)
• Worry intensely about the baby, or have little interest in the baby

Signs and tests

There is no single test to diagnose postpartum depression. Your doctor may have you complete a questionnaire (such as the Edinburgh Postnatal Depression Scale) at your office visit to look for signs of depression or risks for depression.

Sometimes depression following pregnancy can be related to other medical conditions. Hypothyroidism, for example, causes symptoms such as fatigue, irritability, and depression. Women with postpartum depression should have blood tests to screen for medical causes of depression.

Treatment

A new mother who has any symptoms of postpartum depression should take steps right away to get help.

Here are some other helpful tips:

• Ask your partner, family, and friends for help with the baby's needs and in the home.
• Don't hide your feelings. Talk about them with your partner, family, and friends.
• Don't make any major life changes during pregnancy or right after giving birth.
• Don't try to do too much, or to be perfect.
• Make time to go out, visit friends, or spend time alone with your partner.
• Rest as much as you can. Sleep when the baby is sleeping.
• Talk with other mothers or join a support group.

The treatment for depression after birth often includes medication, therapy, or both.

• If you are diagnosed with depression, you may need to be followed closely for at least 6 months.
• There are several types of antidepressant medications that may be given to breastfeeding mothers, including paroxetine, sertraline, and nortriptyline.
• Ask your doctor or nurse for a referral to a mental health therapist. Cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) are types of talk therapy that have been found effective for postpartum depression.

If you are thinking of harming yourself or your infant, seek immediate medical help.

Support Groups

If you are diagnosed with postpartum depression, support groups may be helpful, but they should not replace medication or individual psychotherapy (talk therapy).

Expectations (prognosis)

Medication and professional psychotherapy can often successfully reduce or eliminate symptoms.

Complications

If left untreated, postpartum depression can last for months or years, and you may be at risk of harming yourself or your baby.

The potential long-term complications are the same as in major depression.

Calling your health care provider

Call your doctor if you experience any of the following:

• Your baby blues don't go away after 2 weeks
• Symptoms of depression get more intense
• Symptoms of depression begin at any time after delivery, even many months later
• It is hard for you to perform tasks at work or at home
• You cannot care for yourself or your baby
• You have thoughts of harming yourself or your baby
• You develop thoughts that are not based in reality, or you start hearing or seeing things that other people cannot

Do not be afraid to seek help immediately if you feel overwhelmed and are afraid that you may hurt your baby.

Prevention

Having good social support from family, friends, and coworkers may help reduce the seriousness of postpartum depression, but may not prevent it.

Screening questionnaires may help detect depression or risks for depression early.

Women who had postpartum depression after past pregnancies may be less likely to develop postpartum depression again if they start taking antidepressant medications after they deliver.

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