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Perinatal Depression: The Risks and Benefits of Taking Antidepressants While Pregnant



Some of the common symptoms associated with prenatal depression include persistent sadness, difficulty concentrating, sleeping too little or too much, anxiety, feelings of guilt or worthlessness, a loss of interest in activities that you usually enjoy, and recurring thoughts of death, suicide, or hopelessness. Because a lot of these symptoms are chalked up to hormonal imbalances associated with pregnancy, prenatal depression frequently goes undetected or undiagnosed.

Because I had previously experienced a depressive episode and because I had recently felt low enough to call the suicide hotline, my obstetrician felt my depression was on the more severe end on the scale. She referred me to a perinatal psychiatrist (someone who specializes in prenatal and postpartum depression) and gave me the option to start an antidepressant.

The decision to start antidepressants during my pregnancy was deeply complicated.

Our society has a rigid ideal of what pregnancy should look and feel like. In what has been dubbed the Goddess Myth, we are repeatedly told that not only should our skin glow and our hair shine but that breast is best and that we should only want a vaginal delivery. Mommy bloggers and well-meaning neighbors are there to remind us that for the next nine months our bodies are sacred temples. We give up coffee, sushi, and alcohol. Switch to organic foods. Scour the ingredient list of any new skin care product. How, in the midst of all this, does a pregnant woman willingly start taking a drug?

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Research on the subject has historically produced some scary findings. Selective serotonin reuptake inhibitors (SSRIs), the type of drug typically used to treat depression, have been associated with an increased risk of certain birth defects. But many of these older studies compared pregnant depressed women who are taking antidepressants to pregnant women with no history of depression, which is “like comparing apples and oranges,” says Pooja Lakshmin, M.D., a perinatal psychiatrist and clinical assistant professor at the George Washington School of Medicine.

But newer studies are more nuanced, finally comparing results using the right control group—pregnant women with depression who take antidepressants versus pregnant women dealing with untreated prenatal depression. In 2015 the Centers for Disease Control and Prevention did a critical review of past studies and added new research. They found that while some antidepressants can increase the risk of birth defects, the overall risk is “very low.”

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On top of that, recent research has found that not treating depression during pregnancy can also be harmful. “People are so worried about harming the baby with meds. But if you have prenatal depression and you don’t treat it, you can still cause harm,” says Lakshmin. “Either decision comes with a risk.”

Untreated prenatal depression actually mirrors some of the same risks previously thought to be associated with taking meds for depression, such as preeclampsia, low birth weight, and preterm delivery. Additionally, untreated prenatal depression can limit a woman’s ability to self-care, eat well, and keep up with doctor visits—all things that studies show to be disruptive to maternal bonding and potentially harmful to the baby for years to come. “Women with prenatal depression are at risk for future depressive episodes, and a lot of research shows that their parenting skills are negatively impacted,” says Darius Tandon, Ph.D., a psychologist and principal investigator for multiple Mothers and Babies projects, an evidence-based program that aims to prevent postpartum depression. “There is evidence of negative outcomes not only in the first year of life but persisting into toddlers and school-going age or even into adolescence.”

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The Stigma of Being a Medicated Mom

The good news is that prenatal depression is very much treatable. The bad news is that many women forgo treatment because they can’t get past the stigma of seeking help.

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