Antidepressant Use During Pregnancy
What You Need to Know for You and Your Baby
If you are pregnant and experiencing major depression, panic disorder, and/or obsessive-compulsive disorder, treatment with antidepressants may be necessary for you.
Most Commonly Used Antidepressants
SSRI's: Selective Serotonin Reuptake Inhibitors TCA's: Tricyclic Antidepressants- Elavil (also called Amitriptyline)
- Aventyl (also called Nortriptyline)
- Norpramin(also called Desipramine)
- Tofranil (also called Imipramine)
How do the Antidepressants Work?
In Individuals with major depression, the levels of the chemical messengers serotonin and norepinephrin are lower than in nondpressed individuals. The SSRIs act by increasing the levels of serotonin in the brain. The TCAs act by increasing the levels of both serotonin and norepinephrin in the brain. Both classes of antidepressants are highly effective but differ in their side effect profile. That is, different women will have preferential response to one antidepressant over another. Unfortunately, there is no way of knowing at the time of diagnosis which antidepressant will be most beneficial to you as a patient.
Are Antidepressants Safe During Pregnancy?
All Antidepressants have side effects: the goal of treatment is to minimize these side effects. The risk of exposing your baby to the antidepressant medication (no matter how low the dose) has to be weighed against the risk of not getting treatment.
Treatment Guidelines
- Severe psychiatric symptoms must be treated.
- Treatment should be at the lowest possible dose that is effective
- Antidepressant treatment should be combined with counseling or psychotherapy in order to be most effective.
- Beware of postpartum deterioration: the antidepressant does may have to be increased after the baby's birth.
Summary
For women suffering from severe Major Depression, Panic Disorder, and/or Obsessive Compulsive Disorder, treatment with appropriate antidepressant medication remains a viable, but challenging option. The risks of treatment must be weighed up against the consequences of no treatment.
Untreated psychiatric illness during pregnancy may have long-term consequences for you, the mother, and your baby. Mothers with untreated psychiatric illness may turn in desperation to alternative sources (such as alcohol and drugs), exposing themselves and their babies to serious risk. Further, suicide is always a concern in a severly psychiatrically ill woman. A more long-term consequence is disruption fo the normal mother-infant bonding that starts during pregnancy. If illness persists in the postpartum period, this impaired bonding may become chronic. This has long-term consequences for the child in terms of cognitive and behavioral deficits in school.
The goal in treatment is optimal health for the mother and her baby. To date, the bulk of the research shows that the use of antidepressants during pregnancy is for the most part, safe.