For the first time ever, obstetricians and psychiatrists have issued joint guidelines for the treatment of women with depression who are pregnant and for those thinking about getting pregnant. I was stunned to learn that there were no specific guidelines to help women and their doctors before now.
I talked about these guidelines on Good Morning America and commented on World News as well. To summarize the detailed and comprehensive report: Experts believe that the risk of untreated depression to the health of the mother and baby are considerable and should be balanced against the risk of treatment with medications. They recommend that women with mild or controlled depression should try to wean off their medications before becoming pregnant. Psychotherapy such as talk therapy should always be used for women with depression and that this therapy may be enough for many women.
However, they are recommending continuing or even beginning antidepressant medication in pregnant women with severe depression for which no other treatment has been effective. It is this information that gained the most media attention and has many women understandably worried. The report does emphasize that there needs to be a lot more research on the short-term and long-term risk of these medications. Both untreated depression and use of antidepressants have been linked to smaller birth weights and even premature births along with possible problems for the baby after birth.
Antidepressants have been linked to a combination of symptoms in the baby in the immediate postpartum period such as rapid pulse and a drop in blood sugar. They attribute these symptoms either directly to the medication or to the withdrawal of the medication. So any baby born to a mother on these medications needs to be monitored closely for these symptoms at birth. Developmental problems in the baby have also been raised – however the report mentions that both untreated depression and medications may increase the risk.
As an internist treating women since the 1970's, I have always been cautious about recommending any medication, including the popular SSRIs such as Prozac, during pregnancy. Before SSRIs, women took older antidepressants such as amitriptyline that have more side effects but can be an important option for women.
I believe that many women should wean off their medications before they get pregnant if they can. Psychotherapy, including couples counseling, are helpful treatments that I find are not used often enough. All too often it is easier for doctors to write a prescription rather than refer a patient for some form of talk or cognitive therapy. Then again, insurance has not been as quick to reimburse for this helpful treatment and doctors don't always know who are the therapists who can best treat their patients.