There are many different types of practitioners – from social workers to psychologists and psychiatrists. Only psychiatrists can prescribe medication – and some are more experienced at managing women in pregnancy than others. Cost and access to a good therapist then becomes another barrier to women getting the best care. I think the report should include a guide for doctors to help them refer the right patient to the right therapist. This is not something we are taught in medical school despite the fact that that this form of therapy can be so important and the range of therapy options are so considerable.
I have treated many women who have decided to delay a pregnancy – or not get pregnant at all – because of their fear of their depression returning without medication. They knew all too well that the research studying these medications has been limited. It is always difficult to study a medication objectively when a randomized controlled trial cannot be reasonably done. So the information we have on antidepressants comes from women who have stayed on their medication for one reason or another and likely many of these women had more severe underlying depression that may have affected the health of their baby as well.
I believe this report should give women with severe depression some assurance that they are not alone and that many other women in their circumstances are making the same difficult choice to continue medications. Women with severe depression and those who have been suicidal in the past have a much higher chance of relapsing if medications are stopped. Relapse can occur during the pregnancy affecting the health of the mother and the baby – and after the pregnancy during the post partum period. Taking medication for them may be their only choice -- and it is always a difficult one. Medication sometimes can be the only treatment that works.
To summarize, the purpose of this report was to share with doctors all the research on the risks of untreated and treated depression in pregnancy including the known risk to the mother and to the baby. Experts emphasized over and over that the risks of untreated depression are considerable to the baby as well as the mother and that treatment with drugs like SSRI's need to be considered sometimes. Unfortunately there is very little research on the effects of these medications and I do share the concerns of the many women who wrote to me about this. There are some women with severe depression who make the decision with the advice of their doctors to take the medication during pregnancy as they see they have no other choice. It is hard to disagree with their very personal decision.
The experts all agreed that much more research must be done. I know this is little help for women who need to make this difficult decision now.
What has been your experience with medications during pregnancy? What are your thoughts about this report and the new guidelines?
Dr. Marie Savard is an ABC News medical contributor. Her new book, "Ask Dr. Marie: Straight Talk and Reassuring Answers to Your Most Private Questions," will be available in August.