Depression in pregnancy
Pregnant women with depression face complicated treatment decisions because of the risks associated with both untreated depression and the use of antidepressants. A new report from The American College of Obstetricians and Gynecologists (ACOG) and the American Psychiatric Association (APA) attempts to help doctors and patients weigh the risks and benefits of various treatment options.
Depression is common during pregnancy – it’s thought that between 14 and 23% percent of pregnant women will experience it, and in 2003, about 13% of women took an antidepressant at some time during their pregnancy.
New research carried out by the ACOG and the APA offers recommendations for the treatment of women with depression during pregnancy. “Depression in pregnant women often goes unrecognized and untreated in part because of concerns about the safety of treating women during pregnancy,” says lead author Dr Kimberly Ann Yonkers, associate professor of psychiatry and obstetrics, gynecology and reproductive sciences at Yale University. “It is our hope that this will be a resource to clinicians who care for pregnant women who have or are at risk of developing major depressive disorder.”
Both depression symptoms and the use of antidepressant medications during pregnancy have been associated with negative consequences for babies. Infants born to women with depression have increased risk for irritability, less activity and attentiveness, and fewer facial expressions compared with those born to mothers without depression. Depression and its symptoms are also associated with fetal growth change and shorter gestation periods. Some studies also have linked fetal malformations, cardiac defects, pulmonary hypertension, and reduced birth weight to antidepressant use during pregnancy.
Identifying depression in pregnant women can be difficult because its symptoms mimic those associated with pregnancy, such as changes in mood, energy level, appetite, and cognition. But it is vital that pregnant women are diagnoses, since they are more likely to have poor prenatal care and pregnancy complications, such as nausea, vomiting, and preeclampsia, and to use drugs, alcohol, and nicotine.
“OB-GYNs are the front-line physicians for most pregnant women and may be the first to make a diagnosis of depression or to observe depressive symptoms getting worse,” says ACOG President Gerald F Joseph, Jr, MD. “In the past, reproductive health practitioners have felt ill equipped to treat these patients because of the lack of available guidance concerning the management of depressed women during pregnancy.”
According to the report, some patients with mild-to-moderate depression can be treated with psychotherapy (individual or group) alone or in combination with medication. For women who are taking depression medication and thinking about getting pregnant, it may be appropriate to taper and discontinue medication before becoming pregnant although this may not be advisable in cases of severe depression.
Pregnant women currently on medication for depression may be able to stay on their meds after consultation between their psychiatrist and OB-GYN to discuss risks and benefits, and should only taper or discontinue their meds if their carers advise it. They also should consider psychotherapy to replace their meds (this also may benefit pregnant women who prefer to avoid antidepressant medication). Women with severe depression (with suicide attempts, functional incapacitation, or weight loss) should remain on medication.