depression during pregnancyThe acceptance that women can be depressed during pregnancy is relatively new. Previously it was believed that pregnant women are exposed to hormones that make them happy and so they cannot be depressed. Today we recognize that depression during pregnancy can be a devastating problem with serious consequences on the health of the mother and her child. While treating the depression in these women is important, the approach taken must carefully weigh the risks versus the benefits of medication.

When does depression during pregnancy occur?

Depression is common in all segments of the population but it is highest amongst women of reproductive years. It is estimated that between the ages of 18-44, women have a 2-times higher rate of depression than men of that age range. It is estimated that 10% of women experience depression during pregnancy however this figure is believed to be an underestimate because the condition often goes undiagnosed. In fact, many of the women that experience postpartum depression were actually depressed during pregnancy. A woman is diagnosed with depression if she experiences disturbing moods, feelings, and behaviors nearly everyday for two weeks that significantly interfere with her ability to care for herself, her other children, her home, and her work. It remains difficult to diagnose depression in pregnant women because some of the symptoms of depression (tiredness, difficulty eating and sleeping, and feeling physically uncomfortable) mimic those of pregnancy. Furthermore, changes in hormonal balance during pregnancy can cause mood swings, which may resemble those associated with depression.

Why does depression during pregnancy happen?

It is still unclear why some women develop depression while pregnant and not others. One thing that is certain is that there is a genetic predisposition, with women being more likely to suffer from depression during pregnancy if their blood relatives had. Also, women who had depression in their teens and young adulthood are more likely to develop depression during pregnancy, as well as those that have had previous postpartum depression. Higher rates of depression during pregnancy have also been reported in those with an unwanted pregnancy or with lack of social support and stressful events.

Untreated depression can have serious effects, causing medical difficulties in pregnancy such as premature labor and low birth rate. The biologic correlates of depression, including high cortisol levels and perturbed hypothalamic-pituitary-adrenal function, can result in harmful effects on a developing fetus. Moreover, pregnant women are less likely to seek prenatal care and maintain a healthy lifestyle. If untreated, the depression will likely get worse following the birth of the baby, which can result in negative interactions with the baby.

Antidepressants During Pregnancy

The first line of treatment for depression during pregnancy is psychological counseling but if this treatment does not work then medication may be required. It appears that many antidepressants and antianxiety medications can be used safely during pregnancy with minimal to no effects on the fetus. Current treatment protocols avoid or minimize medication during the first trimester, when the baby is developing most. During late pregnancy, treatment may also be kept to a minimum effective dose to avoid the possibility of premature birth and adverse drug effects on newborns. It should be noted that rapid discontinuation of medications is not recommended because it can substantially increase the risk of relapse.

That is not to say that all antidepressants are safe. Valproate, a mood-stabilizing drug, causes birth defects and exposure during pregnancy is associated with about 3-times as many birth abnormalities including spina bifida, as well as cognitive impairment in newborns. Women who become pregnant while taking valproate should switch to another drug, although it is the only drug that can control seizure in pregnancy and women taking valproate for this reason should be given folic acid to decrease the risk of spina bifida.

While using SSRI antidepressants during pregnancy appears safe, all these compounds cross the placenta and spill into the fetus’ blood stream. During the first trimester, there is some concern of fetal malformation, and in the third trimester there have been reports of feeding difficulties and low birth weight. However, results are inconclusive and long-term effects on child development remain unclear.

Ultimately, as in any other type of medical treatment, one must carefully consider the risks involved. However, while the precise risks of antidepressants are unclear, we know the risks of untreated depression, and the decision to seek treatment should consider the benefits and risks of each option.

What’s next?

If you would like to learn more about finding the correct treatment for depression, continue reading this related blog post: “How To Find The Right Treatment For Depression”.

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[1]Public Health Agency of Canada- Depression in Pregnancy

[2]Stewart, D. Can Fam Physician (2005) 51(8): 1061-1063. Depression during pregnancy.

[3]Ryan, D. Can Fam Physician (2005) 51(8): 1087-1093. Depression during pregnancy.

[4]Ornay, A. Reproductive Toxicology (2009) 28(1): 1-10. Valproic acid in pregnancy: How much are we endangering the embryo and fetus?

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