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The Medicine Cabinet-Ask the Harvard Experts: Depression during pregnancy should be treated

The Medicine Cabinet-Ask the Harvard Experts: Depression during pregnancy should be treated

By Howard LeWine, M.D., Tribune Content Agency

Q: I just found out that I’m pregnant. I’m excited, but worried because I have a history of depression. I’m afraid to take medicine if I start to get depressed again. Any advice?

A: Pregnancy is a joyful time for most women, but not for a pregnant woman who struggles with depression. And it’s common. The limited data available suggest that up to 7 percent of women who become pregnant develop major depression. Another 7 percent develop minor depression.

Mental health professionals, obstetricians and their patients often need to balance:

–The chance that exposure to an anti-depressant drug may harm the developing fetus

–The danger of not adequately treating the pregnant woman

It’s terrific that you want to learn about your options “just in case.” Too many pregnant women don’t seek help. They push aside their feelings and think, “I’m pregnant. I’m supposed to be happy. I’ll get over these feelings of depression.” They also worry that the doctor will prescribe an antidepressant that might harm the developing fetus.

But depression during pregnancy should be treated. It’s important for both the mother and for the developing fetus. Among other risks, untreated depression during pregnancy increases the likelihood that a woman will develop postpartum depression and give birth to a low-weight baby. Also there’s a greater chance that the newborn will be lethargic and more irritable than expected.

For women with mild to moderate depression, talk therapy alone can be very effective. But treatment of severe depression during pregnancy almost always requires antidepressant medicine.

Selective serotonin reuptake inhibitors (SSRIs) are the drugs most often used to treat depression during pregnancy. They include fluoxetine (Prozac), sertraline (Zoloft), and others.

All psychiatric medicines cross the placenta and reach the fetus. But the risks to the developing baby are very small. More recent research suggests that SSRIs are less likely to cause birth defects than previously thought and perhaps no increased risk when used during the first half of pregnancy.

Women with severe depression during pregnancy should keep an open mind regarding the use of an SSRI. Based on current evidence, trying to taper the dose in the second half of pregnancy seems a reasonable strategy. But if your symptoms get worse — especially if you have any thoughts of suicide — you need to tell your doctor or therapist right away.

(Howard LeWine, M.D., is a practicing internist at Brigham and Women’s Hospital in Boston and Chief Medical Editor of Internet Publishing at Harvard Health Publications, Harvard Medical School.)

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