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Major Depression During Conception and Pregnancy: A Guide for ...
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Short Description: experience some depressive symptoms during pregnancy, and. about 10% of women develop major ... becoming depressed in pregnancy, especially if they stopped ...
Content Inside: Expert Consensus Guideline Series Major Depression During Conception and Pregnancy: A Guide for Patients and Families David A. Kahn, M.D., Margaret L. Moline, Ph.D., Ruth W. Ross, M.A., Lee S. Cohen, M.D., and Lori L. Altshuler, M.D. epression is an illness that affects up to 1 in 4 women Unfortunately, research information about the safety of at some point in their lives. It often begins when antidepressants in pregnancy is limited because there are im- Dwomen are in their 20s and 30s, at the same time they portant ethical concerns about conducting such research. may be considering having children. If you or someone you However, many pharmaceutical companies do maintain regis- know has major depression, you may be wondering whether it is tries of pregnant women who have taken their products, and safe to become pregnant--especially if you are taking medica- some hospital clinics publish information on groups of women tion for your symptoms--or safe to continue medication if you who have used antidepressants during pregnancy. These rec- are already pregnant. This guide is intended to answer some ords provide helpful information about several of the most commonly asked questions about the treatment of major depres- widely used antidepressants, although we lack such informa- sion while trying to conceive and during pregnancy. tion about a number of other antidepressants. In deciding whether a woman should use antidepressant WHAT IS MAJOR DEPRESSION? medication while pregnant or trying to become pregnant, a woman and her doctor have to balance the possible risks of the Major depression is a mood disorder. Mood disorders are medication against the severity of the depression. Because our illnesses that affect a person's ability to experience normal research knowledge is limited, we surveyed leading experts in mood states. Research suggests that mood disorders are bio- the area of women's mental health to develop recommenda- logical illnesses involving changes in brain chemistry. Emo- tions based on their best judgments. This article summarizes tional stress can sometimes trigger these changes, though some the results of this survey. individuals may experience depression for no apparent external cause. The symptoms of major depression include: TREATMENT WHILE TRYING TO CONCEIVE · Depressed mood most of the day, nearly every day for 2 weeks or longer and/or Many women who have had depression may be taking anti- · Loss of interest or pleasure in activities that the person usu- depressants to prevent symptoms at the time they wish to ally enjoys. become pregnant. Whether the medication should be stopped Other symptoms can include: depends on how severe the history of depression has been. If a · Fatigue or lack of energy woman has had only 1 previous episode of depression and has · Restlessness or feeling slowed down been feeling well for at least 6 months, the experts recommend · Feelings of guilt or worthlessness that she taper off medication before trying to conceive. Several · Difficulty concentrating weeks may be required before all traces of medication have · Trouble sleeping or sleeping too much been eliminated. The experts also suggest that continuing or · Recurrent thoughts of death or suicide. beginning psychotherapy may be helpful in preventing symp- toms from returning. However, if a woman has a history of DEPRESSION DURING PREGNANCY: SPECIAL ISSUES severe major depression with multiple previous episodes, the experts recommend that she continue medication at full dose Contrary to popular belief, pregnancy does not protect a through conception. If she is already taking an antidepressant woman from becoming depressed. About 20% of women for which there is a fair amount of information suggesting that experience some depressive symptoms during pregnancy, and it is safe (these are listed later), it is fine to continue. However, about 10% of women develop major depression. Women who if she is taking a medication for which there is little informa- have had major depression in the past have a higher risk of tion, she should switch to a medication thought to be safer. becoming depressed in pregnancy, especially if they stopped What about a woman who is depressed, is not receiving taking antidepressant medication while trying to become treatment, and wants to conceive? If the depression is mild, the pregnant. experts would recommend trying to treat her symptoms with Treating depression in a woman who wants to conceive or is psychotherapy alone. However, if the symptoms are severe, pregnant is complicated. When pregnancy is not an issue, whether it is a first episode or 1 of many, a combination of psychotherapy can help with milder symptoms, but antide- medication and psychotherapy is advised. pressant medication is often needed to bring relief from severe major depression. However, in pregnancy concerns arise about TREATMENT IN THE FIRST TRIMESTER using medications to treat depression since they cross the pla- centa and may harm the fetus. At the same time, untreated The first trimester (12 weeks) of pregnancy is a crucial time major depression has serious potential risks for mother and when medication can cause malformations of the fetus. fetus, since it may lead to poor nutrition, smoking, drinking, Women may be taking antidepressants at the start of preg- suicidal behavior, prolonged or premature labor, and low birth nancy for 1 of the reasons discussed above or may have an weights. unplanned pregnancy while on medication. If a woman has 110 · A POSTGRADUATE MEDICINE SPECIAL REPORT · MARCH 2001
