RODALE NEWS, EMMAUS, PA—Approximately one fifth of women suffer from depression during pregnancy, putting them and their babies' health at risk. Yet, those women must weigh their emotional health against the risks of taking antidepressants during pregnancy, which a new study published in the British Medical Journal suggests could lead to congenital heart defects.
THE DETAILS: The study authors collected data from four Danish health registries on 496,881children born between 1996 and 2003, including their mothers' use of antidepressants one month before to four months after they became pregnant. All tolled, 1,370 infants out of the total study sample had been exposed to antidepressants, and among those children, 7 percent were born with defects, compared with 5 percent of unexposed infants. The most significant problems were septal heart defects, in which babies are born with holes in the upper or lower chambers of their hearts. Of the exposed infants with septal heart defects, 2.1 percent had mothers who'd taken a combination of antidepressants, and 0.9 percent had mothers who'd taken one. The antidepressant most prevalently linked to the disorder was sertraline (Zoloft), followed by citalopram (Celexa), fluoxetine (Prozac), and paroxetine (Paxil or Seroxat).
WHAT IT MEANS: Taking antidepressants during pregnancy carries not just the risk of septal heart defects for babies, but also, as previous research has found, of gastrointestinal problems and how a baby's skull is formed. Taking antidepressants during the third trimester can also lead to preterm births, says John Grohol, PsyD, founder of the website PsychCentral.com.
However, untreated depression during pregnancy leads to a higher risk for postpartum depression, and it can interfere with the cognitive and emotional development of the child, lead to sleep problems, and increase the risks of mental and medical disorders later in life. It's important, the authors write, to weigh the risks of the medication with those of the depression. "Pregnant women should definitely talk to their doctor about the fact that they're on antidepressants," says Dr. Grohol. Even if you're considering getting pregnant, it's worth discussing, because you can't simply stop taking these drugs. You need to get weaned off of them, says Dr. Grohol, and that can take anywhere from six to eight weeks.
If giving up medication seems the best course, there are other options for treating depression, some or which may work better for some women than drug treatment. In fact, a study published in a recent issue of the New England Journal of Medicine suggests that antidepressants are only slightly more effective than sugar pills.
Here are some things to keep in mind when dealing with depression during pregnancy:
• Try psychotherapy. "Some people respond better to psychotherapy," says Dr. Grohol. "It's just as effective as antidepressants as a cognitive behavioral therapy." He suggests that pregnant women give it a try, even if it's just for nine months.
• Rely on your social network. Friends and family provide support that may help you overcome whatever it is that's bothering you, Dr. Grohol says. He also says that pregnancy support groups can do the same, if you don't feel comfortable discussing these issues with family members.
• Don't panic. Many pregnancies are unplanned, and this study looked at antidepressant use before a woman conceived through her first trimester, when there's some chance that a woman may be taking antidepressant medication without realizing she's pregnant. But, says Dr. Grohol, as this study and others have shown, "it's a small percentage of women who have problems, or their babies have problems." And it doesn't hurt to wean yourself off with your doctor's guidance after you're already pregnant, Dr. Grohol says.