Even though pregnancy is typically a happy time, it’s common for expecting moms to struggle with depression. And for certain women, prescription medication can be the difference between feeling incapacitated and functioning normally. However, doctors suspect many don’t get the help they need. “We would never suggest that a pregnant woman go without medication for diabetes, but people still see medical treatment for depression as optional,” says Catherine Birndorf, M.D., a psychiatrist and founding director of the Payne Whitney Women’s Program at New York Presbyterian Hospital-Weill Cornell Medical Center in New York City. The stigma surrounding mental illness plays a role in this problem, as do misleading reports linking antidepressants in pregnancy to health problems in babies. Experts explain the science behind some of these studies so you can get the help that’s right for you.
FACT: Late last year, news stories about a study in JAMA Pediatrics put some expectant mothers into a panic. Misreadings of the study projected that using antidepressants in the second and third trimester of pregnancy could increase a child’s risk of developing autism by more than 80 percent. In reality, “the risk of having a child evaluated for autism—not diagnosed, but evaluated—went from 7 children born to 1,000 unmedicated moms to 12 children born to 1,000 moms on antidepressants. The increase was 0.5 percent,” says Alison Stuebe, M.D., associate professor of maternalfetal medicine at the University of North Carolina School of Medicine at Chapel Hill. Furthermore, other studies have revealed no increase in autism diagnoses when a mom takes antidepressants—or an increase so slight (less than 1 percent) that the benefits of treatment far outweigh any medication risks.
FACT: A decade ago, a prominent study linked selective serotonin reuptake inhibitors (SSRIs), a commonly prescribed type of antidepressant, to a rare heart and lung condition called persistent pulmonary hypertension of the newborn (PPHN). In addition, another study connected the drugs to congenital heart defects. In 2006 these findings spurred the FDA to caution doctors against prescribing antidepressants to pregnant women. However, the FDA backtracked on its stance in 2011, when more extensive research deemed the heart risks negligible (between 0 and 1 percent) and the research from the early 2000s deeply flawed. As for the risk of PPHN, on the whole, research still does not support it.
FACT: Untreated depression can carry serious dangers. Depressed moms-to-be are more likely to skip prenatal checkups and to make unhealthy decisions about diet, smoking, and alcohol. As a result, their odds of delivering prematurely and having a low-weight baby are elevated. Newborns also seem to feel their mom’s blues: They’re often fussier, less active, and less responsive than babies born to moms who aren’t dealing with depression. But that doesn’t mean every expectant mother with depression needs drugs. Research shows that some forms of therapy and lifestyle changes can be effective too. If you were taking antidepressants when you became pregnant and your depression is mild or moderate, it may be possible to taper back on your dosage or stop medication. Ask your doctor for a referral to a mental-health professional who can help. But if you need antidepressants during pregnancy, that’s okay. “The bottom line is that women who are ill shouldn’t be afraid to take medicine that makes them feel better,” says Dr. Birndorf. “Being sick isn’t good for mother or child.”