Depression is common during pregnancy. Up to one-quarter of women experience depressive symptoms such as sadness, loss of interest, low motivation, crying spells, loss of appetite, poor concentration and suicidal thoughts. The risk of an episode is higher, 25- 50 percent, among women with a history of depression.
A question I get from many of my patients is whether or not to take psychotropic medications during pregnancy. This is a difficult choice to make for most parents-to-be. The answer is different for everyone and is based on one’s personal risk-benefit profile. No two brains work the same.
One must weigh the risks of untreated depression against risks caused by exposing the fetus to medication. There are many factors to consider when we review the risks of untreated depression.
Some questions to ask concern how often and how severe personal episodes of depression are. Does self-care become difficult, or do suicidal thoughts occur?
Untreated depression is known to hamper bonding between a child and its mother. This can lead to impairments in the baby’s social, emotional and cognitive functioning later in life. A recent study suggested that in mothers who feel very stressed during pregnancy, there is an increased exposure of the stress hormone cortisol to the fetus. Cortisol may have negative effects on a baby’s development.
Babies born to women with untreated depression are at risk of low birth weight, slow growth in utero and premature birth. Depressed women are more likely to have poor prenatal care and complications during pregnancy.
On the other hand, the risks of antidepressant medication are not well proven. Many of the risks previously attributed to such medications seem to be connected to depression itself in newer studies. There have been a few studies looking at cognitive, physical and behavioral development in children up to preschool age exposed to antidepressants in utero. Approximately one-quarter of newborns exposed to antidepressants in the third trimester are known to have transient but mild medication withdrawal symptoms.
For mild to moderate depression, psychotherapy with or without medication may be the treatment of choice. But for more severe depression, including suicidal thoughts or psychotic features, medication may be recommended. Electroconvulsive therapy is also considered safe during all trimesters but tends to be used more often for severe symptoms. Other options like bright light therapy and Repetitive Transcranial Magnetic Stimulation are not yet fully supported by research but do have some positive evidence.
Pregnant mothers should engage in activities that lower stress and improve coping irrespective of the severity of depression. Activities such as prenatal yoga, light exercise, a healthful diet, meditation and psychotherapy may help. Do what works for you to have a healthy and happy pregnancy. Pregnancy-related complications can further increase risk of depression during pregnancy, therefore these activities would help mitigate those risks as well.
I highly recommend seeking the advice of a professional who can help you weigh the risks and benefits, because the solution could be different for each individual, and many factors must be weighed.
Vidushi Savant is a psychiatrist with Savant Care, an integrative mental health practice in Los Altos. For more information, visit savantcare.com.