16 Things You Need to Know About Taking Antidepressants During Pregnancy

Most importantly, you don't have to stop taking them.

 

 Antidepressants can be critical for people who experience symptoms of depression or anxiety, like sadness, apathy, and irritability that just don’t go away. But taking these pills while you're pregnant — a time when your hormones can go rogue, and the pressure is on to feel happy — could affect your baby in some scary ways.

Here’s what every woman of baby-making age needs to know about taking antidepressants during pregnancy, according to existing data and Nancy Byatt, D.O., a physician and associate professor of psychiatry, obstetrics, and gynecology at the University of Massachusetts Medical School.

1. Pregnant or not, depression is very common, and so is taking drugs to treat it during pregnancy. 

About 1 in 7 adults experiences depression at some point in their lives, according to an American Council on Obstetricians and Gynecology (ACOG) report, while as many as 18 percent of pregnant women go through it. “It’s really important that a woman is well during pregnancy to optimize outcomes for her, her new baby, and any other kids she has,” Dr. Byatt says.

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While deciding whether to take antidepressants during pregnancy is a personal decision, and there is no definitive rule or best practice, ACOG estimates that about 13 percent of women do rely on medication to treat depression while they’re pregnant. 

2. Left untreated, maternal depression can have terrible consequences for unborn babies. 

For women who are expecting, pregnancy is tough enough without depression, which can mess with your sleep, drain any motivation to eat well and exercise, and increase your risk of experiencing nausea, vomiting, and high blood pressure, according to ACOG. But babies suffer from their mom's depression symptoms too: In vitro exposure to depression is linked to infant malformations, heart problems, preterm birth, and low birth weight. As babies, they can end up more irritable and less emotive, active, and attentive than babies born to mothers with better mental health, according to ACOG. The effects of in vitro exposure to depression may even trickle into early childhood, causing developmental abnormalities in the brain areas responsible for complex thought and behavior in preschool-aged children, according to a recent study published in Biological Psychiatry.

Experts don’t know exactly why depression affects babies, but Dr. Byatt’s best guess is that babies of depressed moms get different levels of certain brain chemicals than babies born to unaffected moms. That said, it’s still a major myth that going off antidepressants during pregnancy, which can lead to a depression relapse, is the absolute best thing for your baby. “Not getting treatment is not a risk-free decision,” Dr. Byatt says.

3. Antidepressant use during pregnancy could be bad news for babies. 

Research hints that babies exposed to antidepressants in the womb face a slightly higher risk of preterm birth, low birth weight, developmental delays, lower IQ, breathing difficulties, a circulatory system problem known as persistent pulmonary hypertension, malformations, and postnatal adaptation syndrome, a condition marked by a baby’s jitteriness and shortness of breath. These babies are roughly twice as likely to spend their first days of life in intensive care than babies of women who took no antidepressants during pregnancy, according to an observational study on nearly 750,000 births that was recently published in the medical journal, JAMA.

Experts suspect these symptoms have something to do with either toxicity or drug withdrawal. “There’s a lot of work to be done in understanding the details,” Dr. Byatt says — and no evidence that weaning pregnant woman off their meds toward the end of pregnancy, which would alleviate any issues that stem from withdrawal, reduces a baby’s likelihood of experiencing unique symptoms.

But because there aren’t any controlled experiments on pregnant women and antidepressants, which is the only way to prove a cause-and-effect relationship between a condition and an outcome, an even bigger unknown is whether the drugs are really to blame for adverse outcomes among babies in the first place.

“We do not have any data that really confirms or doesn’t confirm whether antidepressants actually cause any of these concerning outcomes that come up in scientific literature,” Dr. Byatt says, adding that existing data is “all over the place” — and that women who rely on antidepressants during pregnancy should find comfort in the data’s inconsistencies.
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4. The vast majority of babies exposed to antidepressants in vitro don’t end up with any problems in the long term. 

Stats that show a baby’s risk factors double with exposure to antidepressants sound really, really scary. But the absolute risk for any baby developing many of the conditions above is very small to start with, according to Dr. Byatt. Moreover, some of the symptoms linked to antidepressant exposure that can land a baby in intensive care — like those jitters or shortness of breath — can and often do resolve themselves within a few days to a couple of weeks and without long-term effects, she says.

5. Generally, the higher your antidepressant dosage, the greater the risk for your baby.

Because prescription drugs get into your blood stream and can cross your placenta to your baby, “you want to use the minimally effective dose without under-treating yourself,” Dr. Byatt says. 

6. The first trimester of pregnancy is the riskiest time to take antidepressants 

— particularly between your third and eight weeks, when all of your baby’s major organs begin to develop, including the heart, brain, and spinal cord, according to ACOG. However, women who develop depression during pregnancy and start taking antidepressants during the second and third trimesters are less likely to affect their babies, according to Dr. Byatt.

7. The effects of antidepressants aren’t cumulative. 

Regardless of how long you’ve been taking antidepressants, the only thing that matters is whether you continue to take them during your pregnancy and expose your baby. “I’d be most worried about someone who’s had to take antidepressants for 30 years if they got pregnant and stopped taking them,” Dr. Byatt says.

8. It’s a terrible idea to quit antidepressants cold turkey when you find out you’re pregnant. 

Because cutting yourself off abruptly can trigger flu-like withdrawal symptoms or a relapse, it's a bad idea to do that anytime. Try it while you're pregnant, and you could expose your baby to depression in addition to the medication they've already been exposed to, theoretically putting them in even more danger.

In the best-case scenario, women who want to wean themselves off medication should start before conceiving. But, in reality, nearly half of all pregnancies are unplanned. If you find yourself pregnant and wanting to get off your medication, it’s best to slowly reduce your dosage under the supervision of a doctor, who can help assess how low a dose you can tolerate. Before you even go there, though, consider what it felt like the last time you were depressed and whether you’re prepared to go through it again, Dr. Byatt suggests. 

9. Most of the information you read about the dangers of antidepressants involve just one type of medication. 

Because selective serotonin reuptake inhibitors (SSRIs), which include Zoloft, Prozac, Lexapro, Paxil, and others, are the oldest and most prescribed class of antidepressants, they are also, by default, the most studied. But they’re not the only treatment for depression and anxiety, nor is there proof that they’re the most dangerous for pregnant women. So while you might hear about the risks of SSRIs most often, there’s no saying whether newer drugs are more or less risky.
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10. The SSRI paroxetine is considered more dangerous than other antidepressants. 

Studies have found that babies exposed to paroxetine (aka Paxil, Pexeva, and Brisdelle) are roughly twice as likely to be born with cardiovascular or other malformations than babies exposed to other antidepressants or no drugs at all. But remember, that still amounts to low risk, with 2 percent or fewer babies affected.

11. Pregnancy is a terrible time to try a new antidepressant. 

Even if you find out you’re pregnant while taking paroxetine, switching medications while you’re pregnant is especially risky because you don’t know whether a new medication will work. Besides, when you expose a baby to multiple medications, the risks related to each go up, according to Dr. Byatt. 

12. Women who wean themselves off antidepressants before getting pregnant can have more difficulty conceiving, 

according to Dr. Byatt. That’s because there are strong ties between infertility, depression, and anxiety: Struggling to get pregnant can trigger terrible feelings, while feeling badly can put a damper on baby making.

13. It’s OK for your partner to take antidepressants while you’re trying to get pregnant. 

Most of the research on antidepressants and birth outcomes focuses on in vitro exposure from drugs taken by a baby’s mother. So unless you and your partner are struggling to get pregnant, there’s no reason for him to go off his meds, according to Dr. Byatt, who adds that it’s often easier for a couple to conceive when both partners are emotionally well. 

14. Some people can manage their depression with therapy, no medication needed. 

Talk therapy, which comes in many forms, is the first defense for mild depression, according to Dr. Byatt. Only when talk therapy doesn’t work or when your depression is so severe that you can’t get yourself to therapy should you even consider taking medication. Otherwise, therapy can begin to alleviate symptoms within the first session. “Just building a trusting relationship with a therapist can help a patient experience symptom relief relatively quickly,” Dr. Byatt says.

15. You shouldn’t feel guilty if you need to take antidepressants during pregnancy. 

Scores of women take mediation while they’re pregnant for illnesses besides depression because the benefits of their treatment outweigh the potential for harm. It’s no different with antidepressants. “I’m often more worried about the impact of depression on the mom and her baby than the effects of medication on the baby,” Dr. Byatt says. In other words, if you must expose your baby to either depression or medication, which each pose their own risks, Dr. Byatt would rather see her patients take the medication they need to feel good.

16. Breastfeeding is best regardless. 

While it’s true that some meds can get into your milk, breastfeeding has such great benefits for both you and your baby that taking antidepressants shouldn’t stop you from breastfeeding, according to Dr. Byatt. That said, Zoloft is less likely than other drugs to end up in breast milk, which makes it one of the safest. So it could be a smart option for any woman who starts taking antidepressants during pregnancy.

Collect By.. http://www.cosmopolitan.com/health-fitness/a8294114/antidepressants-during-pregnancy/