Dr Abida Sajjad, Psychiatrist
One of the hardest decisions women make during pregnancy is to stop or continue using their antidepressants. It is hard to stop them because untreated depression can have harmful effects on both the mother and the baby. But, taking antidepressants while pregnant may increase the risk of problems for the baby.
Bonari et al report that untreated depression during pregnancy appears to carry substantial perinatal risks. These may be direct risks to the fetus and infant or risks secondary to unhealthy maternal behaviours arising from the depression. Recent human data suggest that untreated postpartum depression, not treated with antidepressants in pregnancy, results in adverse perinatal outcome
Pregnancy has historically been described as a time of emotional well-being, providing "protection" against psychiatric disorder; however, studies have shown that Pregnancy is not "protective" with respect to the risk of relapse of major depression. Women with histories of depression who are euthymic in the context of ongoing antidepressant therapy should be aware of the association of depressive relapse during pregnancy with antidepressant discontinuation(Journal of the American Medical Association)
Recommendations for treatment:
NICE recommends that clinicians should consider following for treatment of depression in a pregnant woman:
Side effects of antidepressants during pregnancy:
Antidepressants do pass through the placenta to the baby, and some studies have suggested that they may be responsible for a small increase in the risk of congenital heart problems. Other studies have not shown this to be the case. It is not known if they increase rates of miscarriage, preterm birth or low birth weight due to conflicting study results.
Around one in every three babies born to mothers on antidepressants, will have mild symptoms of withdrawal which can include jitteriness, poor feeding, agitation and fast breathing. These symptoms usually disappear without the need for any treatment, within the first two weeks of life. There is also a slightly increased risk to these babies of a condition known as Persistent Pulmonary Hypertension of the Newborn (PPHN). PPHN is a very rare but potentially very serious problem causing breathing difficulties in the newborn. The rate of PPHN in mothers who are not being treated with antidepressants is about 1 per 1000, and this increases to about 3 per 1000 in women who take antidepressants. In order to exclude PPHN and to monitor any withdrawal symptoms, we recommend that babies born to mothers who have been taking antidepressants from 28 weeks onwards are observed with their mothers on the postnatal ward for a minimum of 24 hours following delivery.
Bonari, L., Pinto, N., Ahn, E. et al. (2004) Perinatal risks of untreated depression during pregnancy.Canadian Journal of Psychiatry49(11), 726-735
Cohen, L.S., Altshuler, L.L., Harlow, B.L. et al. (2006) Journal of the American Medical Association295(5), 499-507
Jong GW, Einarson T, Koren G, Einasron A. Antidepressant use in pregnancy and persistent pulmonary hypertension of the newborn: A systematic review. Reproductive toxicol 2012; 34 (3) 293-297
Levinson-Castiel R, Merlob P. Neonatal abstinence syndrome after in utero exposure to selective serotonin reuptake inhibitors in term infants. Arch Pediatr Adolesc Med 2006; 160:173-176
Nice guidelines, Antenatal and postnatal mental health: clinical management and service guidance (CG192, updated June 2015)
Cite this article as:
Abida Sajjad(2017) Use of antidepressants in pregnancy.The Beautiful Space-A journal of Mind, Art and Poetry. February 2017: TBSB111
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