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Pregnant women suffering from depression

Depression Poses Dilemma for Pregnant Women

Pregnant women suffering from depression face a dilemma: take an antidepressant that might pose a risk to the fetus or battle through the depressive symptoms that could harm the baby in other ways?

To help women in this predicament decide on a course of action, experts from the American Psychiatric Association (APA) and the American College of Obstetricians and Gynecologists (ACOG) teamed up to review existing data and make recommendations for managing depression during pregnancy.

Unfortunately, existing data are limited, given that pregnant women are rarely recruited for clinical trials. There are no data, for example, from the kind of randomized controlled trials considered the gold standard of research. Rather, much of our current information comes from large European observational studies that cannot control for factors other than medication use that may be affecting the pregnancies.

As many as 25% of all pregnant women suffer from depression; about 12.5% use an antidepressant at some point during pregnancy, according to the latest statistics. Although many antidepressants appear to be safe, studies have reported a slight increased risk of some fetal defects. Drug withdrawal and persistent pulmonary hypertension—a condition that can impair blood flow to the lungs—are other potential newborn problems.

Recently, a Danish study in the British Medical Journal reported a link between pregnant women’s use of several antidepressants in the selective serotonin reuptake inhibitor (SSRI) class (e.g., Celexa, Zoloft) and an increased risk for a common heart defect in newborns.

A new study in The Archives of Pediatrics & Adolescent Medicine reports that newborns of mothers who use SSRIs were more likely to have low scores on the five-minute Apgar test—an overall measure of newborn health.
On the other hand, studies have linked untreated depression during pregnancy to premature births.

The current report from the APA and ACOG, published in the September-October issue of General Hospital Psychiatry, highlights that no general rules apply; i.e., all treatment decisions should be made case by case.

The report recommends that talk therapy be the first-line treatment for mild to moderate depression. For severe cases of depression, the risks of antidepressants and even electroshock therapy are relatively low. But, again, the overall take-home message from the report is that generalizations are not possible based on existing data; treatment choice remains an individual decision.

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