Deciding whether to continue or stop taking medication for depression during pregnancy is one of the most difficult decisions a mother can make. On the one hand, if left untreated, it can affect your mental health as well as that of your unborn baby. On the other hand, there is a fear that if you continue taking the medication, it could put your baby at risk. This is a really confusing issue. So let's talk about it openly.
What is the relationship between depression and pregnancy?
Many people used to think that hormonal changes during pregnancy protected women from depression. But that's not the truth. We now know that depression can occur during pregnancy, and that many mothers need antidepressants to manage it. In fact, surveys have found that the number of women using antidepressants increases from three months before conception and throughout pregnancy.
Although there are questions about the safety of using these medications during pregnancy, research shows that most antidepressants, especially SSRIs (Selective Serotonin Reuptake Inhibitors), are generally safe . Although there is a possibility of problems such as birth defects, the risk is very low .
What do medical experts say about this?
Your Ob-Gyn and Psychiatrist will both agree that if you have mild depression and you have been symptom-free for about 6 months, you can try to taper off your medication under medical supervision. Perhaps with just psychotherapy and some lifestyle changes , you can get through this time well.
However, if the following applies to you, taking medication during pregnancy may be more beneficial for both you and your baby.
| Status | Medical advice |
|---|---|
| If you have mild depression and have been symptom-free for more than 6 months. | You can consider stopping medication under the supervision of a doctor. Instead, things like psychotherapy, exercise, and yoga may help. |
| If you have had severe or recurring depression , other mental illnesses such as bipolar disorder, or have had suicidal thoughts. | It is safer for you and your baby to continue taking the medication. |
What are the risks of leaving depression untreated?
This is something we definitely need to pay attention to. Untreated depression can have serious consequences for both you and your baby.
- Less self-care : When you're depressed, you may forget to do things like eat and drink, and go to the clinic on time.
- Risky behaviors: There is a higher chance of smoking, drinking alcohol, or using other drugs. All of these can cause serious problems for the baby, such as miscarriage, premature birth, and low birth weight.
- Impact on family life: Imagine you have another child. If your mental state is not good, it may be difficult to take care of that child and even to be well with your husband. This pressure may be unbearable for the entire family. Therefore, it is very important for you to be well for the family as well.
Untreated depression is not just a silent affliction. It can directly affect you, your baby, and your entire family.
What are the risks to the baby from taking medication?
Of course, no medication is 100% safe during pregnancy. The results of studies on antidepressants are sometimes contradictory. However, most of the risks that have been found are very low.
| Risks and temporary symptoms that may occur to the baby due to medication | |
|---|---|
| Risks to the baby (very unlikely) | |
| PPHN (Persistent Pulmonary Hypertension in the Newborn) | A serious condition involving the blood vessels in the lungs of a newborn baby. |
| Birth Defects | Disorders of the heart, brain, spine (Anencephaly), skull (Craniosynostosis), abdomen (Omphalocele), or limbs. |
| Other risks | Miscarriage, premature birth (before 37 weeks), low birth weight (less than 2.5 kg). |
| Withdrawal Symptoms that the baby may experience after birth | |
| Restlessness | Difficulty breathing, frequent gasping, frequent crying. |
| Other features | Difficulty drinking milk, low blood sugar levels (Hypoglycemia), poor body tone. |
The important thing to understand here is that these withdrawal symptoms are temporary . Some babies may need to stay in the Neonatal ICU for a few days (one to four days) because of these. However, none of these have been found to cause long-term harm to the baby.
Let's understand these risks exactly.
It's reasonable to be afraid when talking about these risks. But we need to look at this in perspective. In any pregnancy, even without any medication, there is an average risk of a baby being born with any type of birth defect of about 3%.
The fact that antidepressants increase the risk is a very small percentage added to this 3%. For example, one study showed that these medications only increase the risk of PPHN by 1%. This means that even if you take the medication, the overall risk of the baby having a problem is still very low .
What medications are best for pregnancy?
Some antidepressants are considered safer during pregnancy than others. Here are some examples:
- Citalopram (Celexa)
- Fluoxetine (Prozac, Sarafem)
- Sertraline (Zoloft)
- Amitriptyline (Elavil)
- Desipramine (Norpramin)
- Nortriptyline (Pamelor)
- Bupropion (Wellbutrin)
But don't worry if you're taking a medication that's not on this list. Even the most talked-about medications, like Paroxetine (Paxil), have very low risks. There are also concerns about suddenly switching medications during pregnancy. It's best to talk to your doctor to decide what's best for you.
Take-Home Message
- Taking or stopping medication for depression during pregnancy is a very personal decision that you and your doctor should weigh up the pros and cons together.
- Never stop taking your medication, change the dosage, or start a new one without medical advice.
- In many cases, the risks to mother and baby from untreated depression far outweigh the very small risks from medication.
- Don't feel guilty about the decision you make. Your doctor wants the best for you and your baby. So trust the decision you and your doctor made together, and spend this time happily.
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