The blues before the baby is born
Pregnancy is a time of hope and anticipation for most women, but for those who have suffered major depression, it can be a time of uneasy decision -- whether to continue on antidepressants and risk a growing baby’s exposure, or to leave off and risk a tumble into the abyss.
It is a decision made more anguishing by uncertainty. How will these drugs affect a growing fetus? How likely is a relapse of depression? And how does a newborn fare when his mom is depressed? A study published in the Feb. 1 issue of the Journal of the American Medical Assn. suggests some answers. The glow of pregnancy, researchers found, is no shield against depression -- but antidepressants provide notable protection for women who continue to take them.
“The presumption is that no medication is always optimal, and I think that may not always be correct,” says Dr. Vivien K. Burt, director of the Women’s Life Center at the UCLA Neuropsychiatric Institute and one of the study’s authors.
Researchers from Boston, Los Angeles and Atlanta tracked 201 women who had a history of depression through their pregnancies to gauge how many would suffer a bout of the disease and whether they had maintained or discontinued their antidepressant medication.
In all, 43% of the women they followed relapsed into depression during pregnancy, but the rate of relapse was much higher for women who discontinued their medication (68%) than for those who stayed on it (26%). Those who declined to take the medication and who fell ill with depression almost always did so within the first two trimesters, with half becoming depressed by the end of their first three months of gestation.
Researchers found that some women were slightly more immune than others to depression’s grip during pregnancy, whether or not they continued their medication. Of those tracked, married patients and women older than 32 were somewhat less likely to become depressed during pregnancy.
But women who had suffered with depression for more than five years, and those who had suffered more than four episodes of depression, were at significantly greater risk of suffering another bout while pregnant.
Dr. Nancy Green, medical director of the March of Dimes, said the JAMA study underscored the importance for women with chronic illnesses to anticipate and plan for managing their disease while pregnant and to stick with treatments through pregnancy.
Depression, no less than chronic conditions such as asthma or diabetes, needs to be treated, for the baby’s good as well as for the mother’s, she said. Women suffering depression take poorer care of themselves and are more likely to use drugs or alcohol, said Green, and the outcomes for their babies suffer when their condition is untreated.
In recent years, a few studies have begun to assess the risk to developing fetuses of exposure to antidepressants.
One 2002 study found no significant increase in deformities or developmental delays with the use of selective serotonin reuptake inhibitors, or SSRIs -- antidepressants marketed under the commercial names of Zoloft, Prozac and Celexa. But the use of SSRIs was associated with a slight increase in earlier births and, as a consequence, lower birth weights.
More recently, researchers have been studying whether in utero exposure to antidepressants can complicate an infant’s early days after birth. Those findings are expected soon.
In the JAMA article, authors observed from clinical experience that many women opt to discontinue their antidepressant medication during the first trimester -- a key period for the development of a fetus’ organs -- and then to resume it for the duration of pregnancy. Their findings, they noted, suggested that such a strategy helps in some but not all cases.
