Q:I suffer from depression and I’ve been on medication for it for years. My husband and I would like to start a family soon and I’m not sure how to proceed. Should I go off the meds before I get pregnant? And then stay off them? Or should I continue with the medication?
A:Kwena answers: Women often face difficult treatment decisions for depression or any psychiatric disorders during pregnancy. Treatment during pregnancy involves a thoughtful weighing of the risks and benefits of proposed methods and the documented and theoretical risks associated with untreated psychiatric disorders such as depression. It is very important to discuss your treatment options with your psychiatrist and to get information on the risks of taking or not taking medication during pregnancy. There is increasing evidence of high rates of the illness re-surfacing after medication is discontinued and other data describes new-onset psychiatric illness during pregnancy. The value of psychiatric consultation during pregnancy and after delivery is intuitive. Mothers who stop treatment during pregnancy are at risk of poor pregnancy outcomes such as: • Preterm births. • Low birth weight (babies small for gestational age). • Poor nutrition. • Inability to care for self. • Substance use or abuse. • Termination of pregnancy. • Postpartum depression. Antidepressants have different effects on the infant, which makes it very important to discuss with the psychiatrist the choice with minimum effects. The risks on the infant in mothers who stop treatment, or who are not treated, for depression in pregnancy outweigh the risks of medication side effects on the infant. Most side effects of the antidepressants on the infant are treatable and manageable, especially with close monitoring by the doctors. Some of the documented medication side effects include the following, referred to as neonatal behavioural syndrome or poor neonatal adaptation. • Respiratory distress. • Low Apgar scores. • Feeding problems. • Jitters. • Altered muscle tone. • Agitation. • Irritability. • Increased crying. Other side effects include stillbirth or neonatal death and congenital abnormalities. However, these are very rare. Most of the side effects are explained by the rapid decrease of medication levels in the newborn (withdrawal symptoms). Antidepressant exposure in the third trimester increases the risk for neonatal behavioural syndrome three-fold. Pregnant mothers with depression need close monitoring by their psychiatrists and obstetricians to reduce poor pregnancy outcomes. Increases in blood volume in a pregnant woman may require medication dose adjustments. It is best to provide careful clinical monitoring of babies with antidepressant exposure or babies born to depressed mothers immediately at birth and continue with this in the first few months of life.
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