Antidepressants while pregnant? It depends...

There is no one-size-fits-all answer, Tuong-Vi Nguyen says.

The topic of antidepressants and pregnancy is often plagued with rampant misconceptions, inaccurate information and stigma.

I am a mental health professional concerned with the psychological changes surrounding reproductive periods, such as pregnancy and the postpartum period. As such, I have seen a great number of young women encounter significant difficulties in accessing reliable and accurate information when facing the dilemma of taking, or not taking, antidepressants during pregnancy or the postpartum period.

Very frequently, pregnant women are told to just stop their antidepressants right away, leading to withdrawal symptoms and increasing the risk of relapse into depression or anxiety. These difficulties are made that much harder by the fact there is, in fact, no “right” decision: Either the woman is exposing the baby to the effects of her depression and anxiety or to the effects of the treatment. Even though modes of treatment other than antidepressants (e.g. psychotherapy, light therapy) are available, they are not accessible or convenient for many women and, in others, do not produce enough improvement.

It is important to note that depression and anxiety, when untreated, carry significant risks to the unborn baby, including but not limited to preterm birth, miscarriage, low birth weight and disruption in cognitive development. Untreated depression and anxiety can also limit the capacity of the mother to take care of herself during the pregnancy and of her child once he/she is born. Further, depression and anxiety during pregnancy represent a strong risk factor for postpartum depression, which is itself associated with developmental delay and behavioural problems in children.

So the decision about whether to take antidepressants during pregnancy is a delicate one — one that must take into account the woman’s previous history of depression and anxiety, response to antidepressants, prior occurrence of relapse when not on antidepressants, prior response and access to psychotherapy, past obstetrical history and overall patient preferences in terms of treatment.

Not all women end up taking — or need to take — antidepressants during pregnancy. But for some, the safest treatment option may have to include the addition of psychiatric medications.

Of the 300 to 400 women I see every year, none would make this decision lightly. Of those who do have to take antidepressants during pregnancy, I have found that they all struggle with tremendous shame and guilt and, more often than not, resistance not only from their loved ones but also from other health professionals. I remain surprised that others would assume a pregnant woman would make such a decision without any forethought. The reality is that they agonize over it, and that we spend several hours, often, over the course of several visits and several months, discussing the pros and cons of such a decision.

One distressed young woman told me: “My co-worker told me she would never be as selfish as I am and would never take medications if she was pregnant.” She ended up discontinuing her medication, and shortly after, relapsed into a severe depression. As a result, she became unable to work and was shunned by her co-workers. As the saying goes: “Damned if you do and damned if you don’t.” This woman was going to be stigmatized either for taking her medications or for her mental illness, making the decision an impossible one for her and, by extension, all women in her position.

This regrettable incident demonstrates how the stigma associated with mental illness is still very much alive and well. In my opinion, being able to access information in order to make informed treatment decisions during pregnancy is something we owe to all women in our society.

As a reproductive psychiatrist, I believe that we can reach a balanced perspective about the pros and cons of treatment during pregnancy and the postpartum period, such that each woman’s choice about her own mind, her own body, and the wellbeing of her baby can be respected.