Pregnancy can be a time of joy and anticipation, but if you're dealing with depression, it can also be filled with worry. For those taking antidepressants, it’s natural to wonder about how these medications might affect your baby. Balancing these aspects is not easy, and finding the right approach can feel overwhelming. We spoke to our Dr Tejal Kanwar, Gynaecologist and Consultant, Ujaas (a menstrual health and hygiene management social enterprise), who explained the effects of taking antidepressants during pregnancy and how to keep maternal and foetal health in check.
What Happens If You Take Antidepressants During Pregnancy?
Taking antidepressants during pregnancy involves weighing potential risks and benefits.
"Risks may include birth defects, preterm birth, and neonatal withdrawal symptoms. Some studies suggest a slight increase in autism risk. However, untreated depression during pregnancy can also pose risks, including poor prenatal care and postpartum depression," said Dr Kanwar.
Benefits of antidepressants include improved maternal mental health, better self-care, and reduced risk of pregnancy complications associated with depression.
The decision should be made individually, considering the severity of depression, previous response to medication, and specific risks. Some antidepressants, like Selective Serotonin Reuptake Inhibitors (SSRIs), are considered safer than others. Close monitoring by healthcare providers is essential to manage risks and adjust treatment as needed.
According to the Journal of Obstetrics and Gynaecology Canada (JOGC), major depressive disorder ranks as the second leading cause of disease burden among women, affecting up to 20% of those of reproductive age. During pregnancy, depression is quite common, with a prevalence of 12.8% in the second trimester and 12.0% in the third trimester. As a result, many women may require antidepressant medication.
Also Read: Fear Vs. Facts: The Truth About Antidepressants And Mistakes To Avoid
Risks of Antidepressants During Different Trimesters
The risk associated with antidepressant use can vary across trimesters. “The first trimester is generally considered the most critical period for potential birth defects, as major organ development occurs around this time. Some studies suggest a slightly increased risk of certain heart defects with SSRI use during early pregnancy,” said Dr Kanwar.
The second trimester is often viewed as having lower risk, but this doesn't mean it's risk-free.
In the third trimester, there is a concern about neonatal adaptation syndrome, where newborns may experience temporary withdrawal-like symptoms. However, the risks must be balanced against the potential harm of untreated depression throughout pregnancy. The final decision should be made in consultation with healthcare providers.
Birth Defects Linked with Antidepressant use During Pregnancy
The most common birth defects associated with antidepressant use during pregnancy, particularly SSRIs, include:
- Heart defects (especially septal defects)
- Persistent pulmonary hypertension of the newborn (PPHN)
- Neural tube defects (Cleft lip or palate)
“However, the absolute risk increase is generally small. For example, the risk of heart defects might increase from about 1% to 1.5-2%. PPHN risk may increase from 1-2 per 1000 to 3-6 per 1000. These risks should be weighed against the potential risks of untreated depression,” added Dr Kanwar.
Also Read: Mental Health Matters: Expert Answers FAQs About Antidepressants
Long-Term Developmental Effects of Antidepressants During Pregnancy
“Research on long-term developmental effects of prenatal antidepressant exposure is ongoing and results are mixed. Some studies suggest a slightly increased risk of autism spectrum disorders and Attention Deficit Hyperactivity Disorder (ADHD), but the absolute risk remains low. Other research indicates potential impacts on language development and behaviour,” highlighted Dr Kanwar.
However, it's crucial to note that untreated maternal depression itself can also negatively affect child development. Separating the effects of medication from those of underlying depression is challenging. Many studies haven't found significant long-term impacts on cognitive function or overall development. The decision to use antidepressants during pregnancy should balance potential risks with the need to treat maternal depression effectively.
Minimising Risks and Exploring Alternative Treatments
If a pregnant woman is already taking antidepressants, several steps can be taken to minimise potential risks:
- Consult with healthcare providers: Work closely with a psychiatrist and obstetrician to monitor medication and pregnancy.
- Adjust dosage: The lowest effective dose should be used.
- Consider switching medications: Some antidepressants are considered safer during pregnancy than others.
- Regular monitoring: Frequent check-ups and ultrasounds can help detect any potential issues early.
- Avoid abrupt discontinuation: Stopping medication suddenly can lead to withdrawal and relapse.
Alternative treatments that might be considered safer include:
- Psychotherapy: Cognitive-Behavioural Therapy (CBT) or interpersonal therapy can be effective without medication risks.
- Exercise: Regular physical activity can help manage mild to moderate depression.
- Mindfulness and meditation: These practices can help reduce stress and improve mood.
- Omega-3 fatty acid supplements: Some studies suggest they may help with depression during pregnancy.
- Acupuncture: Some women find this helpful for managing mood.
- Support groups: Connecting with others in similar situations can provide emotional support.
It's important to note that these alternatives may not be sufficient for severe depression, and the risks of untreated depression should always be considered. Any treatment decision should be made in consultation with healthcare providers
Monitoring Pregnant Women on Antidepressants
Follow these expert-recommended tips to monitor a pregnant woman taking antidepressants:
- Schedule regular prenatal check-ups
- Conduct frequent ultrasounds to assess foetal development
- Monitor maternal mental health through regular psychiatric evaluations
- Perform blood tests to check medication levels and overall health
- Screen for potential pregnancy complications
- Educate the mother about warning signs to report
- Plan for specialised neonatal care after birth
- Consider foetal echocardiograms if there is a concern about heart defects
- Adjust medication dosage as needed throughout pregnancy
- Always involve both psychiatric and obstetric care providers in monitoring
[Disclaimer: This article contains information provided by an expert and is for informational purposes only. Hence, we advise you to consult your own professional if you are dealing with any health issues to avoid complications.]