Parentpedia

What Experts Say^*

Depression is twice as common in women as in men and it tends to increase during childbearing years. According to the National Review of Medicine, it was once thought that depression got better during pregnancy but it is now believed that pregnancy can actually make pre-existing depression worse.

The anxiety about how medication will affect the baby, pregnancy hormones and pregnancy symptoms, like fatigue and morning sickness, can all contribute to exacerbating depression. That said, every woman responds to pregnancy differently and, if you have a lot of support, you might find some symptoms of depression lessening.

Women with pre-existing depression are in something of a conundrum. While several antidepressants (including paroxetine and tricyclics) have been found in clinical studies to be harmful to the fetus, untreated depression has been linked to premature labor and low birth rate and, in extreme cases, maternal suicide. Some of the effects of antidepressant therapy (including (Fluoxetine, tricyclics, sertraline, venlafaxine) can be summarized as follows:

• Antidepressant therapy does not increase the occurrence of intrauterine fetal death;
• Physical malformation (major birth defects) do not result from antidepressant therapy;
• Appetite suppression from therapy may lead to poor weight gain by the mother resulting in decreased birth weight;

• For mild depression, psychotherapy is the treatment of choice.
• For moderate to severe depression with functional impairment, Fluoxetine (Prozac) or Sertraline (Zoloft) are the medications of choice. Medication doses may need to be increased during pregnancy. Psychotherapy should be performed with medical therapy.

Most health care providers believe that if going off antidepressants is going to put the mother at risk, the benefits of such drugs offset the potential harm to the fetus. This is a decision that you should make in consultation with your health care provider. Learn more about which antidepressants are safe during pregnancy.

In addition to medication, if you have pre-existing depression, you may find it helpful to:

• Find a counselor. Even if your depression is biological in nature, talk therapy can help to reduce anxiety about the pregnancy.
• Join a support group. Pregnancy is a time when even the healthiest women need support, and joining a group can help you meet other pregnant women and share your fears.