Seleni: Depression, Antidepressants, and Pregnancy

Making the best choice for you and your baby

by Sarah Gonser

When Jennifer B. became pregnant with her first child, she faced a difficult decision. The 45-year-old physical therapist had been taking antidepressants for five years to treat depression. She was concerned that taking medication during pregnancy could harm her developing baby, but she had also seen what can happen if you stop.

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Common forms of therapy for pregnant and postpartum women include cognitive behavioral therapy, interpersonal therapy, and supportive or psychodynamic psychotherapy.

But if the mood disorder is intense enough to affect a woman's basic ability to function, her quality of life, and her feelings about her developing baby, it is a sign that she may have a more serious depression or anxiety disorder that might be better managed with a combination of medications and therapy according to Stephanie Ho, MD, a reproductive psychiatrist in private practice in New York City and a clinical assistant professor of psychiatry at NYU Langone Medical Center.

Parents Magazine: Is it okay to take antidepressants during my first trimester?

Q: Is it okay to take antidepressants during my first trimester?

A: It's important to weigh the risks and benefits with your doctor. Although the baby's organs are developing during the first trimester, "at this point, the data on SSRIs, TCAs, and serotonin and norepinephrine reuptake inhibitors (SNRIs) do not suggest a clear increase in risk of birth defects," says Stephanie Ho, M.D., a reproductive psychiatrist in private practice in New York City. Two small studies have suggested that antidepressants may slightly increase the risk of miscarriage, but the studies were not able to rule out whether the underlying depression played a role. "Untreated depression has been associated with early pregnancy loss," she adds.

Momtastic: Pregnant Moms: Do you have Pregorexia?

What is pregorexia?

“Pregorexia is a media-generated term for a pregnant woman who takes strict measures to control pregnancy-related weight gain, generally by exercising or restricting calories,” says Stephanie Ho, MD, a reproductive psychiatrist in private practice in New York City. Although women with pregorexia have aneroxia-like symptoms, it’s unlikely that a woman with true anorexia would be able to become pregnant, Dr. Ho explains; a woman with pregorexia is very controlling about her weight gain, but not to the degree of someone with a clinical eating disorder.

What are the symptoms of pregorexia?

According to Dr. Ho, a woman with pregorexia may have one or more of the following symptoms:

• Act as if the pregnancy is not real
• Exercise excessively
• Be very focused on her calorie intake

Who is at risk for developing pregorexia?

Since people with pregorexia demonstrate behaviors that closely resemble anorexia, it’s possible that the same risk factors apply, says Dr. Ho. Those include:

• A history of eating disorders
• Poor social support
• Strong social pressure to be thin

Parents Magazine: Is it safe to take antidepressants during pregnancy?

Q: Is it safe to take antidepressants during pregnancy?

A: .....    Less safety data exists with the newer antidepressants, including bupropion (Wellbutrin),  venlafaxine(Effexor), and mirtazipine (remeron), but, so far, they have not been found to increase the risk of birth defects, she adds. In 2005, the FDA issued a warning on the SSRI paroxetine (Paxil), saying that it may increase the risk for cardiovascular defects in a fetus. That decision "was based on three unpublished studies," says Stephanie Ho, M.D., a reproductive psychiatrist in private practice in New York City. The largest study explored paroxetine exposure in the first trimester, and, according to Dr. Ho, the results suggested that there was no increased risk of heart defects in children exposed to paroxetine in the first trimester compared with children whose mothers did not use paroxetine. If a woman does well on Paxil, and has failed trials with other antidepressants, Dr. Ho says that she will advise that Paxil can be used in pregnancy and the postpartum period safety.  A class of medications called benzodiazepines, used to treat anxiety during pregnancy, which include clonazepam (Klonopin), lorazepam (Ativan), alprazolam (Xanax), and diazepam (Valium), has been shown in some older studies to slightly increase the risk for cleft lip and palate, although subsequent studies have not confirmed that finding.  "[If a woman is] under the care of a physician or reproductive psychiatrist, this class of medication can safely be used during pregnancy, if clinically warranted," Dr. Ho says.