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Pregnant women with a history of anxiety or depression can face difficult and confusing choices about treating their symptoms with antidepressants and other medications.
Both anxiety disorders and depression are more likely to affect women than men, and women who are pregnant are not excluded. In fact, symptoms can develop or worsen during or after pregnancy, though in some cases women notice fewer symptoms while pregnant. Women can have an anxiety disorder and depression at the same time, too.
This is consistent with a 2009 ADAA online poll:
- 52% percent of women who have been pregnant reported increased anxiety or depression while pregnant.
- 32% reported a decrease in symptoms.
- 16% experienced no change.
The effectiveness and safety of treating these symptoms can also vary, and studies looking at these issues in pregnant women with mental health disorders are limited. Read on for an overview of what is known about treatment of anxiety and depression for pregnant women.
If you are pregnant or planning to start a family, it’s best to discuss these options and any concerns with your therapist, physician, and OB-GYN, who can work with you to develop or change your treatment plan. You may also consider a consultation with a psychiatrist who specializes in treating pregnant and postpartum women.
Safety of Medications
Any treatment plan has risks and benefits, and for pregnant women, the risks are of particular concern. Just as particular nutrients are passed to the fetus when food is eaten, so does some medication transfer from mother to unborn child.
A 2015 Centers for Disease Control (CDC) study found that some birth defects occur about two or three times more frequently in babies born to women who took the SSRI medications Paxil and Prozac early in pregnancy. Even with the increased risks for certain birth defects, the actual risk remains very low. And some similar drugs used to treat depression in pregnant women carry no such risks. Read the details here. (The CDC is working to improve the health of women and babies through Treating for Two: Safer Medication Use in Pregnancy.)
Studies have shown that antidepressant use is associated with preterm delivery, but a 2009 report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists advised that additional work is needed to determine whether taking antidepressants or other associated factors such as depressed mood, maternal obesity, or socioeconomic stress are more direct causes of preterm birth.
Use of selective serotonin reuptake inhibitors, or SSRIs, in the third trimester, however, has been associated with an increased risk for pulmonary hypertension in newborns, a rare disorder in which blood flow through the lungs is restricted But some studies indicate that this risk is still less than 1% if a mother uses SSRIs during the third trimester.
Taking SSRIs may pose an increased risk of birth defects. The FDA issues warnings to alert women of potential and new risks. It also strongly advises women to talk with their health care providers if they are undergoing treatment for depression to determine the most appropriate treatment option during pregnancy. Read the drug-safety announcement here.
One consequence of SSRI use during the third trimester of pregnancy, which has been confirmed in many studies, is a neonatal syndrome that may include irritability, poor feeding, sleep disturbance, and other symptoms. This syndrome usually lasts only a few days to a week.
Still, women should not assume it is safe to stop taking their anxiety or depression medication as soon as they find out they’re pregnant; doing so can lead to a relapse of symptoms, which may do greater harm to the child (and mother) than taking medication.
And more pregnant women are taking medication: The rate of antidepressant use at some point during pregnancy more than doubled between 1999 and 2003, to as many as 1 in 8.
Learn more about medication and treatment options, and always talk to your doctor about your concerns.
Recommendations
The American Psychiatric Association and the American College of Obstetricians and Gynecologists recommend the following:
- Women who plan to start a family and have mild depressive symptoms for six months or longer may be able to taper off medication. This may not be appropriate for women with a history of severe anxiety or depression, or who have bipolar disorder or a history of suicide attempts.
- Women who are pregnant, psychiatrically stable, and prefer to continue taking their medication may be able to do so after consulting with their therapist and OB-GYN.
- Women who are pregnant and have severe depression or anxiety should remain on medication, as they are at high risk for relapse.
In addition, women who are pregnant may benefit from therapy to replace or supplement medication. Therapy and other behavioral treatments can be effective in treating anxiety disorders and depression – before, during, and after pregnancy.
Remember to talk to your doctor before beginning or changing your treatment plan. An individualized approach to treating anxiety disorders and depression during pregnancy is usually best.
Updated July 2015
