Depression Management During Pregnancy

I’m sure you’re aware that women experiencing medical problems during pregnancy are commonly prescribed medication. But did you know that the most commonly prescribed medication during pregnancy in the US is an antidepressant (i.e., selective serotonin reuptake inhibitor [SSRI])? In fact, 8% of pregnant women in the US are on antidepressants.

But is anyone concerned about the effects of antidepressants on pregnant women and babies? Surprisingly, the US Food and Drug Administration (FDA) has not approved antidepressants for use during pregnancy. Why not? When you think about it, conducting a double-blind, placebo-controlled study among women who are pregnant and who have a diagnosis of depression would be considered unethical from a research perspective. As a result, we get all our data regarding the safety of antidepressants during pregnancy from large registry databases.

In 1979, the FDA developed a 5-letter classification system (i.e., A, B, C, D, X) for describing the safety of medications during pregnancy. But, unfortunately the FDA’s system has significant limitations and is seldomly updated despite the availability of new data. As a result, we have no reliable list of safe medications for use during pregnancy.

How, then, do you and your doctor decide what to do when you’re experiencing depression during pregnancy? The good news is that you have options!

The first option is weekly or biweekly psychotherapy which can be very helpful for pregnant women with mild depression or anxiety. When considering this route, it’s important for you to find a psychotherapist who has lots of experience with pregnant and breastfeeding women experiencing depression. I would recommend this approach if your depression is mild.
But If your depression during pregnancy or postpartum is more severe, you should talk with your obstetrician about medication management. You may ask your obstetrician to be referred to a psychiatrist who has lots of experience managing depression during pregnancy. We know that the “safest” medication for your depression during pregnancy is the one that works well for you at the lowest effective dose. This means that both the type and dose of medication should be personalized to you. And at each prenatal visit, your obstetrician should be conducting a risk-benefit analysis to decide whether starting or continuing an antidepressant is right for you.
Is there a risk of untreated depression during pregnancy? You bet! Studies show that untreated depression during pregnancy leads to a higher risk of early delivery and low birth weight. In addition, children born to mothers with untreated depression tend to have more behavioral problems and attachment concerns.

So don’t hesitate to talk with your obstetrician about any sadness or depression you experience during pregnancy. You have options!