Synopsis

There are no safe medications to take while you are pregnant. That would be the safest position to take while you are pregnant. However, woman are not immune to illness just because they are pregnant and obstetricians and patients need all the help they can get considering how to care for themselves safely during this all important time.

Full text

Traditionally, the pregnant woman has been depicted as glowing and happy, immune to the stresses of daily life and full of humor about her growing belly. However, this view doesn't take into consideration the 20% of women who experience depressive symptoms during pregnancy, or the 10% of pregnant women who develop major depression. [1] Dr. Steven Goldstein, an obstetrician/gynecologist at the New York University of Medicine recites the guiding philosophy amongst physicians who treat pregnant women: "Baby only does as well as mother." The simplicity of that statement is misleading. When women who are pregnant or hope to become pregnant have concerns about managing depression the decision can be complex, and physicians must rely on a customized analysis of risk versus benefits for the woman and her child.

According to the Expert Consensus Guidelines for Treating Major Depression During Pregnancy and Conception [1], the decision to use antidepressant medication during pregnancy should be based on balancing the possible risks of taking medication against the severity of depression. If a woman has had only one previous episode of depression and has felt well for six months, she should taper off antidepressant medication before trying to conceive. On the other hand, if a woman has several episodes of major depression behind her, she should stay on medication until she conceives. After conception, she can decide with her physician whether to continue taking medication throughout her pregnancy, or to stop temporarily and resume later in the pregnancy or during the postpartum period. In both cases, experts recommend psychotherapy. In fact, the expert panel concluded that although therapy may take two months to show its full effects, the benefits may be long-lasting. [1]

Sadness and pregnancy don't mix well, and depression during pregnancy must be addressed. First, the depressed woman should see a specialist who can evaluate the severity of her depression, and next she should find a therapeutic forum to deal with her unique concerns. Untreated depression is bad not only for mothers, but for babies as well. Depressed mothers are more likely to smoke, drink alcohol and eat poorly during pregnancy, which is one reason that their babies have more perinatal problems. [1] But even in the absence of other health risks, maternal depression is correlated with a less auspicious start in life for a baby. In a study of 90 upper-middle class women, 7.7% had low birth-weight babies (<5.5 pounds) and 13.2% delivered preterm (<37 weeks). The researchers found that women who scored highest for life-event stress (i.e., depression, stress, and strain) had an increased chance of poor birth outcomes. In fact, on a 14.7-point scale measuring life-event stress, each unit increase in a woman's score increased the likelihood by 132% that her baby would weigh less than 5.5 pounds. [2] In a separate study of 623 women, researchers found a significant link between depression and high-blood pressure, which can lead to death and disability for both mother and fetus. [3] Furthermore, a study of 389 women from working class backgrounds showed that depression during the first trimester increases the incidence of low birth-weight babies and pre-term delivery. [4]

In situations where depression threatens the overall health of the mother and baby, physicians consider prescribing antidepressants. Currently, selective serotonin reuptake inhibitors (SSRIs) are used to treat pregnant women. Available clinical data show that women who take SSRIs during pregnancy have children with a rate of birth defects comparable to that of the general population, which is 2 to 3%.The most commonly used antidepressant in pregnant women is fluoxetine (Prozac), which has been around since 1987 and has safety data than the other drugs used in pregnant women, which include sertraline (Zoloft), paroxetine (Paxil), and citlopram (Celexa).1 Physicians use an FDA system, which rates drugs based on their known risk to a fetus. According to this system, category A drugs carry no risk and category B drugs are not associated with any risk to date. However, with category C drugs, risk cannot be ruled out. Category D drugs have positive evidence of risk and category X drugs are contraindicated in pregnancy. Most SSRIs are categorized as category C, however pregnant patients are discouraged from taking these drugs unless necessary and then only under the care of a qualified physician. Most SSRI data are focused on birth defects, however, a few studies have looked at the effect of SSRI exposure on behavior and emotional development in children up to age seven, and found that there was no significant difference between these children and unexposed children. [5] Yet, despite these data, caution is suggested.

Many women understand the power of the mind-body connection most acutely during pregnancy. In fact, the early symptoms of pregnancy usually alert a woman that she may be carrying a fetus. According to Dr. Goldstein, you don't have to worry if you took a drug the week you conceived, because the fetal organs start to develop five to 10 weeks from the date of the last menstrual period. Generally, pregnant women should be most cautious during the first trimester, and if they are challenged by depression---therapy and, in more extreme situations, doctor-administered medication are options to help them stay balanced for themselves and their babies.

Truthfully, drugs during pregnancy can be deadly: 7% of the drugs listed in the Physician's Drug Reference are classified as category X. In the realm of psychotropic drugs, certain agents are off limits for pregnant women. Mood stabilizers, such as lithium and valproic acid are associated with an increased risk of birth defects. [6] Furthermore, monoamine oxidase inhibitors (MAOIs) are not recommended, because they frequently cause an increase in blood pressure, and St. John's Wort, which is an herbal agent touted for its antidepressant properties, is not recommended, because it is unregulated and there are not enough safety data. [7] For more information about drug safety, rxlist.com provides pregnancy-safety profiles of prescription drugs.