Dealing With Depression During Pregnancy

If you are pregnant, or considering becoming pregnant, and have depression, you may be wondering how best to deal with your mood disorder in a way that is safe for your baby. Pregnancy and the post-partum period can exacerbate depression, but you may have heard that many medications are not recommended during pregnancy. Here's a look at the safety of antidepressant medications during pregnancy and some alternatives to them.

When Are Antidepressants Safe During Pregnancy?

There is really only one time that antidepressants are "safe" during pregnancy, and that's when the mother or the infant's life is at risk (or the lives of other family members). The propensity towards suicide or infanticide supersedes any risk that may be incurred by taking antidepressant medication. This is true for breastfeeding mothers as well during the post-partum period.

What's the Issue with Antidepressants and Pregnancy?

There are several things that can make taking antidepressants unsafe during pregnancy or nursing. Serotonin is a necessary component of fetal development, yet it is affected by the very nature of how most antidepressants work (by manipulating serotonin levels in the brain).

Antidepressants cross the placenta, which means if you take them while you are pregnant, elements of the medication make their way into the developing baby's bloodstream. This can affect the baby's serotonin access and also have other effects on fetal growth that have yet to be studied. A big problem with antidepressants is they haven't been studied enough in pregnant women.

Many antidepressants are also excreted in breast milk. That means if you are nursing and taking these medications, your baby is getting them through your milk.

What Are Your Choices?

While it may be necessary to stay on your antidepressant medication if you are at risk of suicide or harm to your family, there are alternatives for less severe mood disorders. New medications come to market nearly every year, and as all of these drugs are studied more, there may be a safer one that you can switch to.

You may also be able to lower the dose of your current antidepressant to minimize the risk to your child. If a commercial pharmacy can't provide a low enough dose for you, sometimes a compounding pharmacy that prepares custom-made medications can do it.

You may also be able to take your antidepressant only during the worst episodes and taper off completely when your mood improves, for example after the first few weeks of pregnancy. If depression symptoms return after giving birth, you could forgo nursing if you need to go back on your medication.

Some alternatives to medication that can still help with depression include

• counseling therapy
• exercise
• nutritional supplements
• changing diet
• light box therapy

You should never discontinue an antidepressant medication "cold turkey" but taper off according to your physician or pharmacist's instructions. Withdrawal symptoms from antidepressants can be quite severe. Discuss your personal situation with your gynecologist or obstetrician, one like North Florida Women's Care, as soon as you think you may be pregnant or even in advance of that, so as a team you can create a strategy that works best for you and your baby.

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