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Facing Depression During Pregnancy

An important tool in fighting depression during pregnancy, antidepressants can help an expectant mother -- without hurting her unborn baby.
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WebMD Feature

With pregnancy comes joy, excitement, baby showers, and the wonder of a new life. But for some, pregnancy is clouded by depression, a condition that puts not only the mother at risk, but the child as well.

For more than 10% of pregnant women, the coming birth of a child is mingled with ongoing feelings of sadness, hopelessness, and anxiety, as well as a decreased appetite and problems sleeping.

Fortunately, expectant mothers need not suffer from this condition: Depression is treatable during pregnancy, with psychotherapy and antidepressant medication.

"During pregnancy, doctors try to keep women off antidepressants unless they have severe depression or if they have a history of relapsing if taken off antidepressants in the past," says Victoria Hendrick, MD. "Instead, other interventions, like psychotherapy, are used to help reduce the need for an antidepressant.

Not Treating is Risky

But if the depression is so bad that a pregnant woman is not eating or gaining weight, for instance, then it needs to be treated as aggressively as possible."

For women at risk for depression during pregnancy -- those who have battled major depression in the past or who experienced depression during a previous pregnancy -- the news is good: The risk associated with the use of antidepressants during pregnancy is small.

But what should be considered when deciding whether or not to take an antidepressant, or to try other therapies first? And, what research is available to help put an expectant mom's mind at ease?

"For mild or moderate depression, I'd rather use psychotherapy or group therapy than antidepressants," says Hendrick, assistant professor in the department of psychiatry and bio-behavioral sciences at UCLA.

But for pregnant women with major depression, the risk of a relapse after stopping antidepressant medication is greater than the risks posed by treating it with medication.

"If health behaviors are not good because of the depression, that could have a negative impact," says Hendrick. "If a woman is not eating, not sleeping, feeling stressed or anxious -- these could have an adverse impact on a developing fetus. And obviously, suicidal feelings are another adverse risk associated with depression."

Untreated depression can interfere with a woman's ability to care for herself, impair nutrition, increase the use of tobacco, alcohol, and drugs, lead to premature labor and low birth-weight babies, and interfere with bonding feelings with an unborn child.

Untreated major depression during pregnancy may also cause infants to have an increased sensitivity to stress.

In cases of major depression, Hendrick explains to WebMD, women need both psychotherapy and antidepressant medication.

"The more multidisciplinary the treatment, the more likely they are to get better," says Hendrick. "Using both therapy and medication greatly increases a woman's chance of seeing an improvement in her symptoms."

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