A Mother's Dilemma: Using Antidepressants During Pregnancy
May 17, 2001 -- For years, conventional wisdom held that those magic hormones of pregnancy protected women from psychiatric illness such as depression. More recently, as recognition of depression during pregnancy has increased, doctors continue to shy away from using antidepressants for fear of harming the fetus.
But psychiatrists at last week's annual meeting of the American Psychiatric Association (APA) in New Orleans say there is an emerging body of medical evidence to suggest that it may be at least as important to consider the possible ill effects -- for both mother and baby -- of not treating depressed pregnant women.
Zachary Stowe, MD, reports that infants of mothers with a history of depression demonstrated an increased sensitivity to stress as measured by levels of cortisol, a naturally occurring hormone produced by the body in response to stress.
In the study, 19 6-month-old infants of mothers with a history of major depression were compared with 11 infants of mothers with no such history. Saliva was collected from the infants to measure the levels of cortisol their bodies produced.
The result: Infants of mothers with depression appeared to have higher levels of cortisol in their saliva -- indicating a greater response to stress -- than the infants of mothers who were not depressed.
"You could pick out the babies whose mothers were depressed during pregnancy," on the basis of their cortisol levels, Stowe says.
While much remains to be learned about the effects of different antidepressant drugs in pregnancy, there has been an "evolution" in thinking about the safest way to treat pregnant women who are depressed, says Lee Cohen, MD, from the department of psychiatry at Massachusetts General Hospital in Boston.
"When many of us trained to be physicians we were told that pregnancy was protective against psychiatric illness," Cohen says. "But now we have better data and we know that women are not protected against mood disorders in pregnancy."
An estimated 10% of women will experience major or minor depression during pregnancy, and more will suffer postpartum depression. Yet many women refuse treatment with drugs for fear of harming their babies.
By far, Prozac has been the object of the greatest amount of research for its effects in pregnancy. And the evidence seems to suggest that use of the drug in the first trimester is not related to adverse birth outcomes.
"The data support the absence of major malformations following first trimester exposure to Prozac," Cohen says.
Similarly, first trimester use of older antidepressants, known as tricyclics, also appears to be relatively safe. "There are good data supporting that when we use the tricyclics in the first trimester, you don't see higher rates of major malformations in children who were exposed to those medications," Cohen says.