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©2006-2012
Deborah Wiig
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Pregnant women with a history of anxiety or depression can face difficult and confusing choices about treating their symptoms with antidepressants and other medications.

Both anxiety disorders and depression are more likely to affect women than men, and women who are pregnant are not excluded. In fact, symptoms can develop or worsen during or after pregnancy, though in some cases women notice fewer symptoms while pregnant. Women can have an anxiety disorder and depression at the same time, too.

If you are pregnant or planning to start a family, it’s best to discuss treatment options with your therapist, physician, and OB-GYN, who can work with you to develop or change your treatment plan.

Safety of medications
Any treatment plan has risks and benefits, and for pregnant women, the risks are of particular concern. Just as particular nutrients are passed to the fetus when food is eaten, so does some medication transfer from mother to unborn child.

Studies have shown that antidepressant use is associated with preterm delivery, but a 2009 report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists advised that additional work is needed to determine whether taking antidepressants or other associated factors such as depressed mood, maternal obesity, or socioeconomic stress are more direct causes of preterm birth.

Antidepressants are also prescribed to treat anxiety disorders such as generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, posttraumatic stress disorder, social anxiety disorder, and phobias.

Use of selective serotonin reuptake inhibitors, or SSRIs, in the third trimester, however, has been associated with an increased risk for pulmonary hypertension in newborns, a rare disorder in which blood flow through the lungs is restricted  But some studies indicate that this risk is still less than 1%.

Taking SSRIs may pose an increased risk of birth defects. The FDA regularly issues warnings to alert women of potential and new risks.

One consequence of SSRI use during the third trimester of pregnancy, which has been confirmed in many studies, is a neonatal syndrome that may include irritability, poor feeding, sleep disturbance, and other symptoms. This syndrome usually lasts only a few days to a week.

Still, women should not assume it is safe to stop taking their anxiety or depression medication as soon as they find out they’re pregnant; doing so can lead to a relapse of symptoms, which may do greater harm to the child (and mother) than taking medication.

Recommendations
The American Psychiatric Association and the American College of Obstetricians and Gynecologists recommend the following:

• Women who plan to start a family and have mild depressive symptoms for 6 months or longer may be able to taper off medication. This may not be appropriate for women with a history of severe anxiety or depression, or who have bipolar disorder or a history of suicide attempts.
• Women who are pregnant, psychiatrically stable, and prefer to continue taking their medication may be able to do so after consulting with their therapist and OB-GYN.
• Women who are pregnant and have severe depression or anxiety should remain on medication, as they are at high risk for relapse.

In addition, women who are pregnant may benefit from therapy to replace or supplement medication. Therapy and other behavioral treatments can be effective in treating anxiety disorders and depression – before, during, and after pregnancy.

Always, talk to your doctor before beginning or changing your treatment plan. An individualized approach to treating anxiety disorders and depression during pregnancy is usually best.

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Resources
Massachusetts General Hospital Center for Women’s Mental Health
Depression During and After Pregnancy (PDF) – U.S. Department of Health and Human Services
Depression During Pregnancy – March of Dimes

Excerpted with permission by the Anxiety Disorders Association of America 

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Page updated October 1, 2009