Antidepressants and pregnancy

Even before Tom Cruise provided his unsolicited “medical advice” to Brooke Shields on her depression during her pregnancy, the antidepressant-pregnancy debate has been a heated one dominated by emotion and opinion rather than science. This week, in The New England Journal of Medicine, two large studies provided reassuring evidence that some of the most popular antidepressants, called SSRI’s, do not pose a significant increase in the risk of birth defects. Although they did find an increase in a couple of malformations in patients who took Paxil, these were rare. Finally, these risks are limited to those taking antidepressants during the first trimester of pregnancy.

Yet despite the good news, the New York Times peppered their report with words of caution, and neglected to provide any information on the risks of not treating depression. The latest evidence shows that the risk of untreated depression is clearly greater than the risk of several of these SSRIs. Here’s why:

When a pregnant woman is depressed, her stress hormones surge, increasing her risk of preterm labor and gestational diabetes. What’s more, several stress hormones cross the placenta where they can increase your child’s risk of developing depression and anxiety as well as learning disabilities and attention deficit hyperactivity disorder. These risks need to be weighed against the risk of treatment—and this point is chronically absent from the debate and most media reports.

The bottom line: I urge you to track mood changes during your pregnancy. Take preventive steps including getting regular daily exercise and prenatal yoga, and take an omega-3 fatty acid supplement (DHA) which has antidepressant effects (and is great for your baby’s brain). If depression is getting worse, talk to your healthcare provider about treatments like cognitive behavioral therapy and the use of these safe antidepressants. The NEJM studies support my own recommendation that Zoloft (sertraline) has the best safety profile—probably because it does not cross the placenta as easily as the others.