Treating Depression During Pregnancy

Pregnant women who suffer from depression face complicated decisions regarding treatment of their depression during pregnancy. As many reports have recently indicated, using antidepressants during pregnancy may affect fetal outcome. However, persistent maternal depressive symptoms also affect the developing fetus. Infants born to women with depression have increased irritability, impaired social skills and display less activity.

The American College of Obstetricians and Gynecologists (ACOG) and the American Psychiatric Association (APA) issued a joint statement in August, 2009 pertaining to this very issue. The report, "The Management of Depression During Pregnancy: A Report from the American Psychiatric Association and the american college of Obstetricians and Gynecologists" is intended to help doctors and patients weigh the risks and benefits of various depression treatment options during pregnancy.

Depression is the most common illness complicating pregnancy affecting 14 to 23 percent of pregnant women. It often remains unrecognized and untreated. Efforts have increased withing in the medical community in the recent past to screen women both during pregnancy and in the postpartum period for depression. However, the diagnosis can be very difficult because depressive symptoms mimic those associated with pregnancy, including fatigue, appetite changes, mood and ability to "think straight". Pregnant women with depression are more likely to have nausea, vomiting and pre-eclampsia. They are also more likely to smoke, use other drugs including alcohol during pregnancy.

Women thinking about getting pregnant

• For women on medication with mild or no symptoms for six months or longer, it may be appropriate to taper and discontinue medication before becoming pregnant.
• Medication discontinuation may not be appropriate in women with a history of severe, recurrent depression (or who have psychosis, bipolar disorder, other psychiatric illness requiring medication, or a history of suicide attempts).
• Women with suicidal or acute psychotic symptoms should be referred to a psychiatrist for aggressive treatment.

Pregnant women currently on medication for depression

• Psychiatrically stable women who prefer to stay on medication may be able to do so after consultation between their psychiatrist and ob-gyn to discuss risks and benefits.
• Women who would like to discontinue medication may attempt medication tapering and discontinuation if they are not experiencing symptoms, depending on their psychiatric history. Women with a history of recurrent depression are at a high risk of relapse if medication is discontinued.
• Women with recurrent depression or who have symptoms despite their medication may benefit from psychotherapy to replace or augment medication.
• Women with severe depression (with suicide attempts, functional incapacitation, or weight loss) should remain on medication. If a patient refuses medication, alternative treatment and monitoring should be in place, preferably before discontinuation.

Pregnant and not currently on medication for depression

• Psychotherapy may be beneficial in women who prefer to avoid antidepressant medication.
• For women who prefer taking medication, risks and benefits of treatment choices should be evaluated and discussed, including factors such as stage of gestation, symptoms, history of depression, and other conditions and circumstances (eg, a smoker, difficulty gaining weight).

All pregnant women

• Regardless of circumstances, a woman with suicidal or psychotic symptoms should immediately see a psychiatrist for treatment


Read complete ACOG News Release here.