Antidepressants should not be avoided in treatment of pregnant women with severe depression

Jul 7 2004

Antidepressants to treat from moderate to severe depression in pregnant women not only are relatively safe but necessary in many cases for the well-being of the mother and the baby, according to Dr. Nicole Cirino, director of the Women’s Mental Health Program at Loyola University Health System, who specializes in the diagnosis and treatment of depression in pregnant women, postpartum depression, postpartum blues and premenstrual disorders.

Doctors may be afraid to treat women who suffer from depression or who are breastfeeding with antidepressants because of the future development of the baby. However, no study has shown an increased risk of congenital malformations or serious side effects. “We have as much research on the safety of antidepressants in pregnant women than any other class of drugs in the world,” Cirino, who also serves as assistant professor in the Department of Psychiatry and Behavioral Medicine, said. Sertraline, known as Zoloft, fluoxetine, marketed as Prozac and paroxetine, also known as Paxil, are the leading antidepressants prescribed for pregnant women because of the significant number of reports that support their safety and efficacy.

Between 12 to 20 percent of pregnant women are depressed, yet the diagnosis may go undetected, according to Cirino. About 12 percent of women in the general population suffer a depressive disorder each year.

“It is extremely important to recognize the symptoms and know how to treat depression in this group of women, so that both mother and baby are safe.” Cirino said.

Research has shown that untreated depression during pregnancy and postpartum can result in negative effects in the fetus and in children, including low birth weight, low head circumference, and later difficulty socializing and a lower IQ. Antidepressants, psychotherapy and cognitive behavior therapy are the best standard of treatment for some of these patients.

Women should typically feel their symptoms improve between three and five weeks. Symptoms of depression in pregnant women include a persistent depressed or irritable mood that can last up to two weeks, difficulty sleeping and concentrating, lack of appetite, suicidal thoughts, low energy and obsessive guiltiness. Patients need to have five out of the nine symptoms to be diagnosed.

In addition, being depressed during pregnancy is a strong risk factor of postpartum depression. Postpartum depression and postpartum blues also are conditions that have been underrecognized, Cirino adds. There is a high prevalence of postpartum depression among women, with 10 to 15 percent of women having the condition and as many as 25 percent of adolescents reporting the symptoms. In fact, studies have shown that the United States has a higher incidence of postpartum depression than any other country in the world. A shorter maternity leave, the need to return to work to help with the income and a fragile support system, with other family members living in other states, are credited for the high incidence, according to Cirino.

Women with postpartum depression experience two weeks of a persistently depressed mood, guilty feelings, high levels of anxiety and lack of appetite. Risk factors for these conditions include being a single mother, an unwanted pregnancy, a history of depression and anxiety, as well as having a child with special needs.

Postpartum blues occurs during the first seven days of delivering the baby. It is characterized by excessive crying, being emotional and feeling isolated. As many as 80 percent of women experience postpartum blues.

The Women’s Mental Health Program at Loyola in conjunction with the Obstetrics and Gynecologic Department is planning to screen all postpartum women through a questionnaire. In addition, Loyola’s program provides pregnant women with information about depression and postpartum depression and blues, as well as a referral hotline. The Women’s Mental Health Program is offering postpartum depression classes to educate participants and their partners about the symptoms and treatments available for the condition.