Study examines antidepressant therapies for pregnant women

May 11 2006

The glossy images of pregnancy often show a woman radiant with happiness. "There is a belief that pregnancy is a state of bliss," said Rachel Manber, PhD. "That's not necessarily the case."

Indeed, reports show that one in five pregnant women suffer moderate to severe depression during pregnancy, and many mothers-to-be find themselves feeling anxious, dejected and listless.

Manber, an associate professor of psychiatry and behavioral sciences at Stanford University School of Medicine, and her research colleagues are aiming to combat the problem. They have begun work on a study examining alternatives to antidepressants for pregnant women suffering from depression. During this study - a first of its kind - 180 women will be randomized to receive either acupuncture or massage therapy to assess these alternative therapies' effectiveness in treating depression.

Previous findings have shown that the prevalence of depression during pregnancy is just as high as - and perhaps even higher than - the prevalence of postpartum depression. Although no one can say for certain why depression strikes women during what is supposed to be a happy time in their lives, Manber's study collaborator, Deirdre Lyell, MD, said that some of it could be attributable to the pending responsibility of motherhood.

"You're thrust into a pretty challenging and difficult role, and sometimes the anticipation of that can put you over the edge," said Lyell, an assistant professor of obstetrics and gynecology at Stanford. "Pregnancy just by its nature can bring out some underlying psychiatric and emotional issues."

Some researchers have theorized that pregnancy provides protection against emotional or psychiatric problems, but recent studies have chipped away at that idea. Earlier this year, a study in the Journal of the American Medical Association showed that the rates of relapse for pregnant women with major depression who stopped their medication were similar to those of other depressed women who stopped taking medication. Pregnancy, in other words, didn't prevent depression.

While antidepressants are commonly prescribed to people suffering from depression, there's no definitive evidence on whether the medications are safe for pregnant women and fetuses. It is not feasible for ethical reasons to conduct randomized studies on the impact of antidepressants on pregnant women and their fetuses, so available research on the issue is based on comparisons of women who did take antidepressants during pregnancy with those who did not.

Manber said the general recommendation for pregnant women is to weigh the risks of depression with the benefits of treatment. "In some cases, taking antidepressants might be necessary," she said.

Yet most women are hesitant to take medications. According to early data from participants enrolled in the Stanford study, 33 percent reported that they stopped taking antidepressant medications either when they became pregnant or when they began trying to conceive.

Both Manber and Lyell said it's critical to offer alternatives for depressed women who forego medication, and they launched their study to identify safe therapies. Previous research, while preliminary, suggests that acupuncture may be beneficial in treating depression during pregnancy. And there's much anecdotal information about the positive effects of massage for people who suffer from depression.

The study is being funded by the U.S. Agency for Health Care and Prevention. Participants will receive at least eight weeks of treatment and will be monitored on a monthly basis for up to nine months postpartum. They will continue to receive treatment until 10 weeks after delivery.

To be eligible, volunteers must be experiencing depression, medically stable and between 12 and 28 weeks of pregnancy. They cannot receive any concurrent treatment for depression while in the study. Interested women should call (650) 723-5886 for additional information.