Our Two Cents — Thoughts on a Recent Study about Antidepressants During Pregnancy

This story appeared in the New York Times Well blog the other day: Antidepressants Not Linked to Stillbirths.

Countless women heaved a sigh of relief. It explained that research published in The Journal of the American Medical Association studied 1.6 million births, including 29,228 mothers who’d taken antidepressants during pregnancy. They found the neonatal death rate (babies dying under one month of life) was no different among these mothers and babies than in the general population.

What it doesn’t answer, however, is the impact antidepressants have on babies that live. Earlier studies indicate possible connections between mothers taking antidepressants during pregnancy and babies being born prematurely or at low weight or experiencing withdrawal symptoms after birth. Specific antidepressants have been linked to birth defects, but the numbers are very small. What these early studies do suggest is most babies exposed prenatally to antidepressants are just fine, especially when you consider how they might fare if their mothers hadn’t taken medication.

I spoke with Jessica Zucker, Ph.D. a clinical psychologist who specializes in maternal mental health about women, depression and the use of medication during pregnancy or the post partum period. DR. Zucker says, “Nuances among women’s experiences of depression during pregnancy are often missing in reports like this. Ideally, women shouldn’t feel stigmatized, ashamed or silenced, but often they do. I worry our culture and studies like these make women quieter about what they’re experiencing and they might not get help in a timely fashion.”

Women experience a range of feelings during pregnancy from exuberance to ambivalence to dread and all can be perfectly normal. But what about women who suffer with depression before pregnancy? What if the stress, circumstances and hormones of pregnancy toss a woman into a very dark place? This is a real situation that millions of women experience as they embark on motherhood. How do they answer the antidepressant question: to take or not to take?

Dr. Zucker says, “I see women in my practice who feel ambivalent about their pregnancies, experience anxiety or feel blue, but they’re not clinically depressed. They may benefit most from psychotherapy and not need medication. I also see pregnant and postpartum women who feel they’re in a really dark place and aren’t able to be present or function and therapy might not be enough. She might need antidepressants to help her regain her health. Other women desperately want medication, but struggle with guilt and worry that if something went wrong with the baby as a result of medication, they’d never be able to live with themselves. In those cases, women may opt to struggle through pregnancy without medication while remaining in psychotherapy to monitor and process whatever emotional issues arise. If medication is indicated after baby arrives, they may reassess and begin antidepressants then.”

Each case is so individualized there’s no way to say, “Yes, women should, or no, they shouldn’t take antidepressants.” For some women, the alternative is so dangerous and dire that neither she nor her baby will thrive or maybe even survive. How do you know if you need help? Dr. Zucker recommends these tips:

• Every pregnant woman and new mother should take her emotional temperature on a regular basis. Ideally, she can identify the depths and complexity of what she’s going through. She might reach out to friends or family who say, “Oh honey, you’re just tired or just hormonal,” and this can become a stumbling block for her to get the help that’s required. If a woman really checks in with herself and realizes she’s in trouble, it’s time to reach out for professional help.
• Every woman needs to be honest and clear with her self about her experience in new motherhood. This can be challenging, especially during this transformative time in women’s lives. What she feels, other women have felt too. The statistics are staggering. Too many women experience perinatal and postpartum mood disorders. It doesn’t make you a “bad” mother to experience a spectrum of feelings about your baby or the change in your identity. We need to move away from the “good” mom VS. “bad” mom dichotomy. The sooner we embrace the roller coaster that accompanies motherhood, the better off women and their families will be. Getting help might be vital.
• Take Action. Reach out to your partner, friends, family, psychotherapist or healthcare provider. Talk about what’s going on so you can get the support you need — the sooner the better. Remember, your baby benefits most when she has a thriving mother. You might benefit from working with a skilled psychologist and/or psychiatrist who specializes in women’s reproductive health. During this tender transition, it’s ideal if you can locate a professional who has training in maternal mental health issues. Depression is fully treatable, but will not go away on its own.

If you’re struggling with uncomfortable or disabling feelings during or after your pregnancy, tell someone and take action. There is help available and millions of women have been right where you are. That’s the message we at EMC strive to deliver — every mother counts and deserves support to achieve her best health and wellbeing.