Often, when a woman who is on an antidepressant learns she is pregnant, she will stop the medication "cold turkey." This is understandable since there is potential risk to the fetus when a pregnant woman is on medications of many types. However, there are problems when stopping an antidepressant abruptly.
First, the woman is likely to have withdrawal symptoms, especially if she has been on the antidepressant for more than 6 weeks. Second, the main concern has to do with malformations, but the fetus has usually completed basic organogenesis by the time the woman knows she is pregnant. In that sense, the "horse is already out of the barn" so stopping the medication at that point may have no real benefit. Third, if the woman needs the antidepressant to control depression, she is likely to suffer a relapse.
It turns out that depression per se causes problems for the developing fetus. For example, women with untreated depression are more likely to have a small for gestational age baby. Also, when the baby is born, depressed mothers have more difficulty bonding with their baby. So, the risk to the developing baby for untreated depression must be compared to the risk from taking an antidepressant.
While there is some controversy about risks from taking antidepressants during pregnancy, the bulk of evidence indicates that the risks are minimal. Major malformations do not appear to be more common than the base rate in the general population of pregnant women. Those studies that do suggest some risk suggest only a small risk. Most obstetricians and psychiatrists who work with pregnant depressed women are comfortable with having the women continue antidepressants of one form or another.
For women who are very worried about possible adverse effects of antidepressants, there is also the option of using psychotherapy for depression during pregnancy. Two forms of talking therapy have shown very good results for depressed pregnant women; theses are cognitive behavior therapy and interpersonal psychotherapy.
The bottom line is that the risks and benefits of taking an antidepressant during pregnancy must be compared to the risks to the fetus and to the pregnant woman from untreated depression. A discussion with a knowledgeable physician is important.
Peter M. Hartmann, MD
