To Med or Not to Med…That is the Question

According to the World Health Organization, depression is on the rise and is expected to be one of the biggest health problems we face by the year 2020. Millions of people take antidepressants every day; a significant number of them are women. We know that depression is far more common in women than in men and that the highest prevalence occurs during child bearing ages (mid-twenties to mid-forties). And, depression doesn’t disappear when a woman becomes pregnant. It is estimated that between 10% and 25% of pregnant women suffer with major depression.

So, while many commonly used antidepressants have been shown to be safe during pregnancy, countless numbers of women are plagued by the decision of whether to continue to take medication during their pregnancy, or stop. Nearly every woman is committed to do everything in her power to nurture and protect the baby growing in her womb. Frequently, those women who don’t or can’t have a serious mental illness, physical illness or addiction that interferes with their ability to care for themselves.

Far too often, women with depression or anxiety decide to discontinue their medications during pregnancy, and they base this decision on myth, fear, stigma and shame rather than scientific evidence of the actual risks and benefits of being on antidepressants during pregnancy.

It is important to remember that most women take these medications for a reason, often because depression has profoundly and quite negatively impacted their lives. Many women and healthcare practitioners fail to take into account the risks for a woman and her baby when stopping her antidepressant. Most healthcare providers are quick to relay the risks of staying on antidepressants, the biggest of which substantiated by the scientific literature, is neonatal withdrawal syndrome, which lasts two to three days after birth and is characterized by irritability and poor feeding. The scientific literature is largely mixed about other hazards of being on antidepressants while pregnant, but the largest study in 2013 showed no increased risk of malformations, miscarriage, stillbirth or pulmonary hypertension in the newborn.

What people spend far less time thinking about and talking about are the risks of untreated depression during pregnancy. Discontinuing antidepressants can have harmful consequences to the mother and her baby, which include:

  • increased use of cigarettes, alcohol or other substances
  • deteriorating social function, emotional withdrawal, worry related to pregnancy and excessive concern about their future ability to parent
  • impaired ability to attend regular obstetric visits and comply with prenatal advice;
  • malnutrition which can lead to low birth weight
  • increase in risky behavior and impaired capacity to avoid dangerous behavior
  • heightened risk of self-injurious, psychotic, impulsive, and harmful behaviors
  • increased risk of postpartum depression or PPD
  • difficulty carrying out maternal duties and bonding with their children

Whether to continue taking any medication during pregnancy comes down to individual choice. But, far better it be an informed, evidence-based decision, than one based on societal pressure, shame or fear. The risks and benefits will depend on the person, her history of depression, severity of depression, length of time on and response to antidepressants, and whether or not non-pharmacologic therapies have been effective in treating her depression. Whatever you decide, it is important to remain connected to people who can help you, support you and recognize signs of depression interfering with your abundant life.