Antidepressants: Weighing the Decision

It's almost the definition of a good mother: someone who puts her child's welfare ahead of her own. So women may agonize if they are pregnant and must decide whether to accept a treatment that could help them but harm their fetus. As many as 20 percent of pregnant women experience significant depression. Stopping antidepressant medication during pregnancy may increase the risk of relapse for the mom, but some drugs may hold dangers for the fetus. What's a mother to do?

The answer is to focus on the right issues. Just as no medical treatment is without risk or potential discomfort, doing nothing also carries risks and discomforts. Try not to overreact to scary news accounts; instead, look at your own situation carefully. Since the sources of depression are very varied, learn as much as you can about the nature of your depression. For example, depression varies in intensity and may disturb sleep or appetite, or interfere with functioning. Mood may be constantly mildly low, or there may be shorter, more severe episodes with relatively normal periods in between. Any amount of distress is worth reporting to your doctor.

Data from decades of research on treatment are reassuring. Until recently, most data have shown that exposing a fetus to antidepressants has not increased the risk of birth defects. The FDA did circulate a warning recently about the drug paroxetine but is still studying it and has not yet issued a final recommendation.

Paroxetine may be a prob-lem at the end of pregnancy, too. If Mom is taking it just before giving birth, the newborn can develop withdrawal symptoms. Other antidepressants can create this problem, but paroxetine stands out because it leaves the body faster than other drugs in its class. Fortunately, these symptoms are not dangerous and usually go away quickly.

Compare these risks with the risks of depression itself. Depressed mothers find it hard to care for themselves. They miss doctors' appointments and are more likely to turn to alcohol or drugs. Children born of a depressed mother may have lower birth weights, and depression can interrupt a mother's bonding with the child at birth. In extreme cases, depression can lead to the death of both mother and child.

Reading about risk makes a decision about treatment seem harder, but there is no reason for alarm. Since you cannot eliminate risks, step back from them and think instead about your values and what you want from your pregnancy experience. Choose a treatment that fits that framework. There are many good options, with or without drugs. Women with milder depression who become pregnant may want to gradually reduce the dose of medication and rely on psychotherapy and family support until the middle of the pregnancy. But that may not be a good choice for women with moderate to severe depression, for whom the burdens of the illness--and the dangers to the fetus--are too great.

If you're anxious about making these choices, it may be because you have a lot more information today than mothers in the past did. You have been given an increased burden of responsibility and anxiety. But, in fact, since the 1960s the overall risk to you and your fetus has decreased . So whatever you decide, the odds are with you.