The early weeks of pregnancy are fragile—and confusing. Here, the answers to your questions.
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ARE ANTIDEPRESSANTS SAFE DURING PREGNANCY?
Studies on babies’ risks from commonly used SSRI antidepressants, such as Prozac, Lexapro and Celexa, are conflicting, as are the opinions of experts. “The majority of patients who have been studied have had no clinically significant effects or measurable risks during pregnancy,” says Heather Flynn, Ph.D., director of the women’s mental health program at the University of Michigan Medical School’s department of psychiatry. The decision to take antidepressants should be made based on history and severity of illness, previous response to treatment and discussion with your heath care provider, she advises.
While a recent Canadian study found that women who took antidepressants during pregnancy had a higher chance of miscarriage, researchers reported that some of the increased risk could be ascribed to the depression itself. And some studies have showed a link between SSRI use and heart defects in babies, though the actual risk is still very low—0.9 percent in women who took an SSRI, compared with 0.5 percent in the control group, according to one study.
It’s also been documented that newborns who were exposed to SSRIs in utero may experience temporary withdrawal-like effects, including hypoglycemia, unstable body temperature, irritability and a weak cry. “I’m concerned about the risks of antidepressants, especially when, for many women, there’s a perfectly reasonable option, which is cognitive behavioral therapy,” says Tom O’Connor, Ph.D., a professor of psychiatry and psychology at the University of Rochester Medical Center in New York.
WHEN PROBLEMS ARE PRE-EXISTING
If you already have a psychiatric problem, major life changes, transitions and stresses—such as preg- nancy—can increase the intensity of your symptoms or the likelihood of relapse, says Heather Flynn, Ph.D. Here’s how some common mental health issues may be affected by pregnancy:
BIPOLAR DISORDER Pregnant women and new mothers with this disorder have an increased risk of hospitalization and of having a recurrent episode. (Note: Lithium, Depakote and a few other drugs fre- quently prescribed for this and other conditions are off limits because of the risk of birth defects.)
OBSESSIVE-COMPULSIVE DISORDER (OCD) A Yale University study found that among women with preexisting OCD, symptoms worsened one-third of the time during pregnancy. It also found that 32 percent of the women who had ever been pregnant had their first OCD symptoms during or soon after pregnancy.
PANIC DISORDER According to Flynn, an estimated 9 percent of women experience this condition during pregnancy, though some expectant women report improvement in their symptoms.
POST-TRAUMATIC STRESS DISORDER (PTSD) This can result from rape or other abuse, an accident or other traumatic experience in a woman’s life. The prevalence in pregnancy may be 1.5 percent to 6 percent, Flynn says. Symptoms often worsen during pregnancy, and new cases can arise as a result of a previous traumatic childbirth or loss of a baby. While these and other conditions can be safely treated during pregnancy, locating a qualified care provider can be difficult. You can find referrals to well-trained specialists at Postpartum Support International (postpartum.net.).