The early weeks of pregnancy are fragile—and confusing. Here, the answers to your questions.
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Between 14 percent and 23 percent of pregnant women experience depressive symptoms— overwhelming anger, sadness, irritability, guilt or hopelessness. But 2012 research regarding the most commonly prescribed antidepressants, selective serotonin reuptake inhibitors (SSris), didn’t bring good news for these moms-to-be: new studies suggest a heightened risk of complications from taking SSris (which include Paxil, Prozac and Zoloft) during pregnancy. One study concluded that taking Paxil could result in an increased risk of high blood pressure in the mother; another found there’s a greater likelihood of preterm delivery.
The obvious answer is to quit your meds, right?
Wrong, says prenatal depression researcher Kimberly A. Yonkers, M.D., professor of psychiatry and OB-GYN at Yale University School of Medicine in New Haven, Conn. “During pregnancy, it’s always better not to take a medication if you can do without it,” she says. “But these are not optional treatments for many, many women.” Also, untreated depression has its own dangers, such as low birth weight, preterm delivery and infant irritability and decreased activity.
The greatest body of evidence regarding SSRIs used during pregnancy points to an increased risk of late preterm delivery. On average, women taking serotonin reuptake inhibitor medications give birth three to five days sooner than moms-to-be who are not taking SSris, Yonkers says. Additionally, in the first trimester, some studies have shown that the risk of fetal heart defects is slightly higher, particularly with Paxil (paroxetine). Using SSRIs later in pregnancy carries a very low risk of persistent pulmonary hypertension in the newborn and convulsions immediately after birth. (The tremors don’t appear to have lasting consequences.)
While SSRIs are the most commonly used class of antidepressants, others, such as Wellbutrin (bupropion) and tricyclic antidepressants, an older class of drugs, have fewer pregnancy-related risks (although tricyclics are often not well-tolerated).
Changes to medication ideally should happen before conception so you have time to adjust. Ultimately, only you and your physician can determine what’s best for you.
Read More: Safe Medications to Take While Pregnant
Never discontinue medication without consulting your physician first. Here are some questions to ponder before you do:
1. How severe is my illness? Women who have had four or more major depressive episodes before pregnancy or an episode within the last six months are most likely to relapse if they discontinue medication during pregnancy, according to a study published in Epidemiology.
2. Have I gone off medication before and relapsed? Some women know they’ll get sick if they wean off their medication, Yonkers says.
3. Have I tried psychotherapy? Depression-focused psychotherapy can be very effective, research shows. Ask your doctor for recommendations, or find one via the American Psychological Association (apa.org).