Q. Is it safe to take antidepressants during pregnancy?
A. It’s estimated that between 14 percent and 23 percent of women experience symptoms of depression during pregnancy, so many women have to decide whether or not to take antidepressant medications. The issue has also sparked a great deal of scientific debate. But the research so far has not been able to tease apart whether an increased risk of some health problems in women who take antidepressants during pregnancy and in their newborns is tied to the drugs or to the depression.
Some studies have linked antidepressant use to a higher risk of rare birth defects as well as preterm birth and lower birth weight, but the evidence is conflicting. Women with severe untreated depression may be prone to behaviors that put them and their newborns in jeopardy. “The challenge for women and physicians is to balance the risks of using medication during pregnancy with the risk of untreated depression,’’ says Sengwee Darren Toh, an instructor of medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute who has researched this subject.
He emphasizes that women should discuss with their doctor the right strategy based on their specific health situation and risks. Women with mild depression can often avoid medications, but the risk of letting moderate or severe depression go unchecked may be too high.
In 2009, the American Psychiatric Association and The American College of Obstetricians and Gynecologists issued a joint set of recommendations on the issue. according to these guidelines, women who have been taking antidepressants and experienced only mild or no symptoms for six months before pregnancy should consider gradually stopping medication. Women who still have symptoms, have recurrent depression, or who become depressed during pregnancy and want to avoid drug treatment may choose psychotherapy, alone or as a supplement to medication. Women with severe depression are advised to stay on medication, and any woman with suicidal or psychotic symptoms should seek treatment immediately.
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