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If you’ve been diagnosed with depression and you’re trying to conceive, you could be worried about the best and safest way to treat your depression. While research on effects of depression medication has historically focused on pregnant and lactating women, a little of what is known may be enough to make people who are trying to get pregnant think twice about conventional depression treatment.
Problems for baby
The worries aren’t all about fertility levels, either. Connections between depression medication and fertility are muddy and vague at best, but we do know that some medications can be harmful to the developing baby in pregnancy’s first trimester. Those treatments, in particular, should be either avoided or at least monitored very closely for women who are TTC.
Alex Shpigel, L.Ac., of San Diego, points to studies of paroxetine (brand name Paxil) that clearly demonstrated increased risk for cardiovascular malformations in babies born to moms who used the drug during the first few months of pregnancy.
“It’s important to note that more than a single study is reflecting this incidence of paroxetine-linked heart defects in babies,” Shpigel says. Paxil has also been linked to DNA fragmentation in sperm, which can decrease male fertility.
No risk-free options
Paxil is only one of several depression medications that are worrisome. The Mayo Clinic website lists the following as options for pregnant women, yet clarifies that potential risks exist for these as well:
- Tricyclics, like Pamelor
- Certain SSRIs, including Celexa, Prozac, and Zoloft
- Wellbutrin
“Depakote is one that we all steer clear of,” says Dr. Kelly Brogan, a perinatal psychiatrist in New York.
Folate more crucial
Another consideration particularly important to the TTC crowd: taking ample folic acid is even more crucial for women who use some medications because of the drugs’ interference with folate metabolism. Dr. Brogan recommends additional screening for MTHFR Polymorphism, which can prevent a woman’s body from using folic acid, thereby impacting different arenas of health from cardiovascular to psychiatric. A prescription strength activated folic acid called Deplin (or the over-the-counter version, l-methylfolate) can be used by women with MTHFR Polymorphism.
Stabilize treatment early
Something to keep in mind, whether you’re considering changing or starting on depression medication for the first time: the entire fertility journey is filled with sometimes drastic hormonal fluctuations. Managing depression well is partly dependent on the stability that comes from treatment consistency.
And since, fortunately, research has clarified which medications pass more readily to baby from mom through breastmilk, Dr. Brogan says “To avoid the need to change medication treatments during the sensitive post-partum period, it’s best to choose something early in the fertility journey that will be safe during lactation later.”
Some women want to change their medication course before pregnancy. Dr. Brogan explains the provisional process: “Many times, I will help patients implement a detox and wellness plan, including a taper-off of medications and a trial of an alternative treatment option prior to pregnancy. If we are unable to keep her well over a two-month trial, medications may be restarted.”
Dr. Brogan is one a few psychiatrists who regularly makes use of medication alternatives and complements. In addition to Board certifications in Psychiatry, she is also board certified in Integrative and Holistic Medicine. Treatments she recommends range from conventional medication to dietary modifications, nutritional supplementation, and breathwork.
“It’s clear that there’s no one-size-fits-all choice,” she explains. “The best medication for a woman to take is, with few exceptions, the medication to which she has had the most complete treatment response already.”
Conscientious monitoring by a prescribing professional is key. You can find a reproductive/perinatal psychiatrist through an organization called Postpartum Support International.
Editor’s update: Dr. Kelly Brogan requested the following comments be added, out of concern that some Paxil users may stop their medication abruptly based on worries cited above:
It seems that more recent data has drawn the FDA’s initial 2005 ruling [about Paxil use and increased incidence of cardiovascular risks] into question. A study out of the MotherRisk Program in Toronto in 2008 reported on the outcomes of 3000 first-trimester exposures and did not find an increased incidence of defects. Without a replicable, consistent defect associated with a given medication, it is likely that we are looking at a confluence of other confounders.Unfortunately, the FDA is not the most informative source on this topic because their current ratings are being transitioned to a new system, and their warnings come and go. This is an excellent example of how difficult and complex it can be to try and interpret research and related, publicized warnings.
About Tracy Morris
I wear a lot of hats while spinning plates and true stories. In between taking care of myself and my family, I write about fertility and other health care topics. Most of my online time lately is spent at two very different places: FertilityTies.com and TrailerParkKarma.com. Perspective is everything -- my pre-teen reminds me daily.
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