Photo: duron123, FreeDigitalPhotos
Your choices about treating depression during TTC times are based on an unknown future: You make the best decisions you can in hopes of both optimizing your fertility and providing the safest environment for your anticipated pregnancy. But once that pregnancy test turns up positive, suddenly your choices carry a more serious tone.
Maternal depression during pregnancy must not be casually addressed, and its treatment cannot be over-looked. But as many women learn, the information on both safety and efficacy of depression treatments during pregnancy is both limited and confusing.
One crucial point in the decision-making process is how the data — that is, what is known or significantly indicated about treatments and their impact on both mom and the developing baby — is constantly changing over time.
It’s easy to feel like you’ve done all that you can to keep up with the latest research findings by scouring the Internet, reading books, talking to friends, and even getting your own physician’s take on what’s safe and what works. But as one reproductive psychiatrist says, “Many general psychiatrists, obstetricians, midwives, and internists, despite best intentions, can mislead and confuse patients with tidbits of ‘updates’ they have come across.”
Dr. Kelly Brogan is a psychiatrist who specializes in helping women around the time in their lives when reproduction — trying to conceive, being pregnant, and the post-partum period — is front and center in their minds and daily experiences.
Of course, it’s important to diagnose and treat depression at any point in your life, but pregnancy brings another person into the picture in a very direct way. And it seems as though study after study points to the potential damage to developing fetuses in women who use certain antidepressants. At another point in the safety spectrum are non-medical treatments that are apparently harmless but also not very beneficial.
As is nearly always the case with medical research, the truth is somewhere in the middle. Just as there is no one-treatment-cures-all for depression, the risks and benefits of treatment vary widely depending on individual women’s situations.
One sentiment does bear up in virtually all studies: Women are better off when they do something to treat their depression, and it’s not a far leap from there to “what’s good for mama is good for baby.” That is to say that there are studies indicating a baby in-utero may experience adverse conditions when the mother is experiencing untreated depression.
Just as a fertility specialist can focus more than an obstetrician on helping you conceive, a reproductive psychiatrist spends her professional life zeroing in daily on the changing latest information about treatments that are safe and effective for women and their babies. Regardless of your preferred treatment modality, Dr. Brogan and her colleagues recommend that women who know they have depression:
- think holistically about the reproductive spectrum — if possible, start considering the post-partum impact of your treatment choices as early as preconception
- seek professional guidance if you wish to change or even quit treatments — tapering off and trying out new things is optimally done prior to pregnancy, but for safety’s sake, you want to be monitored closely whenever you choose to alter treatments
- seriously review your lifestyle activities for impact in your treatment regimen — the “good health” basics of nutrition, physical activity, sleep, and stress management will affect your baby
As for the worries that can overwhelm the minds of new mothers-to-be, Dr. Brogan offers this comment:
“A handful of longer-term studies have looked at the impact of in utero exposure to antidepressants and behavioral/cognitive outcomes in young children. Most of these studies are reassuring and point to a uniquely negative impact of untreated maternal depression relative to medication exposure. Some studies have suggested subtle motor delays in infants exposed, but these delays have not been shown to be outside of the range of normal development.”
For more information and to get help with depression, visit the website of Postpartum Support International, an organization that provides information and resources for women throughout the perinatal period.
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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