How can women with depression be treated without putting the developing baby in utero, or a breastfeeding infant, at risk? There is this treatment called "psychotherapy." For pregnant women, psychotherapy has decent efficacy evidence. What about antidepressants for depressed pregnant women? No decent evidence anywhere that antidepressants are effective for pregnant women. Despite the lack of evidence, the belif in the medical model leads to approx 7 to 12 % (numbers vary) of pregnant women to be taking antidepressants. This is bad, because studies such as this one, and others, are steadily emerging that SSRIs contribute to birth defects, including heart defects.

Depressed women who might be considering getting pregnant somewhere in the future ought to seek decent psychotherapy and avoid the birth defect risk, and the antidepresant withdrawal issues, altogether.

What bugs me is all the articles saying "untreated depression" in pregnant women is worse than the risk of taking antidepressants. What they are really talking about is withdrawal (and they don't even realize it), not untreated depression, because a lot of these women have been on a/ds for years before they even get pregnant. Let's call a spade a spade here and stop pretending these women are all suffering from depression -- they're "suffering" from chemical dependency on antidepressants -- and yes, it's darn dangerous to go through withdrawal while pregnant which is why I have been against using these drugs in women of child-bearing age for years.

it was always hilarious/scary to me how many women on "fertility/infertility blogs" were adamant about staying on their meds, but not touching a drop of drink, a bit of fish, any caffeine, etc.

gah!

That's an EXCELLENT point, Sara, by the way. That's what we're really talking about. Would be ironic if SSRIs were found to lead to IF (infertility), well to me anyway. IF was extremely stressful for me, and I did talk to a therapist . . . but fortunately did not go the meds route. But many did.

medsvstherapy: Although i agree entirely with your conclusion, the option of psychotherapy does not always work. So, while increased use of psychotherapy would limit this problem (of having to weigh the risks and benefits of SSRI) to far fewer women, it wouldn't eliminate it altogether, and therefore i think we need to be looking closely at SSRI effects _as well as_ pushing therapy or emotional support to those who need it.

"a lot of these women have been on a/ds for years before they even get pregnant"... Where can i see this information, Sara? I hadn't come across it before.

The study mentioned by Philip did specify that the risk was mostly concentrated in women who _began_ taking SSRIs _during_ pregnancy, rather than in women who were already on SSRIs and continued through their pregancy.

I do believe that doctors should be much, much more cautious about prescribing these drugs to women during pregnancy and should inform women of the risks in such a way that doesn't unduly influence their decision... But is that even a realistic hope, given the paternalism of the American medical establishment? (I got that word paternalism from Dr. John and i love it.)

And i really wish doctors would be more honest about the fact that _they simply do not know_ all the risks yet. My doctor, who is one of the very few psychiatrists i have ever seen that i respect, has repeatedly told me that SSRIs are safe in pregnancy. I don't think he is trying to mislead me but is rather oversimplifying for my benefit (although, being a reasonably educated person, i don't really appreciate his efforts on my behalf! So i follow up with very pointed questions, then go double-check his answer).

In general i wish doctors would be open to saying "We just don't know yet." It is no reflection on their competence that we simply can't do controlled studies on pregnant women, and so it takes twenty years (or whatever) for sufficient data to pile up.

BlackOrchid: It really makes me a little ill every time i hear of people going on SSRIs for stress. It makes no sense to me; i'd call it a short-term solution, but they take a freaking month to even work. And learning to deal with stress, and grieving, and accepting emotional support, all these things have benefits that will in many cases last longer than the stressful situation itself.

Well, getting more off topic, i have a friend who is planning to get pregnant sometime soon, but is in general not willing to work on her issues, and i am very concerned, not about birth defects, but about her ability to appropriately model emotions and boundaries for the child after it's born. Having shared my opinion with her, i find it really very hard to let go and not judge. Maybe because i worked on my shit and am at a place where i can go off meds... and i usually don't judge people for how they choose to get by in life, but this is a person i love and i want better for her.