What I Tell Women Who Are Pregnant & Struggling With Depression

Written by Alice Domar, PhD

As you may have seen, there’s been a frenzy of media attention around a study published this month in JAMA Pediatrics. The study showed an increased risk of autism in the children of women who took a class of antidepressants, called SSRIs, while they were pregnant.

As a psychologist and a professor at Harvard Medical School, this media attention surprised me and other researchers in the field. That’s because there have actually been quite a few studies published on this topic; the JAMA study isn’t all that cutting-edge.

Still, I guess the good thing about this frenzy is that it has brought the controversy around pregnancy and SSRIs back into the public eye.

So what is my stance on the issue? Overall, the consistent criticism I have about the arguments for or against pregnant women taking antidepressant medication is the assumption that if one is depressed, the only options are medication or nothing. In fact, it’s actually perfectly reasonable in most cases to at least discuss other options.

The majority of studies have shown that cognitive behavioral therapy is equivalent to medication in treating depression.

The option which probably has the most research to document its efficacy is cognitive behavioral therapy (CBT). There have been dozens of randomized controlled trials which have directly contrasted CBT versus SSRIs and the majority of the studies have shown that they are equivalent in treating depressive symptoms.

That’s why I recommend that women who are pregnant or thinking about having a baby at least consider this mode of treatment if they’re struggling with depression. CBT works quickly, usually more quickly than medication in fact, so if it’s going to work for you, you tend to know it fast.

Still, if one tries CBT or other treatments for depression, like exercise, and they don’t work within a few weeks, then it might be time to have a serious discussion about trying medication.

Here’s what else you should know when considering your options:


1. Consult with a mental health professional first.

Only about 20% of women of childbearing age who take an antidepressant are appropriately assessed by a mental health professional.

In fact, most SSRI prescriptions in this country are written by primary care physicians or ob/gyns. In my opinion, especially in the pregnant or hoping to be pregnant population, you should not go on antidepressant medication until you have sat down with a mental health professional, had your history and symptoms assessed, and together you come up with an appropriate treatment plan.

2. There are risks in taking SSRIs — but there may also be risks to not taking medication.

Don’t be terrified by media reports with headlines like “doubling of autism risk.” Going from a 50% risk to a 100% risk is worth attending to. But going from a 1% risk to about a 2% risk, as the recent autism study suggested, feels a lot less scary.

Some other potential risks of taking SSRIs during pregnancy may include miscarriage, preterm birth, and newborn behavioral syndrome. However, there can also be risks of not taking medication in women with severe depression, such as increased harmful lifestyle behaviors like smoking and alcohol, as well as suicide.


3. You know what works best for you.

The way you are treated for your depressive symptoms has to be tailored to you. You know your body, your moods, how you may have responded to therapy or medication in the past, and so on.

So once you understand the risks and benefits of the recommended treatment plan, the decision is yours to make.

4. Understand what really qualifies as a depressive episode.

Be aware that there's a big difference between experiencing a true depressive episode, which lasts at least a few weeks, versus feeling down in the dumps off and on.

It’s more appropriate to use medication to treat a true depressive episode than it is to use medication for what is actually a normal reaction to life’s ups and downs.


5. Consider trying CBT.

Even if you have tried counseling in the past and felt it wasn’t successful, unless you have tried CBT with an experienced therapist, you might want to try it again. It can be highly effective.

The take-home message is that there may be good options other than medication for many pregnant or hoping to be pregnant women.

However, for some women, medication is in fact the best approach to treat their depressive symptoms, especially if they are unrelenting and severe — as long as the risk/benefit ratio is appropriately explained by a health professional. The goal is to increase the chance to carry and deliver a happy and healthy baby.


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