Marriage and Family Therapist
Cyndi Sarnoff-Ross is a licensed psychotherapist with almost twenty years of clinical experience in the fields of clinical psychology and organizational management. She has worked extensively with a wide variety of…
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Antidepressants During Pregnancy: What Are the Real Costs and Benefits?
Posted in Pregnancy by Cyndi Sarnoff-Ross on Nov 19, 2012
There is considerable debate regarding the new information about pregnant women and their use of antidepressants, released in the Journal of Human Reproduction. The news is the result of a study conducted at Metrowest Medical Center in Massachusetts by Dr. Adam Urato, Chairman of the Department of Obstetrics and Gynecology.

For many years women have been told that the risk of depression was far greater than the side effects of certain medications deemed appropriate for use during pregnancy, but now there are doctors who are cautioning against this advice. They are warning of everything from miscarriage to preterm labor and long-term side effects as a result of taking these meds.

To counter these claims, Dr. Jennifer Payne, director of the Woman’s Mood Disorders Center at John Hopkins School of Medicine, is restating the fact that for some women these medications are crucial for their own health and for the psychological well-being of rest of their family. She states that women who are severely depressed tend to miss prenatal appointments and have poor self-care. The repercussions of these behaviors could have dire consequences. Many clinicians report that the use of antidepressant meds during pregnancy can also help to stave off post-partum depression if taken early enough.

Reports such as this one can scare women away from using medication even when they desperately need it. The primary concern of the clinicians who are criticizing this study is that the researchers did not acknowledge that in certain cases the cost benefit analysis does lean in favor of using medication.

I am not a medical doctor, and therefore I cannot weigh in on the medical risks of using these meds during pregnancy. Over the years I have seen many patients in therapy for depression during and post pregnancy and I can report that there are many non-medical treatments for these disorders. That said, there are times when behavior modification and other holistic approaches simply don’t suffice.

As I have mentioned in previous articles, so often there is a tendency to hastily write a prescription. It can be seen as a quick fix. Unfortunately there are no actual quick fixes and any woman who is suffering from depression, while pregnant, should have a thorough evaluation by a mental health professional and should be referred to a psychiatrist if the circumstances warrant.

When I see a woman in this situation I will use a number of different treatment strategies before considering a psychiatric referral, with the hope of avoiding the possible risks of medication. I believe this study would not have been viewed so harshly had the researchers presented a more balanced report instead of painting all antidepressant use during pregnancy with a broad brush. Women who truly need to take this type of medication should feel empowered to do so and should recognize that, as with most serious parenting decisions, there are pros and cons. By no means should they feel shame over the need to do whatever is in their best interest and in the best interest of their immediate family.

- Cyndi

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That being said, I do agree with Fern RL that the doctors do need to turn to physical causes first before assuming a true mood disorder. I have suffered from fatigue for years that my doctor always attributed to my depression (despite the fact that I was medicated and feeling fairly well otherwise). Last summer the fatigue got a lot worse to the point of nearly falling asleep at my desk at work. I went back (again) and she finally did a full panel of bloodwork. Turns out I had very low iron. Did a month on a high daily dose of iron and got a recheck and I am on the low side of normal. Still don't feel perfect, but much better than before. I was put on a maintenance dose of 1 pill/day. She didn't want to go any further into figuring out why my iron was so low (and I'm sure it has been going down for a long time). At my next physical I am going to push for it.
By findmydream  Dec 07, 2012
2
I was on Cipralex when I was pregnant with my 2nd child. She was born with breathing difficulties and had to be closely monitored for a couple of days. There was no other reason for it than the meds. I do think, though that in my case that it was for the best to be on something since I had severe ppd with my first child, who developed ADHD from that (according to his pediatrician). I know that for my case that it was better that I was on the meds as I can not function without them at all.
By findmydream  Dec 07, 2012
1
This is a very interesting article. There are so very many things to consider in our health care, and I am left with the feeling that I certainly need the health care professionals, but since they can't be with me 24/7, I ultimately have to take charge of my own health. Still, I would like it if my PCP could be more supportive, and at least listen to my thoughts.

When I was put on Paxil, I was told "There is no blood test for depression, but we live in a state (Utah) that leads the nation in depression, so you should take the SSRI and see if it works for you." It didn't.

I remember that Utah also led the nation in Goiters until the practice of using iodized salt became common...and that being hypothyroid can cause depression. Doctors also say "Stop adding salt to your food." Iodized salt cannot be used in making pickles and other things high in sodium.

Perhaps a blood test checking thyroid would be a good idea before being automatically prescribed antidepressants.
By Fern RL  Nov 20, 2012
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