I know the last few cool days of rain in the Valley are lovely, but the continuous sunshine just seems to be infecting us all with joy. It is the start of the season of moist plums, laughter at the water park, sandy toes, breezy fragrant endless evenings, and picking out corn kernels from your kids teeth (not quite the same satisfaction you get from picking your own teeth).
By this time of year we are all pretty much out of hibernation and you start re-connecting with people who you may not have seen since last Autumn. Ahhhh…the glorious sunshine!
So why do more people kill themselves in the Spring and Summer versus during other more depressing times of the year?
On the same token, how is it possible to be depressed when pregnant?
Of course it is absolutely reasonable to see how an unwanted pregnancy could intensify misery. But what if you planned for this pregnancy and now you have found yourself in a state of despair? How is that possible when becoming a mother is what you wished for? Furthermore, what about all those women who use anti-depressants before they became pregnant? Should they stop their potentially life-saving medication to prevent a possible harmful effect upon their child?
What is the effect of untreated depression upon a fetus?
It is widely accepted that untreated depression is the number one cause of suicide. With the advent of SSRI (selective serotonin reuptake inhibitors like Prozac) suicide rates have decreased. This article is limited to the discussion of SSRIs as they are the most used anti-depressant during pregnancy.
Here are some things to consider with anti-depressant use in pregnancy:
- Women are 5 times more likely to relapse when anti-depressants were discontinued during pregnancy.
- The effect of untreated depression during a pregnancy can include negative obstetric and neonatal outcomes. There is evidence that uncontrolled maternal depression can cause fetal growth restriction, low IQ, and even can even effect future language development.
- Only really high doses of SSRIs have been showed to cause fetal malformations (in rats-simply because you cannot do those tests on humans).
- Switching medications or lowering dosage is not recommended if current treatment is working. However, treating depression with medication for the first time during a pregnancy is particularly difficult as emotions during pregnancy may be labile.
- However, all medications have side-effects and risks. A baby born to a mother who has been taking SSRIs (especially after 20 weeks gestation) is more likely to experience withdrawal from the medication. One of the greatest risks of SSRI withdrawl is neonatal persistent pulmonary hypertension (PPHN). PPHN symptoms in the newborn are as follows: jitteriness, mild respiratory distress, rapid breathing, weak cry, poor muscle tone, etc. However, these symptoms tend to resolve soon after birth.
- There may be an increased risk of miscarriage with first-trimester anti-depressant use, however it could not be ruled out that this was not also an effect of the depression itself.
- It is recommended that the SSRI, Paxil (paroxetine) should be avoided during pregnancy possibly due an increased risk of fetal heart defects and PPHN.
The American College of Obstetrics and Gynecologists recommend that depression treatment should be individualized to the pregnant patient and based on personal and medication history. Also, collaborative care is recommended with an obstetrician and/or midwife, and psychiatrist and/or counselor.
Please note that this article is in no way stating that prescription medication is the only method for treatment of depression. In fact there is good research to suggest that other therapies (counseling, complementary therapies, good nutrition, regular exercise, healthy relationships and community, etc.) can provide great results in conjunction with or without antidepressant use.
Back in my child-free days…the Summers in my twenties were often spent at friends’ cabins on the lakes of northern Minnesota. I often used to say there is a fine line between wet and dry during the Summer. For some that fine line involves tissues to dry tears and not bathing suits and towels as I had experienced.
Clearly, the decision to stay on anti-depressants would be a tough one during pregnancy, but it may be the only choice in some circumstances. However, some may feel too overwhelmed with guilt or uncertainty about future effects on the fetus to continue the medication.
Perhaps there is also a fine line between wet and dry in pregnancy as well.
http://www.acog.org/from_home/publications/press_releases/nr12-01-06-1.cfm
Overcoming the Stigma of Depression
A few years back small levels of the SSRI Prozac were found in drinking water in the UK and US. If that many people are taking antidepressants such that it is on tap, why is there such a stigma regarding its use? Most people who take antidepressants do not readily admit it. What is really wrong with its use? Is it an admission that one needs chemical help because they can’t figure out their problems any other way? Can people not truly believe that some are born with chemical imbalances in the brain? Or perhaps it is a cultural issue. I have lived in Canada, Scotland, and Ireland the last 5 years. I have noticed that in general people of those countries keep things more to themselves versus Americans. I tend to think Americans to a fault (and I am one of them) are more open about personal issues. However, I do not recall many Americans openly admitting to anti-depressant use when I lived there. Or maybe people keep their mouths shut about Prozac simply because its no one else’s business. Pregnancy and anti-depressant use has its own stigma. Your physical state of a growing belly somehow gives others free reign to offer you their opinions about what you should and shouldn’t be doing for yourself and the baby. The reality is that no one has experienced your unique life circumstances, so they couldn’t possibly know exactly what would be right or wrong for you. If anti-depressants help you and you decide to continue their use during pregnancy, so be it. Also, if you chose to stop to using the medication during pregnancy, that’s okay for you too. Accept who you are.
Guess the other way beside using anti depressant medication in pregnancy is to find & join a local support group. This is where pregnancy women, perhaps also facing the same problems giving each other support & sharing/encouraging each other. It is very encouraging to find comfort in the group where people have gone thru and share their experience.. =)