Considerations of Antidepressant Use In Utero: Navigating Pregnancy + The Postpartum Period

Perinatal mood disorders have been named the most common complication associated with childbirth. Mood struggles during the postpartum period run rampant but are consistently quieted by our culture’s focus on the overly idealized “glowing” new mother. Though many women gracefully transition into motherhood, others feel they are riding an emotional, hormonal, and physiological roller coaster­–with no seat belt and no way to control the speed. In the U.S., 15% to 20% of new mothers, or approximately 1 million women each year, experience perinatal mood and anxiety disorders. Given this glaring statistic, it seems imperative that this public health crisis be addressed systematically and globally.

All too often, women burdened by perinatal and postpartum mental health difficulties sequester their challenges as a result of shame. They fear being called a “bad mother,” they are told by strangers, friends, and family alike that these feelings “will pass” while being encouraged to “enjoy the moment because time passes so quickly in motherhood.” Furthermore, pregnant women often hope that if they “try hard enough” to make their anxiety or depression go away, they will “get over it” on their own. These psychological hurdles embedded in the minds of many create barriers for change. Common cultural beliefs perpetuate anxiety and shame, potentially impeding mothers from receiving the medical and emotional support they need during pregnancy and in the postpartum period. Medical providers, family members, and partners need to be aware of what constitutes a mood disorder, and how to weigh the research to help mothers determine their best course of action.

Mood disorders during and after pregnancy can affect any woman, regardless of age, income, culture, or education. Studies show that a baby’s well-being, interpersonal development, and subsequent attachment relationships are directly tied to the mother’s physical and emotional health. To that end, research has further found that postpartum mental health disorders can be incredibly detrimental for infant development and attachment formation—and consequently to growing children, the family, and society at large. “By 6 months, the infant exposed to a mother’s negative affect learns to extrapolate using that behavior with others. By ten months, the emotional responsivity of infants of depressed mothers is already organized differently from that of normal infants.” When considering the therapeutic treatment course for pregnant women, we must also sensitively keep in mind the impact of her mental health on her developing baby.

Here is a glance at domestic maternal mental health issues impacting pregnant and parenting women:

• Roughly 10-20% of pregnant women experience depression

* Depression during pregnancy is the best predictor for developing postpartum depression

• Approximately 15-20% of all mothers develop postnatal depression

• Approximately 2-5% of new mothers develop obsessive-compulsive disorder

• About 10% of postpartum women are impacted by panic disorder

• 1-2% of post-delivery women experience postpartum mood disorders with psychotic features (30-50% of women have suffered a postpartum depression or psychotic episode in a prior pregnancy)

There is a great deal of scientific and moral debate taking place within the pregnancy and postpartum zeitgeist with regard to antidepressant medication use. If only there was a simple answer to the common question:

“What’s worse, my being off antidepressants while pregnant and feeling anxious and clinically depressed or the potential physical side effects of the medications on my developing baby in utero and beyond?”

Due to the fact that a mother’s mental health impacts the whole of the family, there is no clear-cut, definitive response to this vital question. It is not black or white. The paramount issue at hand is finding and maintaining the delicate balance of healthy, thriving outcomes for both mother and baby. The scientific literature on the effects of antidepressant use during pregnancy continues to expand our understanding of possible physical and psychological outcomes. Alongside this research, discussions in the mental health community are exploring the intergenerational transmission of depression, mother-child bonding, and preconception psychological health promotion. The issue continues to be one of complexity best addressed by assessing each individual mother’s mental health needs.

Research has found that myriad physical issues in fetuses may result from antidepressant use during pregnancy (i.e., reduced head size, preterm birth, heart defects, miscarriage), though these studies are mixed and inconclusive. Conversely, scientists also posit that “because depression itself can affect fetal development and prevent the mother from bonding with the baby after birth, the benefits of medication use are often seen as outweighing the risks in severe depression.” Untreated depression can lead to intractable and insidious psychological and developmental issues for mothers and their burgeoning families. For example, mothers who are suffering with perinatal depression may have difficulty caring for themselves and their children. Also, bonding and attachment may be greatly impacted by the mother’s feelings of intense overwhelm, inadequacy, exhaustion, irritability, anger, guilt, or persistent sadness. In addition to the psychological issues seen in depression during pregnancy, physical components have been found as well, namely preeclampsia, low birth weight, premature birth, and developmental delays.

There are growing bodies of research on every facet of antidepressant medication use during pregnancy. Weighing the risks and benefits on individual mother and baby of taking antidepressants during pregnancy is key. While there is no definitive answer, the most central consideration is taking the mother’s symptoms seriously and proceeding with sensitivity and care regarding the mental and physical health of mother and baby. The ubiquity of perinatal mood disorders underscores the importance of addressing maternal mental health issues in the global reproductive health conversation.