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Antidepressants and pregnancy: What's safe?

"Today" contributor Dr. Judith Reichman shares some advice for women being treated for depression. and thinking about getting pregnant.

Q: I was diagnosed with severe depression last year, and am now trying to get pregnant. Should I stop my medication either before I get pregnant or as soon as I know I am?

A: First of all, don’t do anything without discussing it with your physician.

Up to 20 percent of women undergo clinical depression at some point in their lives, and the time it’s most likely to occur is in your reproductive years.

A recent report in the Journal of American Medicine (JAMA) looked at 201 women enrolled in a study of depression during pregnancy who both had a history of major depression prior to pregnancy and also were currently or recently on antidepressant treatment. The study found that there was a high relapse rate (68 percent) for those women who discontinued their medication, whereas women who continued their medication throughout their pregnancy were far less likely to relapse (only 26 percent did).

In the past, many clinicians have felt that the hormones related to pregnancy were protective and that women who were prone to suffer from depression were more vulnerable when those hormones fell in the post-partum period. This doesn’t appear to be the case, and it seems there may be a high risk of depressive relapse during or after pregnancy if you stop antidepressant medication entirely.

Having now forewarned you not to stop taking your medication, I have to caution you about continuation.

At the end of last year, the FDA issued a public health advisory about the use of one form of anti-depressant therapy called paroxetine (Paxil). Studies had shown that there could be a very slight increased risk of cardiac defects in infants exposed to Paxil during the first trimester of pregnancy.

In the Swedish National Registry, a two percent rate of cardiac defects was found in infants exposed to Paxil versus one percent for infants exposed to other medications. Another study using data from a U.S. insurance claims database found the rate of cardiovascular malformations was 1.5 percent for Paxil versus one percent for other antidepressants.

In addition, a study published in the February edition of the New England Journal of Medicine found that the use of selective serotonin reuptake inhibitors (SSRI’s) in late pregnancy (after 20 weeks gestation) increased the newborn’s risk of persistent pulmonary hypertension. This is a condition in which the pressure in the pulmonary artery (which supplies blood to lungs after birth) remains high and as a result, the blood does not get oxygenated sufficiently when it is sent to the rest of the body. The risk for this condition was five or six times greater for newborns exposed to SSRI’s versus those who weren’t, meaning that about one child per every 100 exposed would be affected.

Based on this information, a woman who is on antidepressants might then come to the conclusion, “Why take a chance?” But it’s important to remember that there’s also evidence that children of women with untreated depression can suffer from low birth weight or developmental delay.

As you may know from the time that you did suffer from clinical depression, it can be a severe and disabling disorder. It’s clear that for some pregnant women, medications are necessary, especially because of the potentially increased risk of depression during pregnancy or after delivery.

So talk to your doctor, and perhaps you and she will consider an alternative drug if you’re taking Paxil, such as Prozac or Lexapro or Pamelar. But if Paxil has been the only medication that has worked for you, you both may decide the benefits outweigh the potential risks.

Dr. Reichman’s Bottom Line: If you’re on an antidepressant and you’re pregnant, don’t think the joy of childbearing will prevent you from a recurrence. Talk to your doctor about the pros and cons of continuing medication.

Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of HarperCollins.