Major Depression during pregnancy

Depression in women in this age group can appear during and after pregnancy like in other times and can recur in other pregnancies.

A major part of postpartum depression is a cause of hormonal changes and psychological stress including baby-care. A small part of depression is a sign of bipolar disorder.

Depression is a disorder which affects one in four women in their whole life. It often starts in the period between ages 20 and 30, when women usually wish to be mother.

If you or someone you know suffer from depression and especially take psychotropic, you may want to know if it is safe to continue medication during your pregnancy.

What is major depression?

Major depression is a mood disorder. According to research mood disorders are biological diseases including changes in brain chemistry. Even in some individuals depression can occur without any obvious external cause, mental stress can sometimes trigger some changes.

Symptoms of major depression:

  • Hopelessness most of the day that is present almost every day for at least 2 weeks.
  • Less interest in activities you used to enjoy

Other signs:

  • Fatigue or lack of energy
  • Restlessness
  • Sense of guilt or worthlessness
  • Difficulty concentrating
  • Difficulty falling asleep or sleeping more

Depression during pregnancy

Contrary to previous beliefs, pregnancy doesn’t protect women from depression. Approximately 20% of women show some depressive symptoms during their pregnancy and about 10% of women may develop depression. If women who have had major depression in their past stop the use of antidepressants the risk of recurrence of depression during pregnancy increases.

In pregnant women or women who plan to be mother treatment of depression is a process in which doctor and patient decide together. Psychotherapy can reduce mild symptoms, but treatment with antidepressants is often necessary for the treatment of severe major depression.

The pass of antidepressants through placenta may unsettle prospective mothers. Untreated depression includes poor nutrition for mother and fetus, smoking, use of alcohol, suicide and risk of preterm birth or miscarriage. Information about the effects of medicaments on pregnant women is limited. Due to ethical drawbacks works on pregnant women aren’t allowed. On the one hand the available information are received from the data of pregnant consumers in pharmaceutical companies. On the other hand hospital reports about patients taking antidepressants during their pregnancy provide information.

Treatment during the planning of pregnancy

During a lot of women suffering from depression take antidepressants to prevent symptoms, many of them want to become pregnant at the same time. The decision for or against stopping medication depends on the severity of depression. If a woman has had a depressive episode and has been feeling well for at least 6 months, the medication can be reduced before trying to become pregnant. Several weeks before getting pregnant is necessary for eliminating the traces of medication. Furthermore psychotherapy can prevent the recurrence of symptoms. However, if a woman has multiple episodes of severe major depression, the experts may recommend the continuation of full dose of medication through conception. If she is already taking an antidepressant thought to be safe, it can be continued. However, if there is very little information about the taken medication, the woman should switch to another medication with more information about its safety.

About women with depression wanting or not wanting to be pregnant

According to experts, in mild depression, psychotherapy alone is sufficient to treat the symptoms. However if the signs are severe, a combination of pharmaco- and psychotherapy is advisable and this independently of the number of episodes.

Treatment in the first 3 months of pregnancy

The first 12 weeks of pregnancy constitute an important period in which medication can result in fetal malformations. Women may be using antidepressants at the beginning of pregnancy due to reasons discussed in the previous section or may become unintendedly pregnant. If she represented only mild symptoms in the past, she should gradually stop the medication within several weeks as soon as she knows she is pregnant. Women who experienced multiple past episodes of severe depression, can remain on medication or switch to medication viewed to be safer. Only in these women experts have the options to continue or stop the medication. Apart of continuing medication or not, psychotherapy is advisable to prevent recurrent depression.

Treatment in the second and third months of pregnancy

Later in pregnancy the drugs don’t cause malformation of fetal organs, but it isn’t well-known whether they impair the development of the child or its organs.

Acceptable reasons for using medication during the first trimester: episodes of severe depression in the past and/or during pregnancy. In this case medication should be continued during pregnancy.

If a woman who hasn’t taken medication, becomes depressed should start psychotherapy. Women with a history of severe depression can resume medication as soon as they feel any symptoms. But if the woman had only mild depression in her past, she should wait until the depression recur before taking medication.

What would be the right approach for women with a history of depression, who is fine without medication through the later stages of pregnancy? Is a restart of medication good approach for preventing postpartum depression? It is recommended to use preventive treatment of depression for women who have had previous postpartum depression but wait until the last month of pregnancy before starting medication.

Medication in the treatment of depression

Antidepressants include different chemical actions and side-effects. Women with depression who are planning to be pregnant or are pregnant should be treated with antidepressants including serotonin – chemical increasing brain levels. These antidepressants are called selective serotonin reuptake inhibitors (SSRIs). SSRIs are currently the most widely prescribed antidepressants and they have been taken by a lot of women. There is evidence for their dominance in effectiveness compared with other antidepressants. Therefore it isn’t a surprise that women become pregnant during the treatment with SSRIs. According to records infants of women using SSRIs don’t show higher rates of birth defects than infants born to women without pharmacotherapy (about 2% - 3%). Although antidepressants aren’t associated with risks of disability, the knowledge about the relations with organic functions will develop over time.

Tricyclic antidepressants have been used for over 40 years. Like SSRIs there is no evidence for the causal association between the use in pregnancy and birth defects. Other antidepressants aren’t used widely during pregnancy and thus there is less information about their safety.

Side-effects of SSRIs

Possible side effects of SSRI: irritability, insomnia, restlessness, nausea, diarrhea, and sexual problems. These side effects differ from one person to another. In case of problems with side effects, contact your doctor immediately. Don’t stop your medication. Your doctor may reduces the dose or switch you to another kind of SRRI.

Kinds of psychotherapy in the treatment of depression:

There is evidence for positive effects of psychotherapy in the treatment of patients with major depression. Moreover it provides successfully effects in pregnancy. Interpersonal therapy emphasize the reduction of strain in relationships while cognitive-behavioral therapy focuses on identifying and changing pessimistic thoughts and beliefs who can result in depression. The treatment only with psychotherapy works more slowly but the effects may be long-lasting.

Psychotic depression

The severe form of depression may include psychotic symptoms like delusions or hallucinations. Psychotic depression is important, because it can lead to a series of dangerous acts that impairs the safety of the mother and her unborn infant. Psychotic depression during any trimester of pregnancy is treated with antidepressant and a second medication called an antipsychotic. Electroconvulsive therapy is an important safe option that can replaces medications during pregnancy. According to experts only psychotherapy isn’t sufficient to treat psychotic depression.