Courtesy of WSJ
Pregnant women suffering from depression should consider psychotherapy before taking antidepressant medications, according to the first comprehensive treatment recommendations issued on the subject from the American Psychiatric Association and American College of Obstetricians and Gynecologists.
Women with moderate to severe depressive symptoms, including suicidal thoughts, or who have experienced repeated episodes of depression should remain on their medications during pregnancy, the recommendations say. Any pregnant woman already taking an antidepressant should talk with her doctor before deciding to continue or to taper off.
"The black box in this -- what we don't know -- are people with milder depression," said Kimberly Yonkers, a professor in the departments of psychiatry and obstetrics and gynecology at Yale University, and the first author on the report, which is being published Friday in the journal General Hospital Psychiatry. "The story is not established in the literature whether that group of people should be kept on antidepressants in pregnancy."
The biggest concern for unborn babies with a popular class of antidepressants known as selective serotonin reuptake inhibitors is increased risk of pulmonary hypertension, or increased pressure in the lungs that can lead to heart failure. Newborns who were exposed to SSRIs after 20 weeks in the womb have a sixfold increase in the relative risk of developing this condition, though the absolute risk is small at 1 to 2 per 1,000, according to the report.
Popular SSRIs include Eli Lilly & Co.'s Prozac and Pfizer Inc.'s Zoloft, both marketed in generic versions. Another SSRI, paroxetine, sold by GlaxoSmithKline PLC as Paxil, has been associated in rare cases with cardiac abnormalities if used by the mother during the first trimester.
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