Antidepressants are always an option for any patient suffering from depression. Depression carries numerous risks for women both in the prenatal and postnatal period which include but are not limited to low baby birth weight, premature birth as well as increased risk of postpartum depression for patients whose depression during pregnancy goes unchecked. Essentially, depression puts the health of both the mother and the baby at significant risk, hence the necessity for treatment. The decision to use antidepressants and the choice of antidepressants depends on various factors including the prevailing health condition of the mother and the severity of the depressive symptoms. Antidepressants have however been known to have several effects on maternal health for women older than 30 years.
The risk of depression among pregnant women positively correlates with age, increasing risk as the women grow older. The risk at 30 years is, therefore, significantly low although the trend may have been affected by other external factors such as economic pressure (Gadot & Gideon, 2015). Moreover, pregnant women suffering from depression are likely to carry preexisting conditions such as asthma, diabetes and hypertension. Psychotropic drug use is also higher among this demographic of women (Gadot & Gideon, 2015).
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Serotonin-norepinephrine reuptake inhibitors (SNRIs) and Selective Serotonin Reuptake Inhibitors (SSRIs) are antidepressants designed to regulate the patient’s mood. Notably, both antidepressants are known to cross the placenta, a factor which in itself may not be a cause for alarm as there are numerous other drugs that possess the same characteristic with no effects (Gadot & Gideon, 2015). SSRIs however, have been linked with respiratory distress among babies often due to persistent pulmonary hypertension. Some other symptoms may include increased irritability and jitteriness. Studies have also suggested low birth weight, miscarriage, stillbirth and congenital malformations to be possible effects of antidepressant use (Prady et al., 2018). In terms of maternal health, antidepressant use has also been associated with increased preeclampsia risk especially if antidepressant use continues past the second pregnancy trimester. Some studies also report a positive correlation with gestation hypertension incidence.
The failure to treat depression among women over 30 during the prenatal and postpartum period has been associated with adverse outcomes both for the mother and for the foetus. Among the leading factors which contribute to untreated depression during and after pregnancy is the fear of teratogenic effects (Gadot & Gideon, 2015). Notably, however, if treatment for depressive symptoms is terminated there is a significant chance of relapse or withdrawal (Prady et al., 2018). Women who either do not complete treatment or fail to treat depression have been observed to experience significantly higher rates of failure to maintain necessary conditions for a healthy pregnancy. There are also higher rates of attempted suicide, hospitalization and morbidity among these women (Prady et al., 2018). One of the leading causes of death among female mental health patients is suicide.
Despite the studies suggesting a correlation between SSRI and SNRI use and teratogenic effects, the claims remain unconfirmed due to the variability of research outcomes (Mitchell & Goodman, 2018). Women who experience depressive symptoms often use a variety of psychotropic drugs many of which are known to have little or no effect to fetal growth and development. There are also studies that indicate that incidence of fetal deformities may not be related to the intake of antidepressants, such as a study that indicated equal incidence of fetal cardiac malformations among women with untreated and treated depression (Gadot & Gideon, 2015). The relationship between antidepressant use and its effect on fetal growth and development is therefore largely unclear, and hence fear of teratogenic effects should not suffice as reason enough to discourage treatment for depression.
Avoidance of antidepressant intake and use of non-pharmacological methods where applicable and effective is a viable alternative that may eliminate the teratogenicity risk altogether. One of the common treatments is cognitive behavioral therapy which helps the patient identify the depressing factors and alter their perspective to alleviate the depressive feelings related to the factors. There are also several psychotherapeutic approaches to alleviate depressive symptoms such as management of external factors causing stress, relaxation efforts such as taking a break from work to rest and spending time with loved ones (Prady et al., 2018). Exercise is also considered helpful in curtailing the effects of depressive symptoms. Activities such as yoga, aerobics and walking not only relieve stress; they also carry benefits to overall health.
The decision to use antidepressants or not is therefore determined by several factors, chief of which is the severity of the depression. Mild depressive symptoms should be managed using nonpharmacological methods. Such symptoms are common in the first trimester of pregnancy and can be caused by various eternal factors such as financial stress, marital issues and loss of loved ones, among numerous others (Mitchell & Goodman, 2018). Severe depressive symptoms such as probable suicide attempts may necessitate more drastic treatment measures such as electroconvulsive therapy. Another factor is the existence of external conditions conducive for management of depressive symptoms without necessitating antidepressant use, such as family support.
In conclusion, antidepressant use or failure thereof should only be determined with the help of relevant professionals and specialists involved in the prenatal and postnatal care of the patient. While studies suggest that antidepressants affect maternal health and foetal growth and development in the prenatal and postnatal period, the exact effects remain inconclusive. There are studies that indicate no difference in outcomes between mothers who use antidepressants and those who do not. Untreated depression is also known to put the mother and the foetus at risk of various adverse outcomes. In making the decision for or against antidepressant use, a professional analysis of the risks and impacts of either course of action is needed.
References
Gadot, Y., & Koren, G. (2015). The use of antidepressants in pregnancy: focus on maternal risks. Journal of Obstetrics and Gynecology Canada, 37(1), 56-63.
Mitchell, J., & Goodman, J. (2018). Comparative effects of antidepressant medications and untreated major depression on pregnancy outcomes: a systematic review. Archives of women's mental health, 21(5), 505-516.
Prady, S. L., Hanlon, I., Fraser, L. K., & Mikocka-Walus, A. (2018). A systematic review of maternal antidepressant use in pregnancy and short-and long-term offspring’s outcomes. Archives of women's mental health, 21(2), 127-140.
