Weigh risks of anti-depressants during pregnancy

DEAR DOCTOR K: I take an SSRI for depression. I’m trying to get pregnant, but I’m worried about going off my antidepressant during pregnancy. Can I continue to take an SSRI?

DEAR READER: You can, but at some small risk to the baby. But if you stop taking the SSRI while you are pregnant, you may increase your own risk of worsening depression during and after the pregnancy. So I don’t have an easy answer.

Treating depression is important for both your sake and your baby’s. Untreated depression during pregnancy increases your risk of postpartum depression. It also makes it more likely that your baby will be lethargic, irritable and underweight at birth.

But what kind of treatment? Medication is one option. Selective serotonin reuptake inhibitors (SSRIs) are the most common drugs prescribed for depression. SSRIs include fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro).

Another option is “talk therapy.” This can be traditional one-on-one sessions with a therapist. It also can mean family therapy, involving you, your spouse and possibly other family members. Cognitive behavioral therapy is a particular talk-therapy technique that can help you learn ways to think positively and solve problems. Even if your doctor says you need to continue taking medication along with talk therapy, you may be able to lower your dose or reduce the length of time you need the medication.

The risk to your baby from taking SSRIs during pregnancy is very small but still real. SSRIs during pregnancy are linked to increased risk of heart birth defects, respiratory problems and withdrawal symptoms in babies. Risk of miscarriage and premature birth may also increase.

Guidelines from the American Psychiatric Association and the American College of Obstetricians and Gynecologists recommend medication for expectant mothers with severe depression. But for pregnant women with mild to moderate depression, they recommend psychotherapy.