Women's Health
ACOG President Gerald F. Joseph, Jr, MD
Treating Depression during Pregnancy
Pregnancy can be a time of joyful anticipation in preparation of a new baby’s arrival. However, for women with depression, excitement about pregnancy or many other life events can be hard to achieve.
Depression is a complex and serious mental illness—involving more than a passing case of the blues or a short period of grief after suffering a loss—and it is common among pregnant women. Between 14% and 23% of pregnant women will experience depression, and some will be diagnosed for the first time during pregnancy.
Identifying depression in pregnant women can be difficult because its symptoms mimic those associated with pregnancy, such as changes in mood, energy level, and appetite. Symptoms may also include lack of interest in things that used to be enjoyable; feeling sad or “down in the dumps;” restlessness, not being able to sit still, or feeling very sluggish; feelings of worthlessness or guilt; thoughts of death or suicide or attempts at suicide; problems concentrating, thinking, remembering, or making decisions; or sleeping toomuch or having problems falling or staying asleep. Experiencing several symptoms all day, every day for an extended period of time may be a sign of depression. Additionally, some women may suffer from headaches or other aches and pains, digestive problems, sexual problems, hopelessness and negative feelings, worry, or fear. Regardless of pregnancy status, you should talk to your doctor if you experience the symptoms of depression.
Pregnant women with depression often weigh treating their illness against concerns about using antidepressants—which have been linked to fetal malformations, cardiac defects, and other negative outcomes—during pregnancy. But not treating depression during pregnancy carries a risk as well. Depressed women are more likely to have poor prenatal care and pregnancy complications, such as nausea, vomiting, and preeclampsia, and to use drugs, alcohol, and nicotine. Infants born to women with depression have increased risk for irritability, less activity and attentiveness, and fewer facial expressions compared with those born to mothers without depression.
Getting depression under control should be a priority for pregnant women and their doctors. Women have several treatment options. After reviewing the risks and benefits, some women may decide to continue using the medication that has worked for them, while others may try to gradually taper off anti-depressants (under their doctor’s supervision). Women with mild to moderate depression may also benefit from seeing a therapist instead of or in combination with medication. Any treatment regimen should be developed with input from a woman, her ob-gyn, and her psychiatrist.