Many women wonder if they should take antidepressants while pregnant. A recent study shows that there are more complications of birth including C-Sections, premature births and induced deliveries. Paroxetine (Paxil) was associated with twice the rate of congenital heart defects and hypospadias (a penis malformation.) Tricyclic antidepressants were more strongly associated with malformations and persistent pulmonary hypertension.
It would be good to avoid antidepressants altogether during pregnancy- and if you wean off of them the hormonal changes of pregnancy may be antidepressant enough. However if it is not, know that there is a danger to untreated depression. But there are several things you can do before deciding to go back onto pharmaceuticals.
First, make certain your magnesium intake is sufficient as magnesium alone can often treat depression, even bipolar depression. We cannot get enough from food unless we eat sea vegetables regularly because it is no longer in the topsoil used for farming. Take colloidal magnesium at the recommended dosage or up to 800 mg magnesium citrate as it is not well absorbed. Taking it with trace minerals and at meals when other minerals are present may help. Magnesium is used in the cellular actions that affect neurotransmitters.
Second take enough fish oil to provide a 1000mg of DHA. DHA is very important to the fetal brain in pregnancy but fish oil also helps the cell membranes be more permeable to neurotransmitters like serotonin.
Third, raise your Vitamin D level to 80ng/ml. People with depression are usually deficient in Vitamin D. You need supplements and levels of 10,000 are safe without a blood test, although you are probably able to get that tested along with your prenatal tests. (A person in the sun for 2 hours without sunscreen at the appropriate time will pick up 20,000 iu or more.) When mothers supplement, the babies have less Type 1 diabetes, MS and other problems. Although it won’t give you Vitamin D in the winter if you live north of Atlanta, being outside may help you absorb the vitamin and produce useful endproducts.
Forth: look at non-drug methods of reducing depression. Exercise is excellent, with efficacy levels comparable to medications, and it can get you out in nature, and the sun. Acupuncture is good for resetting your internal balance, but tell your acupuncturist if you are pregnant so they can avoid certain points. Talk therapy may work- cognitive behavioral therapy being one of the more effective forms. And changing your objective circumstances may help, be it leaving an abusive partner or asserting yourself on the job (but do consider the effects on your insurance coverage.) Sleep enough hours- growing a baby is real work and you may need more that usual, especially in the last trimester when napping on your left side is useful. And eat well, mostly protein and nutrient-dense vegetables, and not too much.
If you have tried all those things, you may consider herbs. Chinese medicine has a long clinical track record with classical herbal formulas considered safe for pregnancy and with individual herbs that are classified as prohibited, used with caution or safe. You won’t find double-blind studies, but then records of long term use is a type of evidence-based medicine. Western herbs may also be traditionally used during pregnancy without harm. Find a good, experienced herbalist, with AHG or NCCAOM designations to work with if you have any doubts. And then listen to your body. Your body is smart and if you get alarm sensations, or if the baby seems to be objecting, then discuss changing the herbs suggested.
There may be a place for antidepressants during pregnancy. Depression itself is not good for the fetus. But because of the risks, nonpharmaceutical forms of antidepressants should be your first line of defense.
Source: Psychol Med | Posted 1 week ago
Delivery outcome after maternal use of antidepressant drugs in pregnancy: an update using Swedish data; Reis M, Källén B; Psychological Medicine 1-11 (Jan 2010)
BACKGROUND: Concerns have been expressed about possible adverse effects of the use of antidepressant medication during pregnancy, including risk for neonatal pathology and the presence of congenital malformations.
Data from the Swedish Medical Birth Register (MBR) from 1 July 1995 up to 2007 were used to identify women who reported the use of antidepressants in early pregnancy or were prescribed antidepressants during pregnancy by antenatal care: a total of 14 821 women with 15 017 infants. Maternal characteristics, maternal delivery diagnoses, infant neonatal diagnoses and the presence of congenital malformations were compared with all other women who gave birth, using the Mantel-Haenszel technique and with adjustments for certain characteristics.
RESULTS: There was an association between antidepressant treatment and pre-existing diabetes and chronic hypertension but also with many pregnancy complications. Rates of induced delivery and caesarean section were increased. The preterm birth rate was increased but not that of intrauterine growth retardation. Neonatal complications were common, notably after tricyclic antidepressant (TCA) use. An increased risk of persistent pulmonary hypertension of the newborn (PPHN) was verified. The congenital malformation rate was increased after TCAs. An association between use of paroxetine and congenital heart defects was verified and a similar effect on hypospadias was seen.
CONCLUSIONS: Women using antidepressants during pregnancy and their newborns have increased pathology. It is not clear how much of this is due to drug use or underlying pathology. Use of TCAs was found to carry a higher risk than other antidepressants and paroxetine seems to be associated with a specific teratogenic property.
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