Last updated on Feb 17th, 2021 at 03:20 pm
By Georgina Guedes
“Women already suffering from depression have a higher risk of postnatal depression,”says gynaecologist Dr Tom Mokaya. Psychiatrist Dr Dora Wynchank adds that 60% of women with postnatal depression say their symptoms started during pregnancy. For this reason, it’s vital for women with pre-existing depression to be closely monitored during and after their pregnancies.
Are antidepressants safe during pregnancy?
After Anna had her first baby, she had four miscarriages and eventually suffered an emotional breakdown. Her psychiatrist prescribed an antidepressant to stabilise her mood. When she was ready to come off the medication, she fell pregnant. Initially, she thought she should stop her antidepressant immediately but her psychiatrist advised otherwise.
“My psychiatrist explained a calm mom has a calm baby. Since I was only on 10mg Cipralex, the medication and dosage were kept the same.”
Anna’s psychiatrist’s view is a simplification of the general consensus among psychiatrists about taking antidepressants during pregnancy.
“All psychiatric medication has to dissolve in fat in order to get to the brain,” says psychiatrist Dr Dora Wynchank. “Therefore, all psychiatric medication can cross the placenta. However, recent research shows that depression is an illness that has ramifications for the baby.”
She explains that elevated stress hormones can adversely affect the unborn baby. Consequently, gynaecologists and psychiatrists generally work together to weigh up the risks of leaving the mother untreated compared with the risk the mother’s depression will have on the baby. The risks of antidepressants, she adds, are very slight:
“Only around 1% of all babies born will have some congenital malformation and studies show this isn’t increased by the mother taking antidepressants.”
On the other hand, many women continue to use small amounts of caffeine or alcohol, despite scientific findings that these have a definite negative impact on the unborn baby:
“These are toxins but you must weigh up the mental health of the mother. If a cup of coffee helps you cope, and you use it in moderation, it’s better to be a well-balanced, happy parent,” says Wynchank.
Weighing up the risks
Although controversy exists around some modern antidepressants, like selective serotonin reuptake inhibitors (SSRIs), these are mild and may cause only a 30g lighter birthweight or labour a week short of full term. Stronger medication, like lithium, which Wynchank explains is actually a mood stabiliser for the treatment of bipolar disorder, has been linked to cardiac problems in babies.
“Biopolar mothers should, ideally, plan their pregnancies. For the first three months we attempt to take away the medication, but for mainstream depression none of the medications are totally contraindicated,” says Wynchank.
But any mom will be concerned about taking medication during pregnancy, so some try stopping their medication before falling pregnant or once they have.
“No medication is completely safe during pregnancy. Some can affect a baby’s nervous system or cause premature labour,” says gynaecologist Dr Tom Mokaya.
“If a patient is on antidepressants, I consult with the prescribing doctor or psychiatrist to get guidance on whether they’re able to stop or not. Some patients can have a severe relapse, which can put them and their pregnancy at risk,” he adds.
Mokaya says that depending on how severe the depression is, doctors will generally try to keep the mother on some form of medication because symptoms can worsen in the first trimester:
“Before they fall pregnant, women should see their gynaecologists and psychiatrists. If they fall pregnant without consultation, then make an appointment to see them as soon as possible.”
Whichever approach the mother chooses in consultation with her doctors, her pregnancy will be treated as high-risk, says Mokaya:
“If she’s on medication, she’ll be advised to have regular visits with her gynaecologist and regular consultations with a psychiatrist. At around 20 weeks, she should visit a foetal medicine specialist to scan the baby for problems with the nervous system or brain fluid.”
He strongly advises women on antidepressants to see their gynaecologist and psychiatrist when they consider falling pregnant or once they know they’re pregnant.
Coming off the meds
Despite concerns about a relapse or further complications, many women successfully come off antidepressants during their pregnancies:
“There’s a hormonal volcano during pregnancy and I’ve seen some women cope very well. It might be the hormonal changes or the shift in focus but I’ve seen some cope well on drugs used for depression, panic disorders or anxiety,” says psychologist Gerhardt Goosen.
This is not true in all cases and he advises that anyone weaning themselves off antidepressants should do the following:
- Be in constant touch with a professional who can make appropriate decisions.
- Ensure you have good support.
- Attend antenatal classes to dispel anxiety about the birth.