STORY BYYou continued taking Prozac after you got pregnant, and are in your third trimester. From past experience you know that when you don’t take your medication you feel a little depressed. Scratch that. A lot depressed. You don’t feel like getting out of bed most mornings. Nothing is fun. You can’t sleep. You need help.
But you heard a recent story that said antidepressants could cause side effects in babies after they are born. And another where Tom Cruise called antidepressants a “mask” for real feelings, and suggested taking vitamins and exercising instead.
For the sake of your baby, you are considering whether to stop taking your antidepressants.
That would be a mistake, say obstetricians.
“Women who need to be treated with antidepressants during pregnancy shouldn’t automatically stop them in their third trimesters,” says Dr. Pamela Berens, associate professor in the Department of Obstetrics and Gynecology at The University of Texas Medical School at Houston. If you still are depressed, suddenly going off antidepressants could cause the depression to rebound and worsen, overwhelming you with emotion. “If you are depressed during pregnancy, you also increase your risk for postpartum depression,” Berens continues.
Pregnancy is an emotional rollercoaster. One minute you are cooing over the cutest pair of baby Nikes—the next, you are sobbing in the greeting card aisle. A certain amount of emotional pendulum-swinging may feel unfamiliar, but is expected.
But feelings of utter despair and hopelessness are different and can’t be chalked up to pregnancy hormones alone. If the feelings last longer than a couple of weeks, they may be symptoms of clinical depression—a serious disorder that needs to be treated.
Ideally, if you have a personal or family history of depression, you should discuss it with your doctor during your first prenatal visit. That way, both you and your doctor can be aware of symptoms of depression that might arise. Women with no history of depression can also become depressed during pregnancy.
Tell your doctor about your feelings and he or she will work with you to develop a treatment plan. Depending on the severity of your depression that could mean counseling, treatment with antidepressants, or both. Some obstetricians may feel comfortable with prescribing antidepressants, while others may refer you to a psychiatrist.
Past studies have shown that the type of antidepressants most commonly prescribed, called selective serotonin reuptake inhibitors or SSRIs, don’t increase the risk of miscarriage in pregnancy or cause birth defects. And a Canadian study on the mental function of preschool children, published in the New England Journal of Medicine in 1997, found no difference between children whose mothers took antidepressants and those who didn’t.
But babies born to women who take antidepressants may have some temporary side effects from the drugs after they are born. According to a University of Pittsburgh study published in the May 18 issue of the Journal of the American Medical Association, babies born to women taking antidepressants in the last three months of pregnancy were more likely to develop drug-related symptoms than those born to women who did not use the drugs or took them only in early pregnancy.
The drugs involved in the study include Prozac, Paxil, and other SSRIs, and also serotonin norepinephrine reuptake inhibitors (SNRIs), which include Effexor, among others. The most complications occurred with Prozac and Paxil.
Symptoms included jitteriness, irritability, weak cry, poor muscle tone and respiratory problems. Most of the symptoms were mild and usually disappeared after about two weeks, and could be managed in a hospital setting. However, some of the babies studied required intensive care hospitalization.
The U.S. Food and Drug Administration recently changed its labeling of SSRIs and SNRIs to include a caution to physicians and patients about the side effects of the drugs on newborns. The label recommends that tapering the use of antidepressants during the last trimester of pregnancy may be an option to eliminate some of the symptoms in newborns. Not all OB/GYNS agree with this approach.
“We believe those recommendations are only partially evidence-based and may put the depressed mother-to-be and her baby at an unreasonable health risk,” say doctors in an article in the May 24 issue of the Canadian Medical Association Journal.
Dr. Alex Vidaeff, associate professor in the Department of Obstetrics and Gynecology at the UT Medical School, agrees. “Risks of untreated depression are much higher than the risks of neonatal hyperactivity, or even the longterm effects (of SSRIs) that we have yet to recognize."
Taking any medication during pregnancy is a serious matter. Both the patient and doctor must weigh the potential benefits and risks to the mother and her growing baby. Not treating depression can cause preterm delivery, premature separation of the placenta and poor fetal growth. Depressed women also sleep and eat poorly.
Vidaeff says women may use drugs, alcohol or tobacco to cope with their depression as a way, “self-medicating, in the absence of adequate help.”
An estimated 13 percent of women are depressed at some point during their pregnancy. Of that number, about one third have suicidal thoughts. Women who are depressed during their pregnancy are also at higher risk for developing postpartum depression.
“After birth, untreated depression has a negative effect on the infant,” Berens says. “There is some information that suggests that untreated depression, when you are raising small children, can negatively affect their growth and development. No one really knows why, but in theory that can happen because the mother is not really paying attention to the baby’s needs. She is depressed. She just can’t do it.”
Like many mental illnesses, depression during pregnancy and postpartum depression is often misunderstood, and carries a stigma. Dr. Donna Rocha, assistant professor of psychiatry at UT Medical School, says coverage of the Andrea Yates murder trial and Brooke Shields’ revealing book chronicling her struggles with postpartum depression are helping educate the public about the seriousness of depression. But Rocha and her colleagues worry that Cruise’s response to Shields' book and public stance against treating mental illness with medication might reverse that progress.
“Given his star power, it (his suggestion that women take vitamins and do exercise to treat postpartum depression) could have a big impact,” Rocha says. “We really don’t know what causes postpartum depression. There is really no proof of studies of whether vitamins are helpful.”
What is helpful, Rocha says, is early intervention. Rocha is working with Berens and Dr. Patricia Averill, associate professor of psychiatry at the medical school, to investigate ways to prevent postpartum depression. Methods may include counseling, support groups and teaching patients about substance abuse and depression. The colleagues are working on a grant proposal to secure funding for their research.
Because pregnancy is supposed to be the happiest time of their lives, and society expects mothers to radiate perpetual nurturance, women may be reluctant to seek help for depression. A spouse or loved one may need to be the person who recognizes something is wrong and gets help. Support and understanding is a crucial part of dealing with depression during pregnancy.
“There are a lot of stressors related to pregnancy and I think that people often underestimate what a big life change it is,” Berens says.
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Dr. Pamela Berens is an associate professor in the Department of Obstetrics and Gynecology at the UT Medical School.
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Eating healthy
reverses metabolic syndrome
Dr. Tasnime Akbaraly of University College London and her colleagues were interested if healthy eating could actually turn-the-tide and reverse metabolic syndrome, which is having 3 or more of the following risk factors: excess abdominal fat; high triglycerides, hypertension, low levels of HDL the “good” cholesterol, or type 2 diabetes. Having metabolic syndrome doubles a persons’ risk of heart disease and greatly increases the odds of developing type 2 diabetes.
The researchers studied 339 British civil servants with metabolic syndrome, and how closely the adhered to the Alternative Healthy Eating Index (AHEI) to see if it could help reverse metabolic syndrome. The AHEI is a set of published nutritional guidelines by the Harvard School of Public Health in 2002 that emphasizes whole grains, fruits, vegetables and decreased red meat consumption.
Five years into the study, nearly 50% no longer had metabolic syndrome. People who followed the AHEI guidelines the closest were nearly twice as likely to have reversed their metabolic syndrome. The results of the study were published in Diabetes Care, online July 29, 2010.
Dr. Alice Lichtenstein, an expert on diet and heart health from Tufts University in Boston who was not involved in the study said, "It's not about focusing on individual components of the diet, it's really the whole package, and that becomes important because it means that if one of the components of a healthy diet is to eat more fruits and vegetables, just buying a pill saying that there's a concentrated extract of fruits and vegetables is probably not what's going to help you."
Call and make an appointment with Wellness Coach Sam Hester, CWC, CPT, LWMC, at 713-500-3327. It's confidential and free. For more information on the wellness services provided, visit UT Counseling and WorkLife Services.
