Pregnancy is not necessarily a time of emotional stability, particularly for women who have a history of mood disorders or those on psychiatric medications or have recently been discontinued. The impact of major depression during pregnancy is still underappreciated. It is estimated that most women are either under treated or untreated for depression during pregnancy. Depression during pregnancy poses a number of problems both for the mother and the baby. Depressed women are unable to care for themselves. They are easily irritable and overwhelmed and if severely depressed may be ambivalent about the prospect of being a mother. In addition depression during pregnancy increases the risks of post partum depression and other mood disorders, which is particularly problematic because this is the time when the maternal responsibilities are the greatest.
Planning for pregnancy is strongly advised for women with psychiatric history.
Important Considerations When Treating Depression In Pregnancy
1. Women with history of major depression should seek consultation with psychiatrists/specialists before becoming pregnant
2. Both partners should be present for consultation
3. For mild symptoms of depression, nonpharmacologic treatment modalities as psychotherapy and marital counseling should be considered.
4. For severe depression treatment with antidepressants should be considered for both maternal and fetal wellbeing.
5. All women with depression during pregnancy should be closely monitored for postpartum depression.
Reasons For Antidepressant
Treatment During Pregnancy
1. Non-medication options have failed
2. History of severe relapsing depression
3. Suicidal ideation
4. Psychosis
5. Poor weight gain
6. History of depression during previous pregnancy
Postpartum Depression
/Mood Disorders
Postpartum Blues - includes mood lability, emotional hypersensitivity and irritability and begins within few days of delivery in 85% of new mothers and usually resolves within two weeks.
Postpartum Depression - begins about four weeks after delivery but may be overlooked for several months. Screening and treatment are critical to reduce risks to children and mother.
Postpartum Psychosis - begins within days of delivery, is a particular risk for women with a history of  bipolar disorder.
The decision to breastfeed while taking psychotropic medication should be made after evaluating the known benefits of breastfeeding, the mother’s desire and the risk of infant exposure to the medications. The choice of medication depends on the diagnosis, side effect profile and dose flexibility. Mothers should be given the minimum dose that can achieve remission. The infant drug clearance of the medication is about 33% at birth and 100% at six months. Most commonly used class of drugs are SSRI’s such as Prozac, Zoloft, Effexor, Lexapro and are all excreted in the  breast-milk. No serious adverse events have been reported in children breastfed by mothers on SSRI’s. There are no studies addressing long-term effects of SSRI’s on child development in children exposed to these drugs via breast-milk.