I found this recent article in the NY Times about antidepressants during pregnancy. It seems the New England Journal of Medicine supports “doctors’ assurances that antidepressants are not a major cause of serious physical problems in newborns.” While this is obviously good news for people who are on antidepressants the article then goes on to talk about possible rare side-effects from taking medication such as the “use of Paxil which was associated with an increased risk of a rare heart defect.” This is clearly a difficult subject to tackle because a woman who potentiallly comes off antidepressants during her pregnancy may suffer her own set of reactions.

Besides possible congenital disabilities, there is also the subject of withdrawel for the newborn baby who has been exposed to antidepressants while in the womb. Studies have not researched the behavioral effects but an article in About.com recommends, “to avoid withdrawal symptoms in newborns, some doctors recommend that these medications be tapered or discontinued 10 to 14 days before the patient’s due date.” And of course, on the subject of breastfeeding…some say SSRI drugs are not present in breast milk while others feel there has not been enough conclusive research and that there may be long-term nervous-system effects.

Clearly if you are seriously depressed and you are already on medication, then it would seem to be advisable to take the lowest recommended dosage of antidepressants during your pregnancy and to be closely monitored by your doctor. You may also consider changing medications to something that is supposed to be safer to take during pregnancy. But that again is a tricky one… since usually if you went on antidepressants in the first place you were probably feeling pretty bad and you are probably very anxious about returning to that state. I know I have a similar thing with my thyroid (I am hypothyroid) and the thought of coming off Synthroid and its repurcussions really scares me.

The first three months are really critical to a baby’s development and if you do decide to come off antidepressants, it should be with your doctor’s consent and with a strong support system around you. Some of the symptoms you may experience include: headaches, dizziness, fatigue, irritability, insomnia, vivid dreams, nausea and vomiting. The Womens Mental Health Organization writes, “Over 2500 women have taken Prozac during pregnancy, and there has been no reported increase in risk for birth defects among exposed children, even when medication was taken during the first trimester.” They also go on to say, “Recent studies indicate that women who are depressed during pregnancy are more likely to give birth to infants that have a lower birthweight, smaller head circumference and lower APGAR scores, which are all negative indicators of well being in the newborn. In other words, avoiding medication use during pregnancy is not always the safest option.” So does this mean, you’re damned if you do and you’re damned if you don’t?

All of this is so very individual — each person’s life history and personal circumstances may require different choices. In some cases, there might be a natural path to take but for others, the thought of stopping meds may be inconceivable. According to Dr. Dean Raffelock, my resident expert on all things mama and natural writes, “We have reached a point at which many people’s brains are having trouble making enough serotonin to match the levels of adrenal catecholamines [he goes into much more detail in his wonderful book] required to cope with life.” He believes, “an inadequate supply of serotonin…. may explain the startling statistic that an estimated one in ten Americans - and one in four women! - is now on SSRI drugs.”

He concludes, “Boosting serotonin (with SSRI’s) will improve most people’s moods, but this is symptomatic relief at best because the nutritional precursors the brain needs to produce its own serotonin remain depleted unless deliberately replenished. As Dr. Breggin says in his book Talking Back to Prozac (St. Martin’s Press, 1994), depression is not caused by a Prozac deficiency any more than a headache is caused by aspirin deficiency.”

Dr. Raffelock also refers to another type of depression that is not at all from low seratonin levels but rather from low levels of another brain neurotransmitter, norepinephrine and increasing seratonin levels with drugs will not help this type of depression. He desribes women with low serotonin levels as usually having a great deal of anxiety while if you have low norepinephrine levels you feel as if you have fallen into a deep, dark hole. He recommends for these people help restoring normal thyroid and adrenal gland function.

Very soon, I plan to add a list of sources for mamas if they are looking to go the natural route. It is not easy to know where to start. Most importantly, don’t feel you are alone with these decisions. There are a  lot of resources to support you through these difficult choices.

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July 3rd, 2007 | Permalink