On the other hand, “the risk of untreated [mental] illness can be very severe – on the woman, on the pregnancy, on the development of the fetus, on long-term parenting,” notes Dr. Veena Prabhakar, a psychiatrist with Wheaton Franciscan Behavioral Health.
In the end, the answers involve a delicate balancing act of risks and benefits.
A Difficult Diagnosis
It was once widely believed that pregnancy protected against mental illnesses such as depression.
But now researchers know that’s not true.
“These disorders don’t just go away during pregnancy,” says Prabhakar
Postpartum depression can lead to negative parenting behaviors, such as ignoring or yelling at the child, and a reduction in positive behaviors, such as singing or reading to the baby, notes Prabhakar
, a woman’s history – especially if it includes prior hospitalizations for depression or a tendency to self-neglect – is most important.
“If a woman has had a history of recurrent depressive episodes, and moderate to severe depression,
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chances are she
would probably benefit from staying on medication during pregnancy,” says Prabhakar
For a woman with milder depression who doesn’t like the idea of medication, psychotherapy, cognitive-behavioral or interpersonal therapies can all be helpful.
Light therapy and the use of omega-3 fatty acids have also shown some promise for alleviating depression.
Although few medications have proven indisputably safe to take during pregnancy, some antidepressants are better than others.
Research to date shows that selective serotonin reuptake inhibitors (SSRIs) such as Prozac (fluoxetine) and Zoloft (sertraline) have a low risk of birth defects – roughly equivalent to that of the general population, Prabhakar says.
The exception among SSRIs, Paxil (paroxetine), has been associated with fetal heart defects.
Women who contemplate stopping their antidepressants during pregnancy should be aware they stand about a 70 percent chance of relapse, Prabhakar
Depending on the situation, such a risk may be far greater than that of medication exposure.
Still, many women simply are not comfortable with taking medicine during pregnancy.
“A lot of women say, ‘No.
I don’t want my babies exposed to any medications … I don’t care how high the risk is that I’m going to relapse; I don’t care how high the risk is of postpartum depression,” says Prabhakar
“If they feel strongly about that, you have to work with them.” In such situations, a doctor continues to evaluate the patient throughout her
pregnancy to make sure she
is coping well with alternative therapies.
Beyond depression and anxiety, there are a host of psychiatric illnesses that affect women, notes Prabhakar