Share this story

Expert’s Corner: Consider all options for treating depression during pregnancy

UMass Chan psychiatrist weighs risk and benefits of antidepressants for pregnant women

Afflicting nearly one in 10 pregnant women, depression can negatively impact the baby as well as the mother, making diagnosis and treatment doubly important. But controversy about the safety of antidepressant use during pregnancy can complicate deciding on a treatment.

“Depression can impact a mom’s health, and impact a baby’s health, and the best thing a mom can do for herself and her baby is to get the help and support she needs,” said psychiatrist and perinatal depression expert Nancy Byatt, DO. “That help and support can include an array of treatment options.”

Antidepressant medications and non-medication therapies such as psychotherapy are mainstays of treatment that can be employed separately or in combination. But ongoing controversy about the safety of antidepressant use during pregnancy prompted Dr. Byatt, assistant professor of psychiatry, to analyze research on the risks and benefits of antidepressant use during pregnancy.

In “Antidepressant use in pregnancy: A critical review focused on risks and controversies,” she and co-authors reviewed the risks of untreated depression and anxiety, the literature on risks of exposure to antidepressants during pregnancy, and the strengths and weaknesses of the different study designs used to evaluate those risks. They found that while some individual studies suggest associations between some specific major malformations, the overall evidence about whether antidepressants cause harm to developing babies is inconclusive, and concluded that the absolute risks appear small.

Therefore, in order to provide clinical recommendations when weighing potential risks of medication against the known risks of untreated depression for both babies and mothers, it is vital for physicians to have a careful discussion tailored to each patient. The review notes that past medication trials, previous success with symptom remission and women’s preference should guide treatment decisions.

“Important questions to ask are what is going to help mom and baby the most, and what might happen if mom isn’t treated?” said Byatt. “That can help make the decision as to whether antidepressant treatment is warranted, and whether the benefits outweigh the potential risks.”

Hear more from Byatt in this Expert’s Corner video.

Related links on UMassMedNow:
More help on the way for Mass. women with depression during and after pregnancy
Byatt to Telegram & Gazette: postpartum depression can interfere with mother-child bond