New Data Aid Decision Making

Several recent articles have provided women with additional information about the risks and benefits of taking antidepressant medications during pregnancy.

Two articles included data about the risk of potential harm that selective serotonin reuptake inhibitors can have on newborn infants (see story at left) and a third showed that nearly 70 percent of mothers with depression who abstain from taking antidepressants during pregnancy are likely to experience a relapse of depression while pregnant, which may also have a negative impact on the fetus (see article below).

Though this additional information may make it even more difficult for expectant mothers to decide whether to take antidepressants, “women can make a more informed decision now,” Darrel Regier, M.D., M.P.H., told Psychiatric News.

“What we have now is information you can tailor to the individual patient depending on the severity of her depression and depressive history,” noted Regier, who is director of APA's Office of Research and the American Psychiatric Institute for Research and Education.

It may be possible for some women to reduce the dose of antidepressants toward the end of pregnancy to lessen the chance for pulmonary hypertension in their newborns, for instance, Regier said.

APA Vice President Nada Stotland, M.D., M.P.H., pointed out that the physician has an important role to play in the patient's decision about whether to continue with antidepressants during pregnancy. Stotland is a professor of psychiatry and obstetrics/gynecology at Rush Medical College.

After obtaining the patient's permission, it may be helpful for the physician to speak to the woman's loved ones about the risks and benefits of taking antidepressants during pregnancy.

“You don't just leave the patient with the numbers,” she said. Instead, the physician should help the patient to make a decision with which she is comfortable and support her in whatever decision she makes.

Stotland also noted that if the patient decides to stop taking antidepressants during pregnancy, intensive psychotherapy can be helpful in lieu of medications. Unfortunately, many health insurance plans discriminate against this type of treatment, she noted.

“This is an argument for psychiatrists to be reimbursed for psychotherapy,” she said. The psychiatrist who provides psychotherapy to the expectant mother can then monitor her depression closely and, if necessary, place her back on antidepressant medications, Stotland added.