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Pregnancy

Q: I am trying to get pregnant, but have a history of depression. In the past, I respond well to medication. Should I worry about taking medicine if my depression recurs during pregnancy?

A: Many women share your concern. Studies suggest that up to 7 percent of women who become pregnant develop major depression. Another 7 percent develop minor depression.

Mental health professionals, obstetricians and their patients often need to balance:

--The chance that exposure to anti-depressant drug may harm the developing fetus

--The danger of not adequately treating the pregnant woman

It's terrific that you want to learn about your options "just in case." Too many pregnant women don't seek help. They push aside their feelings and think "I'm pregnant. I'm supposed to be happy. I'll get over these feelings of depression." They also worry that the doctor will prescribe an antidepressant that might harm the developing fetus.

But depression during pregnancy should be treated. It's important for the mother and for the developing fetus. Among other risks, untreated depression during pregnancy increases the likelihood that a woman will develop postpartum depression and give birth to a low-weight baby. Also there's a greater chance that the newborn will be lethargic and more irritable than expected.

For women with mild to moderate depression, talk therapy alone can be very effective. But treatment of severe depression during pregnancy almost always requires antidepressant medicine.

Selective serotonin reuptake inhibitors (SSRIs) are the drugs most often used to treat depression during pregnancy. They include citalopram (Celexa), fluoxetine (Prozac), sertraline (Zoloft), and others.

All psychiatric medicines cross the placenta and reach the fetus. But the risks to the developing baby are very small. For mild or moderate depression, most doctors recommend starting a low dose SSRI, such as 10 mg of citalopram or fluoxetine or 25 mg of sertraline daily.

Women with severe depression during pregnancy need to keep an open mind about higher doses of medication if needed. Even if you are reluctant to take more medicine, contact your doctor or therapist right away if your symptoms are getting worse -- especially if you have any thoughts of suicide.

(Howard LeWine, M.D., is an internist at Brigham and Women's Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.)

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