Evidence suggests that mental disorders during pregnancy can increase the risk for complications in both mother and child.

There is a stigma attached to taking antidepressants during pregnancy or breastfeeding. How should women decide if they want to take antidepressants or not during this time?

Mental health in pregnancy and after birth

Untreated depression and anxiety during pregnancy have been linked to a higher risk of stillbirths, premature births, low birth weight and low APGAR (an assessment done at the time of birth to assess a baby’s overall health).

Additionally, anxiety and depression during pregnancy can lead to an increase in maternal weight gain or substance abuse. These lifestyle factors may also cause complications in the baby.

Anxiety, depression, and stress before and after pregnancy may affect the bond between mother and child and can hinder their emotional and behavioral development.

Complications in pregnancy can worsen the mental health of the mother.

Some women may not want to take medication while pregnant. Tapao/Shutterstock

It is demoralizing for women to not cope during pregnancy, and this can lead them to self-harm. In Australia, suicide is the most common cause of maternal deaths in the first year after childbirth.

Treatment Options

Treatment options for women experiencing symptoms during or after pregnancy can range from emotional and social support (for instance, support groups) to psychological interventions (such as cognitive behavioral therapy) to medical treatments (for example, antidepressants).

Many women are reluctant during pregnancy to take medication, and even more so while breastfeeding. They fear that the drug may cause complications for the child. Women are naturally concerned about historical instances, such as the use of thalidomide to treat morning sickness that resulted in severe structural defects in thousands of children.

Read more: Thalidomide Survivors are Receiving an Apology for the Pharmaceutical Disaster That Changed Pregnancy Medicine.

Robust evidence about medication use in pregnancy is lacking. This may be due to ethical limitations around trialing medications in pregnant women. The limited data available, mainly from observational studies on selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), the most commonly prescribed antidepressants during pregnancy, has mixed results.

While some studies report no increase in the risk for congenital abnormalities, there is evidence that shows a marginal increase in abnormalities like heart defects (2 extra cases per 1,000 newborns with SSRIs).

Collaborative decisions

It is important to find the right balance between treating the mom and protecting the baby. In order to make informed decisions, the patient and mental health professionals must have an open dialogue about the risks and benefits of taking antidepressants.

Antidepressants may be the best option to protect the child from adverse outcomes due to the poor mental health of the mother.

It’s usually not necessary for women who already take antidepressants to stop taking them during pregnancy. Antidepressants should not be abruptly stopped as this increases the risk of relapse.

Breastfeeding while taking antidepressants may be the best option due to the benefits of breastfeeding and the dangers of not breastfeeding.

Read more: 20% of pregnant Australian women don’t receive the recommended mental health screening.

Recently revised guidelines on mental health care in the perinatal period (during pregnancy and after birth) warn health professionals against the dangers of failing to prescribe necessary medication:

You should be aware that not taking medication for depression or anxiety during pregnancy and postnatally can affect the mother-infant relationship, parenting, mental well-being, and infant outcomes.

The guidelines recommend that all women in the perinatal phase be screened for depression and anxiety symptoms. It is important to refer women to mental health services early if they need it.

Mental health problems during pregnancy and postpartum are often not detected and treated.

Treatment options are available for perinatal depression and anxiety. Pormezz/Shutterstock

Supporting perinatal mental wellbeing

Mental illness during pregnancy is a serious public health issue. The screening is not always done effectively. There is currently no data on the use of perinatal mental healthcare screening services or their outcomes.

My colleagues’ study of pregnant women’s use of perinatal mental healthcare services revealed that only one-third accepted a referral, and less than 50% attended their appointment. Women may not want to participate due to stigmatization, lack of childcare, or social support.

In order to address this issue, we need to create strategies and resources with pregnant women in collaboration. This will help them identify the solutions that are most effective for them. These might include childcare assistance, telehealth access, visits by a perinatal psychiatrist, or written information about medications.

Read more: Considering going off antidepressants? Here’s what to think about first.

Care must be holistic and include partners who may be best placed to support pregnant women in making complex decisions. Healthcare providers need to be respectful of individual needs and provide compassionate care to engage vulnerable mothers who may understandably feel uncertain regarding their options.