Pregnant pause?

During her first pregnancy four years ago, Erin Shea didn't even bother to ask her doctor whether she could keep taking an antidepressant. She figured the answer would be no.
So Shea stopped on her own. She struggled through the next nine months with panic attacks, the condition for which she had started taking Zoloft.
Her second pregnancy, which culminated in her son's birth in June, was completely different. This time, her obstetrician knew she was on the anti-depressant, and she remained on the drug.
"I made a big mistake," says the Indianapolis resident of her original decision. "So many medications, when you're pregnant, you're not supposed to take. I just assumed that I couldn't take it. . . . I should have used my senses and asked."
It's an issue that faces a lot of women when they find out they're expecting: Is it better to quit taking antidepressants because they might harm the fetus, even if that means allowing depression to potentially complicate a pregnancy?
Most doctors don't issue blanket recommendations either way. A decade ago, data didn't exist to show that such drugs could be taken during pregnancy. Studies conducted in recent years, however, suggest that in most cases, the medications, known as selective serotonin reuptake inhibitors (SSRIs), cause no damage to a fetus.
The decision should be an individual one between a patient and her doctor, according to guidelines released in December by the American College of Obstetricians and Gynecologists. That statement also recommended against the use of Paxil, which it said is associated with an increased risk of cardiac malformations.
About one woman in 10 experiences depression during pregnancy or post-partum, according to the group. Two to three percent of women take antidepressants while they are pregnant.
"The population at most risk for depression is reproductive-age women," says Dr. Jonathan Lupton, an obstetrician-gynecologist with Southside Ob-Gyn. "So the population that's most likely to have it is the population we're most likely to see as pregnant patients."
Experts say they engage in a detailed discussion with their patients, asking about the woman's history of depression, whether she's been hospitalized, and whether she wants to remain on medication.
They also let them know that studies suggest infants exposed to SSRIs during pregnancy may have a higher risk of being admitted into the neonatal intensive-care unit and be of low birth weight.
Some babies may experience a short-term withdrawal from the SSRI after birth, experts say. They may be irritable, jittery and breathe rapidly. These drugs taken in the last trimester may also increase the risk of a rare lung problem.
On the flip side, doctors point out, pregnant women who go untreated for depression may have other problems. They may indulge in unhealthy behaviors, from sleeping or eating poorly to smoking and drinking.
"Moms need to be well during the pregnancy," says Dr. Diana Dell, an assistant professor in the departments of psychiatry and obstetrics-gynecology at Duke University Medical Center. "And when a person is anxious and depressed, they generate some pretty noxious chemicals on their own."
A study published last year in the Journal of the American Medical Association found that 68 percent of women who went off their anti-depressants during pregnancy relapsed, compared with 26 percent of those who stayed on the drug.
For Shea, who tried one pregnancy off Zoloft and one on, there was no debate about which was better.
In her first pregnancy off antidepressants, she had regular panic attacks. The day after her daughter came home from the hospital, Shea was in the emergency room with a panic attack.
Only after her daughter was born did Shea, now 26, tell her doctor she'd gone off the medication during her pregnancy. Not necessary, he told her.
During her second pregnancy, Shea stayed on the drug. She even received it in the hospital after her son's birth.
"I'm glad I took it," she says. "After her, I cried for two months with the baby blues, and with him I didn't have them at all."
Some doctors, however, caution that the jury is still out on the lifelong safety of these drugs. Just because they don't have the same immediate effect as, say, thalidomide (which caused birth defects), does not necessarily mean that problems will not arise down the road for children exposed to these medicines in utero, they say.
"The unknown part from the drug perspective is, does this -- in two years, 10 years -- does this affect child development?" says Dr. Peter Marcus, an associate professor of obstetrics-gynecology at Indiana University School of Medicine. "And that's a big wash. There are not that many good studies to determine long term follow-up on these kids."
That's why some encourage patients who describe their symptoms as mild to consider alternatives to medications. Dr. Kevin Henderzahs, an obstetrician-gynecologist with the Community Health Network, suggests his patients try counseling instead. For some, becoming involved with their religious community or relying on friends and family will work, he says.
"Depression is a very serious and common problem for women, and if they need to be treated, it is OK, but on the other hand, we don't want to treat people that don't absolutely need medicines with them. There are other ways to treat them," Henderzahs says.
For those who opt to stay on medication, he recommends taking the lowest effective dose.
IU's Marcus also refers many of his patients, whether they opt for drugs or not, to a post-partum depression support group to ward off any problems that might arise.
Other women may take their own steps to ensure that they and their unborn children are as safe as possible.
Years before Heather Hutchinson of Fishers conceived, she switched from another antidepressant to Prozac, which she had heard was safer in pregnancy than other related drugs. The experience of weaning off one drug and taking another persuaded her that she needed the medicine.
"It's not all mind control," said the mother of 3-year-old twins and an infant. "You have a chemical imbalance. That is something that you cannot help, and there's nothing wrong with getting help with it."

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