Depression and Anxiety in Pregnancy
Depression is twice as likely to affect women as it is to affect men. With the risk of depression being the greatest during a woman’s childbearing years, the lifetime prevalence ranges from nine to 26 percent. With 50 percent of pregnancies being unplanned, women may become pregnant while taking an antidepressant or have their depression and anxiety return during pregnancy or postpartum, as 70 percent of women report having depressive symptoms.2 Staff Psychiatrist for the Reproductive Life Stages Program at the Women’s College Hospital in Canada, Alicja Fishell, M.D. discusses the effects of fetal exposure to psychotropic medicines and how to manage perinatal mood and anxiety disorders in her article “Depression and Anxiety in Pregnancy.”2
There is a wide variety of medicines used to treat depression and anxiety in pregnant women. The most common are selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, and atypical antipsychotic agents.2 Oftentimes, SSRIs sertraline, fluoxetine, citalopram, paroxetine, and escitalopram are used.2 Also, the SNRIs desvenlafaxine and duloxetine are commonly prescribed.2 Tricyclic antidepressants, such as nortriptylline and desipramine, are used as they have the least of the anticholinergic side effects.2 Other women take bupropion or mirtazapine.2 For better sleep and higher levels of anxiety, atypical antipsychotics may be used.2
According to Fishell, there are risks of congenital malformations (three percent) and cardiovascular malformations (one percent) in the general population.2 Also, the risk of spontaneous abortion is between 15 and 25 percent.2 Preterm births occur in 13 percent of pregnancies.2 Overall, antidepressants do not seemingly increase the risk of malformations above the general population baseline.2 However, controversies have arisen since 2005, stating that there are major risks during the first trimester.2 According to Fishell, these studies have had major methodological flaws and lack consistency, therefore weakening their credibility.2 It is, in fact, safe to use antidepressants during pregnancy in severe cases, and if the mother is concerned about the risk to the fetus, there are tests that can be done to keep a watchful eye on the development.2
One effect of antidepressants on a newborn baby is poor neonatal adaptation syndrome (PNAS), which occurs in four to 30 percent of babies. It is a combination of serotonin toxicity and discontinuation syndrome.2 Usually, the newborn will feel the effects within a few hours of delivery, and symptoms include irritability, hypertonia, tremor, jitteriness, and difficulty feeding.2 However, the symptoms often go away on their own and many infants do not need to be admitted to a neonatal unit.2 Instead, Fishell states that a three-day monitoring period is recommended before discharge, as well as follow-up with a pediatrician on a normal basis afterwards.2 There have not been any influence on the fetuses cognitive development, mood, temperament, activity, or behavior problems reported.
According to Fishell, women who plan on becoming pregnant should schedule a prenatal consultation, which covers the options available for controlling depression and anxiety.2 If symptoms are mild, psychotherapy should be considered instead of medication; however, in severe cases medication should be used, but kept to just one agent.2 Medicines can be chosen based on past history, but if none exists, sertraline is a favorable choice, as it is alright to pair with breastfeeding.2 Also, venlafaxine is a good choice for those with severe anxiety.2 Overall, the use of antidepressants during pregnancy for the treatment of depression and anxiety is acceptable.2
 Kornstein SG. Gender differences in depression: implications for treatment. J Clin Psychiatry 1997;58(Suppl 15):12-8.
 Fishell, A. (2010, Oct. 26). Depression and Anxiety in Pregnancy. J Popul Ther Clin Pharmacol 17(3): e363-e369.
 Suri R, Altshuler L, Hellemann G, Burt VK, Aquino A, Mintz J. Effects of antenatal depression and antidepressant treatment on gestational age at birth and risk of preterm birth. Am J Psychiatry 2007;164(8):1206-13.
 Nulman I, Rovet J, Stewart DE, et al. Neurodevelopment of children exposed in utero to antidepressant drugs. N Engl J Med 1997;336(4):258-62.