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It can often be difficult to find good psychiatric care in your area. Katherine Stone at Postpartum Progress has put together a list of programs in the United States and Canada offering care for women who suffer from mood and anxiety disorders during pregnancy and the postpartum period.
About 15% of women suffer from depression during pregnancy, and many reports have suggested that depression during pregnancy may have negative effects on the fetus A new study has discovered a link between depression and anxiety during pregnancy and infant sleep problems after childbirth.
Dr. Thomas O’Connor and his colleagues evaluated data from a large study in England called the Avon Longitudinal Study of Parents and Children (ALSPAC). They analyzed data from over 14,000 women giving birth. Maternal mood and anxiety levels were assessed during pregnancy and the postpartum period, and infant sleep was assessed at 6, 18, and 30 months. Higher levels of prenatal maternal anxiety and depression predicted more sleep problems at 18 and 30 months.
For instance, O’Connor tells WebMD, "Mothers with elevated anxiety at 18 weeks were 39% more likely to have children with sleep problems at 30 months. Mothers depressed at 32 weeks were about 40% more likely to have a child with sleep problems at 30 months. That’s true even after controlling for smoking, alcohol intake, and postnatal mood."
O’Connor and his colleagues speculate that the stress hormone cortisol is behind the pregnancy mood and sleep problems link. "We know moms who are anxious in pregnancy have higher levels of the stress hormone cortisol," he says. "There is an association between a pregnant woman’s level of stress hormone and stress hormone in the amniotic fluid. The placenta has an enzyme that breaks down the stress hormone. But evidently some still gets through.
This is yet another study that points to the importance of screening women for depression and anxiety during pregnancy. Initiating treatment early on may have important beneficial effects for both the mother and her baby.
About 10% to 15% of women suffer from depression during pregnancy. Literature accumulated over the last decade supports the use of certain selective serotonin reuptake inhibitors (SSRIs) and the older tricyclic antidepressants during pregnancy, indicating no overall increase in the risk of congenital malformation in children exposed to these medications during the first trimester of pregnancy. Still, questions remain regarding the reproductive safety of SSRIs, including one report suggesting an association between exposure to SSRIs late in pregnancy and persistent pulmonary hypertension of the newborn (PPHN) and several other reports suggesting that paroxetine use may be associated with an increased risk of cardiovascular malformation.
In a very thorough and thoughtful article published in the American Journal of Psychiatry, Dr. Marlene Freeman discusses various options for treatment. In summary:
Sorting out the risks and benefits of treatment for depression, particularly those of antidepressant medications, is complicated in pregnancy. The selection of treatment should be based on the severity of symptoms, the patient’s depression history (including past response to medication), and the patient’s preferences. In women with mild depression, nonpharmacological approaches may be useful first-choice treatments. In women with moderate to severe depression or a history of previous postpartum depression or recurrent major depression, antidepressants should be strongly considered, alone or in combination with nonpharmacological treatment.
And here’s another good review of the topic from Dr. Claudio Soares:
About 10% to 15% of women suffer from depression during pregnancy. Literature accumulated over the last decade supports the use of certain selective serotonin reuptake inhibitors (SSRIs) and the older tricyclic antidepressants during pregnancy, indicating no overall increase in the risk of congenital malformation in children exposed to these medications during the first trimester of pregnancy. Still, questions remain regarding the reproductive safety of SSRIs, including one report suggesting an association between exposure to SSRIs late in pregnancy and persistent pulmonary hypertension of the newborn (PPHN) and several other reports suggesting that paroxetine use may be be associated with an increased risk of cardiovascular malformation.
In a very thorough and thoughtful article published in the American Journal of Psychiatry, Dr. Marlene Freeman discusses various options for treatment. In summary:
Sorting out the risks and benefits of treatment for depression, particularly those of antidepressant medications, is complicated in pregnancy. The selection of treatment should be based on the severity of symptoms, the patient’s depression history (including past response to medication), and the patient’s preferences. In women with mild depression, nonpharmacological approaches may be useful first-choice treatments. In women with moderate to severe depression or a history of previous postpartum depression or recurrent major depression, antidepressants should be strongly considered, alone or in combination with nonpharmacological treatment.
PSI is now offering free Postpartum Open Forum via it’s 800 teleconference line. Limited to the first 15 callers, these sessions, which are informational only, will offer participants an opportunity to ask questions and obtain information from PSI healthcare professionals. The sessions are opened to women who feel they may be suffering from a pregnancy related mood disorders as well as concerned family members and friends.
Participants must call 1-800-944-8766 five minutes before the call begins.
Literature accumulated over the last decade supports the use of certain selective serotonin reuptake inhibitors (SSRIs) and the older tricyclic antidepressants during pregnancy, indicating no overall increase in the risk of congenital malformation in children exposed to these medications during the first trimester of pregnancy. Still, questions remain regarding the reproductive safety of SSRIs, including one report suggesting an association between exposure to SSRIs late in pregnancy and persistent pulmonary hypertension of the newborn (PPHN) and several other reports suggesting that paroxetine use may be be associated with an increased risk of cardiovascular malformation.
A study presented at the annual meeting of American Psychiatric Association did not report any association between SSRI use and these potentially serious complications. Researchers at the Mayo Clinic in Rochester, Minnesota reviewed the medical records of 25,214 deliveries, including 745 mothers who had been treated with SSRIs during their pregnancies. They found no association between the SSRI use during pregnancy and the occurrence of PPHN. Of the 16 infants diagnosed with persistent pulmonary hypertension, none had been exposed to SSRIs. Furthermore, the study did not demonstrate any association between SSRI use and any cardiovascular malformations, including septal defects.
This study, like many earlier studies, suggest that the risks associated with SSRI use during pregnancy are low. While women considering the use of antideprssants during paregnancy must be counseted regarding the use of these agents during pregnancy, they must also be informed of the effects of untreated depression during pregnancy.
