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.