27 Sep Antidepressants and Pregnancy
By Nicolette Ferreira.
Whether or not to take antidepressants, mood stabilisers or other psychiatric medicines during pregnancy (hereafter I will only refer to antidepressants for the sake of simplicity) is an exceedingly controversial topic. There are numerous opinions on the matter – a quick Google search will lead you to a plethora of different beliefs. Suffering from Depression myself and being the mother of a one-year old, I decided to explore what some mothers, as well as professionals in the field of psychiatry and gynaecology think about this divisive subject.
“I have been on what some people jokingly (or with disregard) refer to as ‘happy pills’ for six years before I got pregnant. I immediately stopped using my medication. I spoke to my gynaecologist and he suggested that I continue taking the pills. Still a bit apprehensive (there were just too many differing opinions), I decided to stop taking my antidepressants.
“As a way of prevention I started seeing a psychologist. I was amazed that I never felt depressed during my pregnancy. After Lucas was born, however, I felt completely overwhelmed – I sensed the darkness of Depression enfolding me and immediately went to see my doctor. He prescribed me a specific antidepressant, which, as a bonus, also increased milk production.”
“I was depressed during and after both my first two pregnancies. When number three was on her way, I was already on a specific antidepressant and continued using it under the supervision of a professional (I also did my own research on the topic). I felt much better as a result of being on the medication and I truly enjoyed both the pregnancy and taking care of my newborn.”
What Do Professionals Say?
There are researchers who believe that the safety of antidepressants during pregnancy should undeniably be questioned (a quick Internet search will lead you to a wide range of such opinions). On the other hand, there are obstetricians, gynaecologists and psychiatrists who believe that the use of certain antidepressants during and after pregnancy (think breastfeeding) is safe. Obstetrician and Gynaecologist, Doctor George Du Toit from Stellenbosch, has the following to say about the use of antidepressants during pregnancy:
“Depression is a medical illness, which should be treated as any other illness. The cause is biochemical in nature: it involves a shortage of serotonin, a molecule responsible for the transfer of brain signals. Similar to the way in which the administering of insulin ‘fills’ the shortage, so does antidepressants ‘fill up’ the serotonin stores. Untreated Depression in pregnancy can result in long-term disturbance of the mother-baby bonding. That said, it is vital to know that certain antidepressants have been found to be unsafe during pregnancy. It is therefore important to talk to a psychiatrist about your specific medication and your pregnancy.”
Professor Piet Oosthuizen, author of Ontsnap van Depressie, says, “The use of antidepressants during pregnancy is problematic: because research about the use of antidepressants in pregnancy is ethically impossible, the information we have is limited. The information that we do have regarding the use of antidepressants in pregnancy comes from so-called birth registers of pharmaceutical companies collecting information about pregnant women who do make use of antidepressants. Also, because certain antidepressants have been available for many years, there is now much more information available to us. 
Researchers who are against the use of antidepressants during pregnancy name the following possible effects that these medicines could have on a baby:
- An elevated risk of miscarriage, preterm birth or stillbirths;
- Withdrawal symptoms such as tremors, convulsions and increased crying;
- Possible long-term neurobehavioral abnormalities;
- Congenital anomalies (birth defects);
- Pulmonary hypertension;
- Low infant birth weight;
- Breathing and heart problems.
Psychiatrist Doctor Henk Botha* feels that one should compare the advantages the medication offers to the mother’s emotional health (which is already essential before the birth of her baby for her baby’s future) to the potential disadvantages (for example, premature births, pulmonary hypertension, irritability from the baby, etc.): “No rules can be made here – each and every case should be evaluated and handled uniquely. It is not just the case with antidepressants, but with medicine in general, that no pharmaceutical company can claim its safety in pregnancy. We do, however, have much more experience with certain antidepressants, because they have been on the market for longer. There are antidepressants that should definitely be avoided, as it can be harmful to the foetus. The first way of treatment that should be considered should be non-pharmacological (psychotherapy), but in certain cases medication definitely needs to be considered, especially if the person has a history of Depression.”
It is clear then, that it is extremely important that you work together with a psychiatrist who will be able to inform you about the safety of the various psychiatric medications during pregnancy. Never stop ‘cold turkey’ with your medication – this could be perilous to your emotional health, which understandably needs to be positive in order for you to give of yourself to your baby.
Alternatives to Anti-Depressants
There are, of course, as Doctor Botha indicated, alternatives to taking antidepressants. Nikoleen van Der Spuy shares her own story of how she got through Depression during pregnancy:
“My husband and I don’t like using medication and we try to, as far as possible, go the natural way. When I struggle with Depression, I rely on prayer, exercise and the support of positive people who help me maintain an optimistic mind and perspective.
“A few months after the births of both my children, I realised something was wrong with my mindset. I knew I needed me-time and that I was over-tired. I got a sitter, started exercising again and made sure I got out of the house on a regular basis. I started focusing on meditating – focusing on God. I also often see a friend of mine who is a psychologist.”
Both Cognitive Behavioural Therapy (CBT) and Psychotherapy have proven very successful in managing Depression (see the following Internet source where a distinction is made between CBT and Psychotherapy: http://cbtvspsychodynamic.com/CBTvsPsychodynamic.html). Moms struggling with Depression have also suggested that reading self-help books are exceptionally encouraging, as well as having an adequate diet or pursuing a hobby.
Pregnant mothers should make an informed and responsible decision. Both stopping your medicine ‘cold turkey’ and continuing with it unadvised could have a harmful effect on mom and baby. Get professional advice… and Doctor Google does NOT count as professional advice!
 Oosthuizen, Piet. Ontsnap van Depressie. Paarl: Tafelberg Uitgewers, 2007.
 Conditions in which brain damage or dysfunction produces primarily intellectual (cognitive) and behavioral change. Weisberg, LA, Garcia, C and Strub, R. “Clinical Neurology: Neurobehavioral Disorders (Organic Brain Syndromes).” www.psychneuro.tulane.edu/neurolect/
 High blood pressure that occurs in the arteries of the lungs. It involves the pressure the heart must exert to pump blood from the heart through the arteries of the lungs. American Heart Association: “What is Pulmonary Hypertension?” http://www.heart.org/HEARTORG/
* A pseudonym has been used