Todd:
Hi, and thank you for joining us at EmpowHer--the home of women’s health online. I am Todd Hartley.
Wendy:
I am Wendy Hartley.
Todd:
And in the “Los Angeles Times” there’s a fascinating story that I am sure ladies are interested in. It’s treatment guidelines issued on depression during pregnancy.
Now that’s the title, and for women with serious conditions, medication may be the best route, but talk therapy may alleviate suffering for others. And according to a document prepared by two national physicians’ groups, they are interested in bringing this to the light of day, and that’s why Dr. Shoshana Bennett is with us and to bring us up to speed really about antidepressants and pregnancy. Hi, Dr. Shosh.
Dr. Shoshana Bennett:
Hi.
Todd:
Tell us a little bit about depression. Give us an overview if you could, and how it affects women who are pregnant.
Dr. Shoshana Bennett:
Oh, wonderful question. About 15-20% of pregnant women are clinically depressed. So many people think that pregnancy will really protect women from mood disorders, but in fact it’s quite the contrary. We are at our most vulnerable during pregnancy and certainly postpartum. But, we are talking about one in seven women are severely depressed, are not just going through some moodiness, but are clinically depressed during pregnancy.
Todd:
How do you define depressed? I mean, what do those symptoms feel like, and if you are going through it, can you kind of describe, and I know you have had some depression, so you could probably describe it a lot better than most.
Dr. Shoshana Bennett:
Very much so. My depression was postpartum, but it can feel very, very similar during, during pregnancy. Most pregnant women, normal pregnant women, for instance, are typically feeling an increase in appetite, but when a woman is depressed in pregnancy, typically she feels a decrease. She might have difficulties sleeping and often what happens is a pregnant woman, for instance, if she is eight month’s pregnant she might go to her OB and say. “I am having a hard time sleeping.”
If the OB or staff person isn’t aware that depression could really be affecting this woman, they might just dismiss what she is saying and, you know, basically say, “Well, of course you are having a hard time sleeping; you are eight month’s pregnant.” But she could be fine physically and just with her head racing with anxious thoughts. It might be anxiety keeping her awake or worried about not being a good mother or just scary thoughts going through her head. So that’s another, that’s another symptom of insomnia. Insomnia is always a warning sign.
So there’s appetite problems; there is sleep problems, certainly self-esteem. There can be very normal worries, of course, you know, when one is pregnant about, “Oh, will I, be a good mother? Is this going to work out?” That’s all normal, but when she is having feelings such as, ”I know I am going to be a terrible mom and I feel awful about myself,” and when her self-esteem is really that low that it gets in the way of her daily life, then she really does need help.
And certainly, if she is feeling hopeless, like, “My life is over,” or certainly if she is overwhelmed and little things that used to be simple are suddenly feeling huge. Certainly, if she if she is resting and her energy does not return that’s also a sign because typically in pregnancy once you sit down or lie down you can restore energy, but if there’s depression, that doesn’t happen. She can really stay fatigued.
So those are the kinds of things, some of the things we look for. There are certainly others.
Wendy:
Dr. Shosh, is it ever okay for a woman to be on antidepressants while pregnant?
Dr. Shoshana Bennett:
This is such a hot issue right now and the answer is yes. You know, it’s very important for women to receive treatment if they are depressed in pregnancy. We know that depression itself crosses the placenta. Depression can hurt the growing baby. It doesn’t only hurt the mom herself who might be trying to self-treat; she might be smoking or she might be drinking; she might be taking over-the-counters; she might be not eating well; she might not be going to her pre-natal visits. So that can certainly hurt her, but it can also be hurting the growing baby.
Depression can affect, can cause pre-term delivery just for starters, and there’s some other detrimental effects that have been showing up in the research. If a woman truly needs an antidepressant in order to feel like herself, then yes, that’s exactly what she should do. And that’s what the consensus is of the medical folks, and the, you know, medical and mental health professionals who have specialized in this field. They believe; we believe that if she needs an antidepressant then that’s exactly what she ought to do.
And unfortunately, many women are so worried; I think the media kind of blows things up sometimes and really, there’s a lot of hype out there about the fear of taking antidepressants and what it might cause. And when she finds herself pregnant and she is taking an antidepressant, the, you know, a very typical response unfortunately is to suddenly, you know, very abruptly stop, cold turkey. That can be very dangerous, both to her, because it can certainly cause relapse and all kinds of problems, but it’s also not good for the fetus.
So often, if she truly needs that antidepressant in her, not only is she having symptoms when she stops, but when she relapses, which very frequently she does, she will be back on the medications. So, there’s that ”on again, off again” having the medication in the system, and then it’s out of the baby’s system, and then it’s in again. That isn’t good for anybody.
Will she definitely need an antidepressant? No, I mean, ideally if a woman is taking an antidepressant or any psychiatric medication, she should consult someone who really knows her psychiatrist or another medical professional who really understands what’s okay and what’s not okay during pregnancy even before she conceives. So ideally she is having a pre-pregnancy consultation so an excellent plan of action can be discussed and can be set out.
Maybe can, you know, she is ready to wean off for instance, or maybe she should be switching to a different medication before she gets pregnant, or maybe she should stay on, but that really, ideally should be discussed before she is pregnant. In the real life, of course, many women get pregnant and they weren’t expecting it, and there she is on the medication.
So, if you find yourself pregnant on an antidepressant, definitely, before you do anything with the dosage, talk to a medical professional who really has this specialized clinical expertise and then make a decision as to what to do about it.
Todd:
Has there been any research? I know that would be interesting to Wendy and I. Has there been any research on babies and how they are affected by moms on antidepressants?
Dr. Shoshana Bennett:
You know, there has been, but there’s still a big question out there as to whether it’s the underlying depression causing some of the difficulties or whether it’s the antidepressant. So the jury is still out on that and we are all kind of waiting for some kind of conclusive, you know, information as to which it is because both depression, as I mentioned earlier, antidepressants cause problems. We know that.
So we know that because women who are depressed who are not on the antidepressants often have babies with problems, with health issues. And the women who are taking antidepressants, sometimes those same health issues are there. So, unfortunately, we don’t have a clear-cut answer to that yet. Possibly a certain antidepressant with certain dosages cause problems, but we don’t know that as of yet.
Todd:
You know, Wendy and I have a family member that’s been struggling over the years with depression and we were talking about how, when she was pregnant, that we were wondering how if her baby was going to be, have depression also. I am happy to say that her baby is probably, tell me if I am wrong Wendy, the happiest baby you’ve ever seen, right?
Wendy:
The happiest baby, and also, Dr. Shosh, I had a girlfriend several years back who was on antidepressants. She had her first baby at 41. Her baby was super smiley, just really like extra happy, and I was wondering, gosh, if the medication really helped. I guess that would be the neurotransmitters–the dopamine and the serotonin in the baby. But I did notice as the baby got older, she was, had a very low weight and a very low percentile to her class. So she is having some issues with growth; I don’t know if there’s any, you know, contribution with that.
Dr. Shoshana Bennett:
Right, and that’s a difficulty. We don’t know there is cause and effect there or whether that would have happened in any case. I mean, many of the psychiatrists who specialize in the field will actually go so far as to say that we not only don’t know whether there is any problem with women taking antidepressants during pregnancy, but some of them will say that, you know, there’s just as much evidence to say that it might be neuroprotective.
We don’t know if it might be helping the baby. I know that’s a pretty strong statement and it’s not one that one tends to hear in the media, you know, with all the hype, but so we really don’t know. It might be; we don’t know what the effects are, but we definitely know that depression is harmful. We don’t need any other information to prove that.
So, whatever she needs to do, sometimes she is able to use completely natural and alternative methods of treatment. Sometimes there’s a phototherapy or acupuncture or certainly taking a look at her sleep, making sure she is sleeping well and she has the right nutrients in her–omega-3 fatty acids from fish oil– extremely important, and sometimes that alone, you know, with some good therapy and possibly taking a look at her relationships or whatever else she might need. That might be enough to carry her through and to really make her feel herself.
So, I am not a particular lover of the pharmaceutical companies and whenever we don’t need it, it’s lovely not to take it. I mean, I have yet to see a pregnant woman or a postpartum mom excited about taking an antidepressant. Nobody wants to be on an antidepressant, but they are very eager to feel like themselves, and they are willing to do whatever they need to do to feel like themselves. But very frequently we are able to keep women, pregnant and postpartum, off psychiatric medications when we have a very good solid plan of wellness, a strategy for wellness with sleep and nutrition and therapy and support–physical support, emotional support, exercise, something to oxygenate her brain–these are the things that when in place, often she doesn’t even need the antidepressant.
But again, if she does, we are believing that it is better for her to take it in many cases than try to suffer through because suffering through, you know, trying to white-knuckle it through the pregnancy can set her up, and set her baby up, for a poor prognosis later on.
Todd:
Well, Dr. Shosh, I noticed on your website, drshosh.com, you wrote a blog about this. I encourage women to go up and read about it if they want more information. She is Dr. Shoshana Bennett. As I mentioned, you can find out more at drshosh.com. She is also the author of “Postpartum Depression for Dummies,” and on behalf of EmpowHer, I am Todd Hartley.
Wendy:
I am Wendy Hartley.
Todd:
Wishing you health, happiness, and, of course access to the best health information possible.