If you’ve been prescribed antidepressants, you know that the right dosage may be all that separates you from enjoying things that other people take for granted, and feeling like you can barely get through the day. Or worse: Depression can lead to suicidal thoughts or actions (per Web MD). So what would make you think twice about taking your medication? Pregnancy.
In an interview with The List, Zaher Merhi, MD, HCLD, FACOG, a fertility expert at New Hope Fertility Center, explained, “Maternal depression and other mood disorders, such as anxiety, can have devastating effects on the pregnant woman. Indeed, suicide exceeds hemorrhage and hypertensive disorders as a cause of maternal mortality.”
Your doctor will screen for depression and anxiety at least once during your prenatal care. As many as 9 percent of women will deal with depression during pregnancy, according to Merhi. “Some of the reasons that are associated with depression during pregnancy include unintended pregnancy, single status and lack of social support, history of depression, life stresses in general, domestic violence, and lower income,” he explained.
The antidepressants that are the most and least safe to take during pregnancy
Merhi describes antidepressants as being on a spectrum rather than “safe” or “unsafe.” Drug safety in pregnancy is classified by the FDA using categories — for instance category A means that controlled studies show no risk to an unborn baby. Category B means that there’s no evidence of risk in humans; bupropion is an example. Most antidepressants fall in category C, in which risk cannot be ruled out. These include sertraline, fluoxetine, duloxetine, venlafaxine, escitalopram, trazodone, citalopram, and amitriptyline. Lithium, meanwhile, is category D, which means there is positive evidence of risk.
Moms-to-be taking these medications need to discuss their conditions with their obstetricians to weigh the pros and cons of staying on their current prescription, taking a lower-risk option, or seeking non-medical therapies, Merhi added. “Based on the severity of the mental health problem, the provider should decide whether the use of antidepressants and other mood stabilizers are worth taking the risk of medication side effects,” he explained. “For example, if a pregnant woman verbalizes a plan to attempt suicide, it is imperative that she would be on medications and probably admitted to a hospital for observation.”
Merhi said non-medical interventions may help, too, such as meditation, yoga, exercise, healthy eating, and taking supplements.
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