Depression Is a Dilemma for Women in Pregnancy

When Sherean Malekzadeh Allen of Marietta, Ga., learned she was pregnant, she was 43, had been married for two years, had gone through two miscarriages and had all but given up hope of having a baby.

But instead of being overjoyed, Ms. Allen was immobilized: panic-ridden, nauseated, listless and thoroughly depressed. She could not rouse herself to go to work in the marketing business she founded and ran, or even get through the newspaper.

And she faced the pregnant woman’s quintessential dilemma: take drugs that might pose a risk to the developing baby, or struggle through an anguishing pregnancy that could harm the baby in other ways?

“Every single thing you put in your body when you’re pregnant, you wonder, ‘Oh, my God, am I growing my baby an extra finger?’ ” Ms. Allen said. “I was worried that I would hurt the baby if I took the pills, and I was worried I would hurt the baby if I didn’t.”

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Antidepressants once seen as miracle drugs: now risks are becoming evident

Since the horror of the Thalidomide scandal in the 1960s, pharmaceutical companies and medicines regulators have been acutely aware of the dangers drugs may pose to the unborn child.

Establishing what the effect of a drug may be on a foetus, however, is no simple task. Companies must rely on animal studies in the early stages of research and hope that the drug will behave in humans in the same way. Trials on pregnant women are rarely carried out, for obvious reasons.

Depression and anxiety became big business for the pharmaceutical industry in the 1990s as doctors became better at diagnosing the problems, exposing a population of over-achieving, highly-stressed, worried-well.

Women, always more willing to see a doctor than men, were a large proportion of those diagnosed and put on SSRIs (selective serotonin reuptake inhibitors) such as Prozac and the British drug Seroxat, known as Paxil in the US. For a while, these seemed to be the new miracle drugs. They were safer than older antidepressants because the severely depressed could not overdose on them.

But in court cases about to begin in the US, it will be argued that insufficient attention was paid to the possible dangers for young women who were pregnant or might become pregnant and more particularly, for their babies.

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Coping With Depression During Pregnancy

Christine Doherty Ashley, currently six months pregnant, realizes that her first trimester was fraught with depression. Now, with the perspective of an improved mood, Ashley recalls being particularly judgmental of her doldrums, questioning, "Am I allowed to say I'm sad or that I hate how I feel?" Nausea kept her on the couch and logistics kept her isolated: She was a high school teacher on summer break, had just moved to a new town, and she and her husband were not yet sharing the news because, at 41, she was at higher risk of early miscarriage. "It was a perfect storm," she explains.

Depression in pregnancy not only causes mom to suffer; it can also pose health risks to the baby. Research published today in the journal Human Reproduction found that women with symptoms of depression were more likely to experience a preterm birth. The greater the severity of depression symptoms, the greater the likelihood of early delivery. This research adds "strong evidence that depression during pregnancy is bad for the fetus," says lead study author De-Kun Li, reproductive and perinatal epidemiologist at Kaiser Permanente's Division of Research in Oakland, Calif., "This should not be dismissed anymore." Preterm birth, write the study authors, is the leading cause of infant mortality and medical expenditures for newborns.

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