Strategies for depression management during pregnancy

We often hear about the risks associated with postpartum depression, and we should, but clinical depression during pregnancy (antenatal depression) is a similarly serious issue that doesn’t get the attention it deserves, given how disruptive it can be for both a pregnant woman and her gestating baby.  

Like other forms of depression, there are a few different options for treatment of depression during pregnancy, including medication, therapy, and lifestyle changes. For many, a course of treatment will involve all three. Every pregnancy is different, and every case of depression is different, so there’s no one-size-fits-all recommendation for how to manage depression during pregnancy. If you’re struggling, an open and honest conversation with your provider about your mental health can be the launching pad for a comprehensive plan for treating your depression, and having the healthiest pregnancy possible.

There are some differing opinions about the use of depression medication during pregnancy, but most of the data we have available today suggests that most common first-line antidepressants, like SSRIs (with exceptions your healthcare provider will know) and SNRIs, are safe to continue taking during pregnancy. Though there are some possible risks, it’s believed that in many cases, the risks stemming from untreated maternal depression outweigh the risks of antidepressant medication.

If the depression gets worse even after a woman is started on a first-line antidepressant, a healthcare provider might move up the ladder, and prescribe something like bupropion, or a tricyclic antidepressant, which are generally only used when a first-line treatment isn’t working. These medications are also both believed to be safe to take during pregnancy.

Although these medications are generally accepted as safe during pregnancy, a healthcare provider may often be hesitant to prescribe an antidepressant to a woman who wasn’t on one prior to conceiving, unless they believe the severity of the depression outweighs any risks created by taking antidepressants. For this reason, healthcare providers may often first recommend lifestyle changes and talk therapy before moving to medication for those who weren’t previously on antidepressants.

Although there are many different courses of treatment one can take when dealing with depression during pregnancy, they all start from the same place: recognizing that a problem exists, and speaking with a healthcare provider about it. Whether you have been on an SSRI for years, or are just now noticing the first signs of clinical depression, having an open and honest conversation with your healthcare provider about your mental health can help you determine the course of treatment to keep both yourself, and your growing baby, as happy and healthy as you possibly can.

Read more
  • Mayo Clinic Staff. “Antidepressants: safe during pregnancy?” Mayo Clinic. Mayo Clinic, February 28 2018. Retrieved July 2 2018.
  • Mayo Clinic Staff. “Depression during pregnancy: you’re not alone.” Mayo Clinic. Mayo Clinic, November 24 2016. Retrieved July 2 2018.
  • Jennifer L. Payne, Samantha Meltzer-Brody. “Antidepressant use during pregnancy: current controversies and treatment strategies.” Clinical Obstetrics and Gynecology. 52(3): 469-482. September 2009. Retrieved July 2 2018.
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