Harvard Mental Health Letter

Alternatives to antidepressants during pregnancy

Although pregnancy is a joyful time for many women, others struggle with depression and other mood disorders. The limited data available suggest that 7.5% of women who become pregnant develop major depression, and another 7% have minor depression, before giving birth. Consensus is growing that depression during pregnancy should be treated, for the sake of both the mother and the developing fetus. Among other risks, untreated depression during pregnancy increases the likelihood that a woman will have postpartum depression and give birth to a lethargic, irritable baby whose weight is lower than normal. Medication is one option for treating prenatal depression (see "Medications for prenatal depression"). In 2003, 13% of pregnant women used antidepressants at some point during pregnancy. But anecdotal reports from clinicians suggest that many women prefer not to take antidepressants during pregnancy, mostly because of concern about exposing the developing fetus to any type of drug. Guidelines issued jointly in 2009 by the American Psychiatric Association (APA) and the American College of Obstetricians and Gynecologists (ACOG) offer detailed advice for clinicians. In general, the APA-ACOG guidelines recommend psychotherapy for pregnant women with mild to moderate depression, and medication for patients with severe depression, psychosis, bipolar disorder, a history of suicide attempts, or a co-occurring psychiatric disorder that requires drug treatment. Unfortunately, scant research exists on alternatives to medication — whether psychotherapy or other modalities. As such, a decision about how best to proceed is an individual one and depends on clinical experience and the patient's preference.
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