Running head: ANTIDEPRESSANT TREATMENT RISKS ON MOTHER AND BABY
Antidepressant Treatment of Depression During Pregnancy and the Postpartum
period
Michelle S. Murray
Regis College
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ANTIDEPRESSANT TREATMENT RISKS ON MOTHER AND BABY
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Problem Statement
Depression is a serious mental health issue within society today. It is not only debilitating
but can also be life threatening, if left untreated. When one adds in the hormonal changes and
stress associated with pregnancy, depression while pregnant becomes a very serious mental and
health issue and can be harmful to both the mother and the infant. “The incidence of depression
during pregnancy and the postpartum period is estimated to be anywhere from 5.5 to 33.1
percent, and the American Academy of Pediatrics estimates more than 400,000 infants are born
to mothers who are depressed.” (Agency for Healthcare Research and Quality, 2014, 1) The
question then becomes, what is the best form of treatment that will help the mother through her
pregnancy and depression with the least amount of harm to the fetus. According to Walton et al.
(2014), mothers with depression are at risk for suboptimal antenatal care, poor nutrition,
substance abuse, subsequent postpartum depression, and are less likely to breastfeed. Walton et
al. (2014), also found that infants exposed to depression in pregnancy are at risk for prematurity
and poor fetal growth. When depression occurs during pregnancy, it is shown to have negative
child developmental outcomes, poor maternal infant attachment, and it might also be passed
down to the fetus. The main treatment for depression is the use of antidepressant medications,
but the concern of side effects becomes severe when one takes the medication while pregnant.
Decision making surrounding treatment of depression in pregnancy is complex because
the harm of treatments must be balanced against the potential harms to mother and fetus of
untreated depression. (Agency for Healthcare Research and Quality, 2014) Despite the potential
harms to both, there is very limited information and research to assist mothers and their doctors
in treatment options. Even with this limited information and research, according to Science
ANTIDEPRESSANT TREATMENT RISKS ON MOTHER AND BABY
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Daily (2017), between 2 and 8 percent of pregnant women are on antidepressants. It is true that
the management of depression in pregnancy or the postpartum period varies case by case, so
many women may be willing to take the risk that medication will not affect their baby as much
as not taking it will affect them.
This paper will address answering a few questions this subject brings about by
conducting a review of literature and evidence made by research studies. The most important
questions to answer are: What are the effects of antidepressant used during pregnancy on the
fetus? What are the effects on the mother and fetus if antidepressants are not used to help with
depression symptoms? What are the long-term effects of antidepressant used on the fetus? Has
there been enough research done on this subject to make an educated decision?
Background
“Approximately 20% of women are at risk for developing a depressive disorder and 30%
may experience the onset of an anxiety disorder at some point in their lives.” (Yonkers, et al.,
2014) The time between adolescence and menopause is found to be when women are at greatest
risk for developing a mood or anxiety disorder, hence it is likely that at least some majority of
pregnant women will be diagnosed with and treated for a mood disorder. The most commonly
used treatment is through the use of psychotropic medications, which have a number of side
effects for the mother. The main question then becomes, what effects do these drugs have on the
unborn fetus and is the risk of potentially life-threatening side effects to the baby worth the risk
for the mother to receive treatment. There are many opposing arguments that pregnant women
should not take any medications during pregnancy in order to guarantee that the fetus will not
come under any harm.
ANTIDEPRESSANT TREATMENT RISKS ON MOTHER AND BABY
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This will be the main focus of this paper, whether or not it is worth the potential rick to
the fetus for the mother to have her psychotropic medication. Depression is a very serious and
sometimes life-threatening mood disorder that affects approximately 10% of pregnant women.
(Walton, et. al, 2014) There is data that shows over 50% of pregnant women are taking a
prescription medication in pregnancy. (Yonkers, et. al., 2014) It is known that pregnant mothers
with depression are not only risking their own health, but that of their babies. According to
Walton, et. al., (2014), infants exposed to depression in pregnancy are at risk for prematurity and
poor fetal growth. “Depression in pregnancy is also linked to negative child development
outcomes and poor maternal attachment”. (Walton, et. al., 2014) Treating depression among
pregnant women becomes the priority when creating the healthiest pregnancy possible for the
individual. Unfortunately, there is very limited research surrounding the side effects to the fetus
and the long-term effects to the child of psychotropic medications. Hence many women and
physicians have a hard time making the most educated and confident decision of whether or not
to treat their depression with medicine.
Review of Evidence
The EBSCO database was used to conduct the research used for this review of literature
and studies on the topic. Key words used to find the literature included, postpartum depression
and antidepressants, side effects of antidepressants, pregnancy and depression, and treatment of
depression during pregnancy. All of the studies used within this review were peer edited and
reviewed, recent within the last 5 years and contained extensive resources. A review of the
studies includes, Agency for Healthcare Research and Quality, (2014), Byatt, (2013), and MunkOlsen, (2012).
ANTIDEPRESSANT TREATMENT RISKS ON MOTHER AND BABY
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In the first article by, Agency for Healthcare Research and Quality, (2014) the
information was very well explained and laid out. The authors wanted to evaluate the benefits
and harms of various pharmacological treatment options for depression during pregnancy and
postpartum period compared with each other, with nonpharmacological treatments, and with
usual care or no treatment. (Agency for Healthcare Research and Quality, 2014) This
examination was done by studying a population of pregnant women and women during their first
12 months after delivery who received pharmacological and nonpharmacological treatment for a
depressive episode. Although these were limited to observational studies they did generally meet
the criteria for effectiveness studies. Due to the type of studies done, there was no direct
evidence on maternal harms of pharmacological treatments for depression during pregnancy.
Also, there was no direct evidence for the risk of infant mortality with the maternal use of
antidepressant drug found.
The overall conclusion of this study was that there is insufficient evidence to inform
clinical decision making on whether or not to prescribe antidepressants to pregnant or postpartum women. The benefits and harms of antidepressant use among pregnant and post-partum
women is unclear and needs further examination. There needs to be a study that not only
observes its participants but also examines them physically, mentally and emotionally.
In the next study, Munk-Olsen, (2012), the prevalence of antidepressant drug use from 12
months prior childbirth to 12 months postpartum and those within the group who did not give
birth was studied. The population studied comprised of pregnant women and their controls drawn
from a 25% sample of the entire Danish population. The researchers found this sample from
prescriptions for antidepressants that were redeemed and also those patients that were referred to
psychiatrists. These individuals were observed over two-year period around childbirth. During
ANTIDEPRESSANT TREATMENT RISKS ON MOTHER AND BABY
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this time, 3.17% of the women had one or more prescriptions for antidepressants, and 1.76%
were referred to a psychiatrist.
The results from the study showed that women giving birth received less drug treatment
than those of reproductive age. Also, the period associated with the lowest level of antidepressant
use was in pregnant women during the third trimester. There was also a decrease of redeemed
prescriptions during pregnancy and increased postpartum. The final result from the study was
that prescriptions during pregnancy decreased whereas those redeemed during postpartum
increased. This concludes that depression may be more prevalent and intense during postpartum
than pregnancy.
In the last article, Byatt, Deligiannidis, & Freeman, (2013), it was a critical review on the
risks of antidepressants during pregnancy. The objectives of this study were to review the risks of
untreated depression and anxiety and the risks of exposure to antidepressants during pregnancy.
This study used MEDLINE to search for articles surrounding the previous stated objectives. The
overview of this study proved that there needs to be more research done on this subject. It was
proven that no single type of malformation has been consistently observed across studies with
any commonly used antidepressant. Still the evidence is very limited and thus physicians and
women are unable to make an educated decision.
Analysis
The articles by Agency for Healthcare Research and Quality, (2014), Munk-Olsen,
(2012), and Byattt et. al., (2013) all revealed similar findings in that there is not enough research
done on the effects of using psychotropic drugs during pregnancy has on the fetus. Another
point that was brought up during this review of the studies was the fact that the management of
depression during pregnancy and post-partum varies on a case by case basis; providers and
ANTIDEPRESSANT TREATMENT RISKS ON MOTHER AND BABY
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patients are often concerned with the safety of pharmacological treatment during pregnancy and
the post-partum period. (Agency for Healthcare Research and Quality, 2014)
Looking at the data of what has been learned from the three articles, it would be
necessary to find more information surrounding the effects of antidepressants on the fetuses,
even if it meant conducting new research. All three studies concluded that although more data
was needed to make a definite decision, using what was known, antidepressants do have some
effect on the unborn fetuses however it is unclear if the effects outweigh the risks to the mother if
they are taken off their medication during pregnancy.
Moving forward with this topic, the best way to gain the most informed decision would
be to produce a new study to see the true effects of psychotropic drugs on a fetus. Following a
group of pregnant women, in the same demographic and characteristics, throughout their
pregnancies, with half on the medications and half not, will give a more definite conclusion on
the effects of the drugs to the fetus. You will analyze the baby’s vital signs, weight, and
developmental aptitudes to determines these effects and maybe even follow them throughout
their childhood to find any long-term effects. Becoming highly educated on the effects that
medications have on unborn fetuses is a very important topic that defiantly needs more research
done on it so that those individuals involved can make the most informed decision.
Discussion
The three articles reviewed all did a thorough job providing the most data they could and
all concluded with mainly the same findings. All of the studies were conducted through similar
means buy analyzing previous studies and their results to conclude an educated decision on the
effects antidepressants have on pregnancy and post-partum. Each article came to the same
conclusion that there needs to be more research done on the effects of antidepressants so that
ANTIDEPRESSANT TREATMENT RISKS ON MOTHER AND BABY
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women and practitioners can make an educated decision on whether it is safe to continue taking
their medication while pregnant or if they should stop. Byatt, et. al. (2012) stated that the current
evidence base was limited by data that do not systematically assess infants, use appropriate
control groups, use blind raters of neonates, and take into account maternal diagnosis or
symptoms or other conditions.
In conclusion, of all of the studies that have been reviewed and analyzed, it is clear that
more research needs to be done on this topic. Apart from having inappropriate control groups,
and not available access to infants, the medical community needs to figure out a way to conduct
a study that will end in a conclusive decision of whether or not taking antidepressants during
pregnancy is safe for the fetus. This may very hard to do since each treatment varies from person
to person, and the side effects on the fetus may also be determined by other factors, including
socioeconomic status, genetics, and personal knowledge of taking care of one’s self pregnancy.
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References
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