Postpartum depression (PPD) is relatively common, occurring in about 10 to 15% of women after delivery. Several reports have documented the efficacy of selective serotonin reuptake inhibitors (SSRIs) sertraline, fluoxetine, and fluvoxamine for the treatment of this disorder. In a recent report, Cohen and colleagues have demonstrated the efficacy of venlafaxine for the treatment of PPD.
For women with bipolar disorder who are planning a pregnancy, it is common practice to discontinue mood stabilizers prior to attempts to conceive, since the mood stabilizers most commonly used to treat bipolar disorder (lithium, valproic acid, and carbamazepine) all carry some risk of birth defect. The problem with this approach is that, after discontinuation of maintenance treatment, a woman is at very high risk for relapse. The longer it takes to get pregnant and the longer she remains off medication, the greater is her risk for having recurrent illness.
When discussing the use of antidepressant medications by breastfeeding women, It is somewhat misleading to say that certain medications are “safer” than others. All medications taken by the mother are secreted into the breast milk. The amount of drug to which the infant is exposed depends on many factors, including the medication dosage, as well as the infant’s age and feeding schedule. To date, we have not found that certain medications are found at lower levels in the breast milk and may therefore pose less of a risk to the nursing infant. Nor have we found that any antidepressant medication has been associated with serious adverse events in the baby.
The following post was written in 2001. The inforamiton has not changed considerably, but here are some more recent articles on this topic:
Most women and their doctors try to avoid using medications during pregnancy. Of greatest concern is that a medication used during pregnancy may in some way harm the developing fetus or, at the very worst, cause a birth defect. But what happens when a pregnant woman needs to take a medication?
During the two weeks prior to the onset of a menstrual period, many women experience physical symptoms, such as bloating, breast tenderness, headache, and muscle aches. A small proportion of women also note a change in their mood and complain of irritability, mood swings, depressed mood, or feeling tense. If these symptoms interfere with a woman’s ability to function, she may have premenstrual dysphoric disorder (PMDD).
Unfortunately the mood stabilizers most commonly used to treat bipolar disorder (including lithium and valproic acid) can increase the risk of certain types of birth defects or congenital malformations in children exposed to these medications during the first trimester of pregnancy. For this reason, many women with bipolar disorder choose to discontinue maintenance treatment during pregnancy. However, we have observed very high rates of illness during pregnancy among these women who discontinue treatment; over half of the women relapse, most frequently during the first trimester.
Women who take antidepressants for their depression must make a difficult decision when they plan to become pregnant. Should they continue their medication during pregnancy? Or should they stop? Although there is information to support the reproductive safety of at least some antidepressants, most women, understandably concerned about exposing their babies to medication, choose to discontinue their antidepressant during pregnancy.
Selective Serotonin Reuptake Inhibitors or SSRIs have been shown to be effective for the treatment of premenstrual symptoms. These medications are not only useful for treating the irritability, depression and anxiety that occur during the 1-2 weeks before the menstrual period but may also help alleviate some of the physical symptoms of PMS.