Antidepressant Treatment During Pregnancy: One Woman’s Experience (Part III)
Part 3: Planning for the Postpartum Period
What is the Impact of Depression During Pregnancy?
In a recent study by Gerardin and colleagues, the authors note that more research has been done to demonstrate the consequences of postpartum depression than depression during pregnancy (also called antenatal or prenatal depression). Infants born to mothers with depression during pregnancy have been demonstrated to have lower scores on motor behavior and more crying and irritability. Few studies, however, have assessed the longer-term effects of antenatal depression.
![By Vera Kratochvil [Public domain], via Wikimedia Commons](https://womensmentalhealth.org/wp-content/uploads/2015/06/Mother_Kissing_Baby-320x202.jpg)
Serotonin Reuptake Inhibitors and Fertility (Part 2): What Can Basic Science Tell Us?
Serotonin (5-HT) is one of the neurotransmitters involved in mood regulation and has been implicated in the development of mood and anxiety disorders. Serotonin transporters (SERT) facilitate the transfer of serotonin into neurons; serotonin reuptake inhibitor (SSRI) antidepressants bind to these transporters and appear to exert their effect on mood by inhibiting the reuptake of serotonin and thus increasing the levels of this neurotransmitter at the synapse.
Clinical Case: Should SSRIs Be Tapered Prior To Delivery?
Ms. T is a 33 year old woman with a history of recurrent depression who is 32 weeks   pregnant with her first pregnancy. She has remained on her citalopram (Celexa) throughout pregnancy and has been well. Her gynecologist has encouraged her to enquire about coming off the Celexa prior to delivery in order to avoid symptoms of neonatal distress. What should she do?
Making Individual Decisions Regarding the Use of Antidepressants During Pregnancy
Women face difficult choices when deciding whether or not to continue psychiatric medications during pregnancy. This choice can be especially difficult for women taking newer medications which lack adequate reproductive safety data.
American Academy of Pediatrics Recommends Screening for Postpartum Depression
Postpartum depression is experienced by 10-15% of women and carries risks to both mother and baby. Untreated maternal depression is associated with negative outcomes for children including behavioral problems, cognitive or developmental delays and impaired attachment.  Treatment of a mother’s depression can improve not only her own functioning and quality of life, but can improve her children’s symptoms as well (Pilowsky 2008). Given the importance of a mother’s mental health on her baby’s well-being, the American Academy of Pediatrics (AAP) released a recent report which recommends that pediatricians screen mothers for postpartum depression at baby’s one-, two-, and four-month visits (Earls 2010).
Antidepressants and Weight Gain
Many individuals have the experience of weight gain while receiving treatment with an antidepressant, and often wonder if selective serotonin reuptake inhibitors (SSRIs) are associated with weight gain. This is an excellent, complex, and clinically important question.
SSRI Use Associated with Reduced Intention to Breastfeed
Given the potential health benefits of breastfeeding on both mother and baby, the U.S. Public Health Service for Healthy People 2010 set a goal to have 75% of mothers breastfeed in the early postpartum period and 50% of mothers to continue breastfeeding to 6 months by the year 2010 (US Dept of Health and Human Services 2000). Groups of women who are less likely to breastfeed have been targeted in this effort.
Risk of Depression is High in the Parents of Young Children
The New York Times published an interesting article on the high risk of depression among new parents. Â While we are now more aware of depression in mothers after delivery and making greater efforts to screen for postpartum depression, the article points out that both parents are at risk for depression and that the risk extends well beyond the immediate postpartum period.