Pregnancy can feel like a magical experience filled with joy and anticipation. However, for many women, it becomes a dark and lonely time overshadowed by stress, fear, and sadness. Rapid hormonal changes occur, which contribute to mood swings, and estrogen levels rise to their highest peak of any time in a woman’s lifecycle.
Depression During Pregnancy
Depression is a serious illness that can devastate people’s lives. It can steal the ability to experience joy and lead people to feel worthless and hopeless. It can lead to insomnia, poor appetite, inability to concentrate, lethargy, and, in extreme cases, suicidal thoughts. Women especially are afflicted by depression, affecting about one in five within the course of their lifetimes. When depression intersects with pregnancy, which occurs in about 7 percent of women, the effects can be crushing. Pregnant women suffering from depression are at risk for poor compliance with prenatal care, inadequate nutrition, and lack of self-care. They are more likely to turn to alcohol, cigarettes, or drugs in an attempt to cope with these negative emotions (Guo et al., 2018; Alwa et al., 2007).
Consequences of Antenatal Depression on the Developing Baby
The consequences of depression during pregnancy, or antenatal depression, can wreak havoc on a woman and her family. These women may be plagued by incessant worrying and feel overwhelmed. Untreated depression raises the risks of premature delivery and low birth weight of the newborn. Dr. Catherine Birndorf, a reproductive psychiatrist and co-founder and medical director of The Motherhood Center, explains that antenatal depression is one of the leading risk factors for the development of postpartum depression. Contrary to common perceptions, pregnancy does not protect against depression, and antenatal depression is likely to worsen after birth if untreated (C. Birndorf, personal communication, October 30, 2024). This is consistent with studies that have shown that almost 40 percent of women with antenatal depression go on to develop postpartum depression (Underwood et al., 2016).
How to Treat Antenatal Depression
Many reproductive psychiatry specialists now believe that the best option for treating moderate to severe depression during pregnancy includes the use of antidepressant medications along with non-pharmacological approaches, such as therapy and exercise. Dr. Birndorf—co-author of What No One Tells You: A Guide to Your Emotions from Pregnancy to Motherhood—specializes in the treatment of pregnant and postpartum women and empowers them to make informed choices regarding the use of antidepressants. She emphasizes that the best thing for a pregnant woman and her growing baby is maternal wellness and that some women require medication to be well. Untreated depression poses significant risks, including becoming unable to work, function, or care for one’s children (C. Birndorf, personal communication, October 30, 2024).
My Experience Treating Women During Pregnancy
As a specialist in psychopharmacology and reproductive psychiatry, I have treated many women taking antidepressant medications during their pregnancies. We often engage in multiple discussions about the risks and benefits of medication use when they are planning to conceive. For patients with a significant history of depression—those who have experienced severe or multiple episodes—many choose to continue their antidepressant medication at least until pregnancy is confirmed. At that point, we may consider tapering the medication under close supervision. If signs of relapse appear, we generally restart the medication promptly.
I encourage my patients to proactively engage in non-pharmacological approaches, such as therapy and regular exercise, to support their mental health. Some patients decide to remain on their antidepressant throughout pregnancy, recognizing that the risks of discontinuing medication could be catastrophic for them. Others have had positive experiences with antidepressant use during previous pregnancies and opt to stay on their medication.
In my experience, I have never encountered a woman who regretted taking an antidepressant during pregnancy. However, I have treated women who suffered from antenatal depression and felt severely traumatized by the experience.
Medication Use During Pregnancy Is Common
About 80 percent of pregnant women report taking at least one medication during pregnancy (U.S. Food & Drug Administration, 2023). Some have underlying medical conditions such as diabetes, Crohn’s disease, or lupus and require maintenance medications. Antibiotics for an infection or steroids for asthma may be necessary. New illnesses may develop, such as gestational diabetes, hypothyroidism, or high blood pressure, that require treatment. In addition to medication exposure during pregnancy, many women use alcohol or other substances in the early weeks of pregnancy before realizing they are pregnant.
Research on Antidepressants During Pregnancy
Randomized controlled studies are not possible during pregnancy for ethical reasons. However, data is collected through Pregnancy Exposure Registries and outcome measures have been overall encouraging. Most studies found that early pregnancy exposure to selective serotonin reuptake inhibitors (SSRIs), such as Prozac and Zoloft, was not associated with a significant increase in risks of congenital heart defects or of most other categories of congenital disabilities (Alwan et al., 2007; Huybrechts et al., 2014). Some conflicting data exists regarding whether there is a slight increase in congenital disabilities with SSRI use; however, when adverse effects have occurred, it is unclear whether they are attributable to SSRI use, underlying depression, or other variables (Alwan et al., 2007; Anderson et al., 2020). For example, patients with depression are more likely to use alcohol, cigarettes, and drugs, which are potential risk factors for adverse birth outcomes (Huybrechts et al., 2014).
A recent study from Brigham and Women’s Hospital and Harvard Medical School evaluated over 145,000 pregnancies with antidepressant exposure and assessed neurodevelopmental outcomes in children (Suarez et al., 2022). Their findings suggested that antidepressant exposure during pregnancy was not associated with autism spectrum disorder, attention-deficit/hyperactivity disorder, specific learning disorders, intellectual disabilities, or behavioral disorders (Suarez et al., 2022).
Pregnancy Essential Reads
Barriers to Antenatal Depression Treatment
Dr. Birndorf explains that one of the most significant barriers to antenatal depression treatment relates to myths around what pregnancy should be, such as the notion that everybody else is glowing and that the woman is somehow defective or weak or broken because she has this problem (C. Birndorf, personal communication, October 30, 2024). Feelings of shame or guilt may prevent women from disclosing their suffering and lead to avoidance of treatment. Other barriers include a lack of awareness that antidepressants can be taken during pregnancy, as well as poor access to specialized treatment.
Removing the Stigma
The wall of silence around antenatal depression is starting to crumble. Celebrities such as Britany Spears, in her memoir The Woman In Me, wrote about her experience of depression during pregnancy, including loss of pleasure and feeling angry. Actress Shay Mitchell described her experience of crippling depression, anxiety, and isolation during her pregnancy (Good Morning America, 2019). Actress and author Jenny Mollen wrote about the darkness and fear she experienced during pregnancy (Global News, 2017). These brave women help to remove stigma and encourage those suffering from antenatal depression to seek support and make informed decisions about taking antidepressants during pregnancy.
Non-pharmacological Treatment of Antenatal Depression
Non-pharmacological management strategies such as therapy, exercise, and meditation should be maximized to treat depression during pregnancy. However, for moderate to severe depression, antidepressants may become necessary for adequate symptom relief. Proper medical treatment is critical for the health and well-being of the expectant mom and the developing child.
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