Last week’s Toronto Star article on prenatal depression (depression during pregnancy) highlighted a real issue that we are seeing more and more of in pregnancy. Fortunately, this story has a happy ending but it very easily could have ended another way. As Dr. Bill Mundle comments in the article, pregnancy can be a time when women have a first episode of depression. Pregnancy, under the best of circumstances, is associated with increased anxiety and anything out of the norm can further add to this anxiety, contributing to the development of depression. The incidence quoted in the article from the Public Health Agency of Canada, 1 in 10 women, is likely an underestimation for a condition that is often not recognized or not reported.
As doctors, we are certainly seeing more and more women coming in to their pregnancy on some sort of antidepressant. Having any kind of a history of depression not only increases the chance of postpartum depression but also prenatal depression. Many women stop or try to cut back their antidepressants because they have concerns about the potential for effects on the fetus. However, I always warn my patients that the use of any medication in pregnancy is a balance of risks and benefits. If it is something that they really need, then they should certainly continue to take that medication, albeit at the lowest dose that works. Coming off a medication and having a complication is of no benefit for the woman, the pregnancy or the baby. In fact, women with a history of depression or antidepressant use often find that they need to start, restart or increase their dose of medication for symptom control as the pregnancy progresses. I always recommend to women and their partners to keep an eye on symptoms that could suggest a worsening of depression and to seek medical help immediately.
If you are on antidepressant medication prior to pregnancy, or in pregnancy and are considering stopping it, talk to your doctor first or go for counseling prior to getting pregnant; if you have a medical condition requiring treatment you should go in to any pregnancy as stable as possible. Also, if you or anyone in your circle of family and friends is concerned about what you are doing or saying, contact your health care provider to get help. Mental illness, especially during pregnancy, affects more than just the pregnant individual.
To learn more about depression after pregnancy, read our Postpartum Depression section.