To Take or Not to Take Antidepressants During Pregnancy

Deborah Cowley, MD

Women with prior experience of taking antidepressants and greater illness insight were more likely to use antidepressants during pregnancy.

The decision to take antidepressant medication during pregnancy is complex and involves weighing risks of untreated depression against risks of medications to the fetus. However, other factors may enter into such decisions. Investigators prospectively examined reasons for accepting or declining antidepressants in 50 women with moderate-to-severe major depression and comorbid anxiety. None of the women were suicidal or psychotic.

Participants (mean age, 33 years; 77% white; 83% married) were recruited between 18 and 34 weeks' gestation, after they had decided about antidepressant treatment during pregnancy. Thirty women had decided to take medication (adherers), and 20 had declined (nonadherers). Demographic variables and baseline depression severity were similar in the two groups, but history of prior antidepressant treatment differed (73% in adherers vs. 20% in nonadherers). During the remainder of their pregnancies, the adherers became significantly less depressed and anxious whereas nonadherers became more depressed and anxious. The primary reasons for avoiding medication were fear of fetal exposure and the belief that symptom severity did not warrant medication treatment. Adherers had a more positive view of antidepressants and greater insight into their illness.

Citation(s):

Misri S et al. Factors impacting decisions to decline or adhere to antidepressant medication in perinatal women with mood and anxiety disorders. Depress Anxiety 2013 Jun 18; [e-pub ahead of print].