Pregnant people deserve clear, rigorous information, says Miller. “Each person’s circumstances are unique. The most meaningful way to weigh risks and benefits is through open, individualized conversations with a trusted clinician who can interpret the existing evidence appropriately and center your concerns, values, and goals,” she says.
Some of the key issues to discuss include:
- Severity of the Depression and Past History of Symptoms Pregnancy and the postpartum period are a vulnerable time for people with mental health conditions, says Riddle. “There are biological and psychological changes that place them at high risk of worsening or recurrence,” she says.
- Medication Choice Two common SSRIs, sertraline (Zoloft) and fluoxetine (Prozac), have a lot of registry data that place them in the low-risk category based on current, well-designed evidence, says Riddle.
- The Decision to Continue a Current Antidepressant or Switch That may be challenging because of the many factors involved in deciding on a treatment regimen. That may be a good conversation to have prior to pregnancy, says Miller. “Medications are not interchangeable even within the same class — patients have different responses and may experience different side effects,” she says.
- The Possibility of Tapering the Dose or Trying Nondrug Therapies The guiding principle is “fewest number of medications at the lowest effective dose(s),” says Miller. Turning to psychotherapy or support groups, in addition to or instead of antidepressants, may be the best choice depending on the person.
In a best-case healthcare scenario, “All options to treatment are provided to patients, including discontinuing medications, but couched in a conversation about their prior history, their prior pregnancies, their risks while ill, and the risks of the medications,” Miller says.
Nondrug therapies can often be effective for treating mild to moderate depression, but not everyone has access, Miller says. “Additionally, many patients do not only have depression; they may also have an anxiety disorder or post-traumatic stress disorder,” she says, the combination of which may respond best to medication.
If you’re currently taking an antidepressant, whether you are pregnant or not, always talk with your doctor before you stop taking it.
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