Another option for pregnant women with severe depression is electroconvulsive therapy. This treatment can be used safely in expectant mothers, provided practitioners use special precautions when administering anesthesia. Practitioners should also be certain to position the patient on her left side during treatment to avoid compromising uterine blood flow.

The American Psychiatric Association and the American College of Obstetricians and Gynecologists published a joint guideline on treating depression during pregnancy that can help guide treatment decisions.


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PATIENT COUNSELING

If a physician does decide to prescribe SSRIs, how should he or she discuss the risks of treatment with the patient?

When addressing this issue, physicians should be certain not only to discuss the risks of pharmacotherapy, but also the risks presented by the depression itself. Women should be aware that if they do opt for treatment with SSRIs, the most likely side effect that the baby will experience is mild withdrawal symptoms in the 48-hours following delivery. These infants typically have mild respiratory symptoms, irritability and other minor neurobehavioral changes during withdrawal. However, the majority are still able to go home within 48 hours. Women should also be informed of other, rarer risks associated with SSRI treatment such as cardiovascular problems and growth changes. Physicians should consider recommending additional medical support for these infants at birth in the event that they suffer withdrawal symptoms.

If a physician believes that the risks of untreated depression are greater than the risks posed by SSRI use during pregnancy, but the patient is resistant to treatment, how can he or she overcome that hesitance?

Ideally, discussions about depression treatment during pregnancy should take place prior to conception. If a woman has severe recurrent depressive illness, she should be aware that stopping her medication puts her at high risk for relapse. But if a woman is resistant to using medication, the best route may be to tell her you understand her choice and provide her with other options, such as interpersonal therapy, CBT or lifestyle changes.

However, advise the woman that you would like to evaluate her condition regularly throughout her pregnancy and that you may need to revise treatment if her symptoms worsen.

Keep in mind you don’t want to frighten a woman who is already anxious and depressed. But it is important for her to understand this is not a “risk” versus a “no risk” situation. SSRI treatment does present some potential hazards, but she should also understand that untreated depression could also harm her baby.