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I have been diagnosed with postpartum depression. Is my baby at risk?

With recent media coverage of high-profile criminal cases of women who harmed their children while suffering from postpartum illness, the diagnosis of depression in the postpartum period can result in concerns regarding the baby's welfare. The benefit of significant coverage of such tragedies is that it brings into the open and to the attention of clinicians the very real

Depression occurs in approximately 10% to 15% of all postpartum women, which approximates the occurrence in the general population. Thus, although hormonal factors are believed to be contributory, they are not strictly causative. Factors associated with an increased risk for postpartum depression are past history of depression, a family history of depression, limited social support and interpersonal conflicts, and negative life events.

risks of untreated depression in the postpartum period. Although infanticide is in fact a rare outcome of mental illness, the real risks can be subtler. Depression after a birth can result in low self-esteem, reduced confidence in mothering abilities, and decreased attachment and bonding between mother and infant. Depression in the postpartum period is often dismissed as "hormonal" or normal "baby blues."[1] In fact, clinical depression is more severe than the baby blues, because it can be associated with suicidal ideation. Untreated depression has other risks that are more likely than infanticide. A depressed mother will be less in tune to the baby's needs, less able to monitor the environment for safety, and less apt to engage in a nonverbal dialogue with the baby. Early attachment[2] is important in an infant's development, because poor attachment confers risks later in life for emotional and behavioral problems. Once diagnosed with depression, however, it is important to understand that with treatment the risks will dissipate. Support from family members or friends can be enlisted to help bridge the gaps in tending to the baby's needs while treatment is initiated. In most instances of postpartum depression, the mother will be able to continue to care for her child while treatment is initiated. Rarely are there circumstances when mother and baby need temporary separation to maintain the baby's safety.

I am pregnant and feeling very depressed. Can I take medication?

Treatment of depression during pregnancy can be complicated, because risks to the fetus have to be considered. It has often been difficult for women to obtain medication treatment for depression during pregnancy because of concerns about the effect of medication on the fetus. Because no controlled, clinical studies exist that examine medication effects on fetal development, risks versus benefits need to be extrapolated from case reports mainly and based on the individual circumstances for the woman involved. Psychotherapy alone would be the ideal treatment modality but may not be efficacious enough for chronic or moderate to severe depression. Untreated depression can have deleterious effects on the developing fetus itself. Maternal prenatal stress has been associated with lower infant birth weight and gestational age at birth. Animal studies have found that high levels of stress hormones in the maternal blood correlate with behavioral deficits in the offspring. Thus, if you are pregnant and suffering from a severe depression, what medication choices are available? Although no antidepressants have been associated with intrauterine death or major birth defects, in late 2005 the manufacturer of paroxetine posted a warning indicating that it may cause malformations, particularly of the cardiovascular system. Few data are available on potential adverse behavioral development in infants exposed to antidepressants in utero. One study done on TCAs did not show any difference in behavioral development. Immediately after birth, however, there have been signs of neonatal withdrawal both from SSRI and TCA exposure, and the FDA has issued a warning that SSRIs and venlafaxine can be associated with neonatal distress when taken late in the third trimester. The exact cause of the distress, such as a discontinuation syndrome or serotonin syndrome, is not known. Neonatal withdrawal may be more likely with antidepressants that have a shorter half-life, such as paroxetine, if caused by a discontinuation syndrome. It is possible to avoid a withdrawal situation by tapering off the antidepressant before the anticipated delivery. There are situations in which an untreated depression would be of higher risk than use of an antidepressant. If, however, a woman is still concerned about potential harm to the baby from medication, consideration can also be given for ECT, which has no risk on the developing fetus. ECT is a known safe somatic treatment during pregnancy. If psychotic symptoms are present, ECT is often the treatment of choice as well so that antipsychotic medication can be avoided.

Of the psychotherapeutic techniques, interpersonal psychotherapy has been shown to be effective for depression in pregnant woman. Other modalities are also likely to be helpful, as described in Question 37. Even if medication is required, psychotherapy is an important part of the treatment.

  • [1] common symptoms of sadness and tearfulness that occur in the days after giving birth that are thought to be the result of hormonal changes associated with the birth event.
  • [2] the psychologic connection between a child and his or her caretaker. Infants develop attachment behaviors within the first month. Deficits in early attachments can result in problems in later relationships in life.
 
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