Caught between a rock and a hard place: Should I discontinue my antidepressants when I get pregnant?

Between 8-20 percent of pregnant women experience clinical depression. The majority is sub-optimally treated or untreated. Women who discontinue taking antidepressants at conception are at tremendous risk of relapse (68%), and inadequate treatment of depression during pregnancy contributes to maternal suicide, reduced use of prenatal care, substance abuse, self neglect, and premature infants. Anecdotal evidence suggests that many pregnant women discontinuing antidepressant therapy out of fears about risks to the fetus that are, in fact, unfounded. A major obstacle to providing optimal treatment and counseling of depressed, pregnant women is that data are lacking on the reasons why women discontinue their antidepressants. We conducted a pilot qualitative interview study with a convenience sample of 25 women who were taking antidepressants prior to planning or initiating a pregnancy. The vast majority of women chose to discontinue medication, and most of these women experience some level of relapse but felt they had to suffer in order to protect their fetus. Beliefs about the risks of antidepressants appear to be grounded in cultural expectations that women will keep their bodies “clean” during pregnancy and the stigma associated with mental illness and the use of drugs during pregnancy. Physician support and reassurance was a key theme for women who continued taking their medication. All participants would have willingly participated in observational research designed to study the risks of using antidepressants during pregnancy.