Weighing the option of taking an antidepressant during pregnancy

Managing depression with medicine during pregnancy puts women in a bind, but experts say some risks are better than others.

On and off for two decades, new mom Corrie Ordway has had the kind of depression that hits hard.

She gets an upset stomach, she can’t eat or sleep. She even gets the shakes when it’s really bad.

Today though, Ordway, 33, lives in Sunnyvale, California, with her husband and 15-month-old daughter, Ellie. She laughs easily, and smiles even as she remembers her first diagnosis of depression at age 12.

The doctor suggested medicine, and Ordway says the antidepressant pills helped her feel like herself again. But she didn’t like to talk about it.

“I wouldn’t let my mom call it medication,” Ordway says. “I wouldn’t let her call it antidepressants. We called it my vitamins.”

Embarrassed, she found herself in a push-pull dance throughout her late teens and 20s. Ordway would stop taking the drug, and be OK for a while. But sooner or later, she’d hit another wall of depression.

Finally, her doctors said Ordway should probably just plan to take an antidepressant for the rest of her life.

Ordway says she was at peace with that. That is, until she started trying to have a baby and wanted to have a drug-free pregnancy.

Ordway was on antidepressants when she found out she was pregnant. She couldn’t have been happier, but simultaneously, she thought, “I’m hurting this baby.”

There’s some medical guidance out there for mothers-to-be about whether to stay on the medicine while pregnant—but no definitive answers. So women have to make a judgment call, along with their doctors.

Psychopharmacologist Patrick Finley from the University of California, San Francisco helps mothers make that kind of decision. He says, when it comes to the most common kinds of antidepressants, SSRIs (Selective Serotonin Re-uptake Inhibitors), there doesn’t seem to be a substantial risk for serious birth defects.

But, the risk isn’t zero. Some of the most serious potential side effects of SSRIs are heart problems and lung problems in the newborn. SSRI exposure has been linked to babies born a little early, a little underweight, and fussier than average in the first few days, Finley says.

What information we have on safety and side effects comes from pregnant women who took antidepressants outside the controlled environment of a clinical study, he says. So that means the safety data are not based on the most rigorous approach for testing drugs, in which one group of people gets the drug, while another gets a placebo.

“You can’t do that with a pregnant woman,” Finley said. “It’s unethical.” It’s unethical because a fetus can’t give consent.

Every medicine comes with some risk, but Finley says the effects of really bad depression can be much worse for both mom and baby than the risks posed by most antidepressants.

Pregnant women with severe depression often don’t get mental health care and some use other things to cope.

“They’re more likely to abuse substances, including smoking, which has a terrible outcome,” Finley said. “They’re more likely to miss their appointments during their pregnancy. They don’t eat as well. They don’t exercise as much.”

Women with this kind of deep, unrelenting depression are even more likely to have a miscarriage or become suicidal. So Finley often counsels those patients to go on—or stay on—an antidepressant. That’s also the official recommendation from the College of Obstetrics and Gynecology.

But if a woman has mild to moderate depression, Finley says, drugs aren’t always necessary. Instead, women can try things like psychotherapy, acupuncture, and diet changes.

Corrie Ordway’s depression was severe, so she took the medicine.

“Anybody who has to care for somebody else needs to be healthy,” Ordway said, as she caressed her daughter’s fluffy blond hair.

Corrie Ordway’s dilemma was classic, says Lara Buchak, philosophy professor at the University of California, Berkeley. The stakes were high and there was just one chance to make a choice.

Buchak teaches rational choice theory and she says that’s the paradigm case of risky decision-making.

“Do I go for the known thing or do I go for the unknown thing that might be better but it might be worse? That’s the human condition,” she said.

You see examples all over health care. Taking morphine at the end of life may ease pain, but may also hasten death. A needle-stick test to check for birth defects during pregnancy comes with a slight risk of miscarriage.

Buchak became interested in the topic because decisions have always been hard for her. She says she was “always known as the person who, you know, would stare at the sock drawer in the morning before being able to pick out a pair.”

Buchak says there are lots of ways to work through difficult decisions. Not the sock drawer kind, but the life and death kind. First off, precedent can help—looking at what we or other people have done in the past and how that worked out.

Mom Corrie Ordway says when you’re having a baby, you can’t help but look around and be influenced by friends, family or society in general.

She says she “just had this sense that you shouldn’t be taking medication when you’re pregnant.” But she’s not sure why she had that thought.

The case of Thalidomide is an historic incident that casts a shadow over many women trying to decide whether or not to take medicine during pregnancy.

Thalidomide was a popular morning sickness medication in the early 1960s. The pills caused serious birth defects in tens of thousands of babies worldwide and eventually led the U.S. government to toughen U.S. Food and Drug Administration regulations and to increase resources for the administration.

The drug received so much negative attention that in 1962 President John F. Kennedy gave a press conference.

In a newsreel from “News of the Day,” Kennedy said: “Every woman in this country must be aware that it’s most important they check their medicine cabinet, that they do not take this drug.”

For better or worse, that medical catastrophe set a precedent that reverberates in the decisions pregnant women make today.

Rational choice expert Lara Buchak says mood is another thing that can shape our decisions. How you’re feeling, she says, often determines how much risk you’re willing to take at any moment.

If you’re in a good mood, she says, or if it’s sunny outside, then you’re more likely to be optimistic.

“Maybe you think it’s more likely that there will be an upturn in the stock market,” she said, “or that you’ll get a promotion. But you’re actually less willing to take risks.”

That’s because you’re happy enough with the status quo. On the other hand if you’re depressed or in pain, you’re more willing to take risks to get out of what seems like a bad situation. And sometimes, says Buchak, those risks can be good ones to take.

Buchak’s final tip is don’t muddy the waters with too much information and well-intentioned advice from other people.

Sitting at her kitchen table, Corrie Ordway says when she was expecting her daughter Ellie, she didn’t talk to a lot of people about her decision to take antidepressants. But Ordway did take her psychiatrist’s advice. She switched to an antidepressant with fewer believed risks for pregnancy and breastfeeding.

Mother and daughter are both doing great these days, Ordway said.

As Ellie fidgeted in her mother’s lap and reached for a cookie, Ordway said she made the best choice she could and she’s living with it.

Still, sometimes she wonders if there’s anything about her daughter that was changed by the antidepressants, she wonders if the medicine left chemical traces in Ellie’s body.

“But then we all have traces of everything in our body,” she said.

Ultimately, the decision to manage her depression with medicine was the right thing for them, she said.

“It would be again,” she said.