Pregnant Women With Depression Face Tough Choices, No Easy Answers
Antidepressants and anti-anxiety medications can be harmful to the developing fetus. Pregnant women who suffer from serious depression face a difficult dilemma: Should they continue taking medication and risk unknown side-effects to the fetus, or go through their pregnancies trying to handle their depression without medication?
Author Andrew Solomon tells Fresh Air's Terry Gross that there is an "enormous amount of research which establishes relatively definitively that the drugs don't cause significant birth defects." But the long-term effects of these medications aren't clearly known. "The jury is still out on what happens in a developing brain and whether those people, as they get into adulthood, will have slight shifts in their personality or consciousness or their vulnerability to depression on the basis of their prenatal exposure," he says.
But Solomon points out that a depressed mother can also be harmful to the fetus. Stress can also increase the level of cortisol, a hormone, and affect the fetus. "Women who are depressed are less likely to keep all of their obstetrical appointments, are more likely to drink or use substances of abuse, are less likely to regulate their exercise and what they eat in the ways that are best for a developing fetus," he says. "It's harder to be good at pregnancy when you're depressed."
Solomon's article, "The Secret Sadness of Pregnancy With Depression," recently appeared in The New York Times Magazine. Solomon's own depression led him to write his 2001 book, The Noonday Demon: An Atlas of Depression, which has just been published in a new edition with a new chapter about the latest developments in treating depression.
On the problems in doing research on how medications might affect pregnant women
We can say to a group of nonpregnant women, "We're going to give half of you Prozac and half of you a placebo, and we're going to follow you for the next two months and see what happens." It is outside of ethical guidelines to do the same thing with pregnant women. You can't have people taking that risk for a developing fetus, and you can't say, "We're giving half of you this drug and half of you a placebo and we'll see what happens." Instead, studies of the effects of drugs on fetal development or on pregnant women are based on retrospective work. You say, "Let's look at all of the children who have a particular cardiac defect and see how many of their mothers were taking medication." Or you say, "After the whole thing is over, let's see how the women who were voluntarily taking medication fared as oppose to the women who chose to stay off it." But those are often not comparable groups. The people who choose to stay on medication during pregnancy are likely to have more severe depression than the ones who are able to go off, or to have a very different structure of personality that makes it harder for them to deal with the depression. So the confounding factors are enormous and confusing and the research is therefore never very definitive.
On how depression and stress can negatively impact a fetus, such as causing high levels of the hormone Cortisol
It appears that cortisol is implicated in the constriction of the uterine artery, which means that it reduces the blood flow to the placenta. That is a very serious matter that warrants consideration. It would also appear that some of the other chemicals that circulate in the brains (and therefore in the bloodstream) of people who are depressed will be circulating and making it through to that placenta and that fetus, and they will be having a direct effect, which may be comparably dramatic, to the direct effect of anti-depressants...
A large portion of women who are depressed during pregnancy will be depressed after the baby is born. It's not as though the baby comes out and suddenly the whole thing goes away. Depression in the early stages of taking care of an infant involves terrible suffering for the mother who feels utterly overwhelmed and unequal to what she is now required to do, and it's not good for the baby, because depressed mothers tend to be irritable and inattentive and neither of those is a good way to be with a newborn.
On what he's learned about managing his own depression
You always have to be vigilant with it, you always have to deal with it. It is, for most people, a lifetime condition and it requires constant management. I go and see a psychotherapist every week, not so much because what happens in any individual session is transformative, but because I feel it's important that there be someone, a trained professional, who is watching what is going on. And he said to be me one day, when I was being a little cavalier about some of what I thought were minor symptoms of depression, he said, "Let us never forget in this room that you are very capable of taking the express elevator to the bargain basement of mental health." And I think that consciousness has had to be something that I've learned.
In talking to so many people and hearing about so many situations, really what I've come to is the feeling that depression mostly is manageable, but if not well managed it can be tragic, and that most people who are seeking treatment are not getting very good treatment, and that many people who would benefit from treatment are not even seeking that treatment.
On his very unconventional family
My husband John is the biological father of two children with some lesbian friends in Minneapolis. My very dearest friend from college had got divorced but wanted to be a mother, and I wanted to be father and so we decided to have a child together. Mother and daughter live in Texas. Then John and I wanted the experience of bringing up a child ourselves and so we have my son — I am the biological father, John is the adoptive father, we had an egg donor and our surrogate was Laura, the lesbian mother of his two biological children in Minneapolis. The shorthand is six parents (really including the partner of my daughter's mother); six parents of four children in three states. ... It is all working out and there were a lot of people who said, as we began on the various bits and pieces of it, "This can only be a disaster. It's all going to be awful." I've just finished making plans with all of them about who is coming for what parts of the summer and when we'll all see one another. It has turned out to be an amazing joyful experience, with its challenges, of course, but very joyous.
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