Antidepressants-Pregnancy Dilemma

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Millions of Americans take antidepressants, including an increasing number of women in their child-bearing years.

But The Early Show's Melinda Murphy says a severely depressed pregnant woman faces a dilemma: Should she take the drugs, or not? That's because it could be risky, for her, and her unborn child.

Lisa Kirshenbaum had to make that choice. She has struggled with depression for most of her adult life, and has treated it with medication for years. She was diagnosed at about the age of 20.

But, says Murphy, because Kirshenbaum was worried about the effects of antidepressants on a fetus, Kirshenbaum got off the drugs, under a doctor's care, before she got pregnant.

"I had a pretty good pregnancy with my son," Kirshenbaum says. "I would definitely say I had anxiety, but I managed to get through it and I had a healthy baby."

But, Murphy reports, when Kirshenbaum stopped taking antidepressants to get pregnant a second time, her life spun out of control.

"I wasn't eating. I wasn't sleeping," Kirshenbaum says. "I was in this deep, black hole. And I crashed. …I had a severe, severe episode of depression."

It affected her whole family.

Husband Evan Kirshenbaum says, "There really was no end in sight, except for the hope that maybe tomorrow will be better. But that never happened."

"I couldn't interact with my son," Lisa recalls. "I didn't even have enough energy in my voice to read a story. My body had shut down. So … probably not surprisingly, I did have a miscarriage at nine weeks."

Why wouldn't a woman take antidepressants during pregnancy? Because, notes Murphy, there's continuing debate about whether those drugs can harm fetuses.

Dr. Philip Sanford Zeskind, director of neurodevelopmental research at the Carolinas Medical Center in Charlotte, N.C. believes they can: "What we found was that the infants whose moms took antidepressants spent most of their time - the great majority of their time - just sleeping and … were less rhythmic and less regular in their heart rates than babies of mothers who did not take antidepressants."

The Food and Drug Administration has strengthened its warnings to pregnant women about certain antidepressants.

But Murphy notes that most experts believe luntreated maternal depression can also be bad for the baby.

Psychiatrist Lee Cohen of Massachusett General Hospital, a consultant to Eli Lilly, which manufactures the antidepressant Prozac, has been researching this topic for almost 20 years: "Patients who are not sleeping, not eating, not gaining enough weight for their pregnancy - those patients are at risk."

So what should a woman do if she wants to have a baby, but is struggling with depression?

On this point, says Murphy, both experts agree.

"We're not going into this saying absolutely no medication. We're just saying we need to be a little bit smarter about whether medication has an ill effect," Zeskind says.

"In medicine, there's no perfect decision. No decision is risk free," Cohen observes.

Lisa Kirshenbaum felt there was no choice. She did become pregnant a third time - and stayed on Prozac.

She says bluntly there's no way she would have had another child without being on the medication.

Her doctors kept a close eye on the baby's development, and Lisa's emotional well-being.

The Kirshenbaums say their daughter arrived healthy and, at 16 months, is doing just fine. "We feel like a complete family," Lisa says. "I feel completely full. Complete. I call her my miracle baby, 'cause she wasn't necessarily going to be here. And she is, and she's the most amazing child."

In the end, Murphy says, it comes down to a woman consulting with her doctor before she gets pregnant and coming up with a plan that hinges on the degree of depression.

And, Murphy adds, there might be alternatives to medication.

Lisa tried yoga, acupuncture, relaxation and exercise. In her case, those methods didn't work well because her depression was so severe.

But each woman is different, and some pregnant women have had success managing their depression with some of those alternative therapies, Murphy concludes.
  • Brian Dakss

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