DEAR DOCTOR K:

I take an SSRI for depression. I'm trying to get pregnant, but I'm worried about going off my antidepressant during pregnancy. Can I continue to take an SSRI?

DEAR READER:

You can, but at some small risk to the baby. But if you stop taking the SSRI while you are pregnant, you may increase your own risk of worsening depression during and after the pregnancy. So I don't have an easy answer.

Treating depression is important for both your sake and your baby's. Untreated depression during pregnancy increases your risk of postpartum depression. It also makes it more likely that your baby will be lethargic, irritable and underweight at birth.

But what kind of treatment? Medication is one option. Selective serotonin reuptake inhibitors (SSRIs) are the most common drugs prescribed for depression. SSRIs include fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro).

Another option is "talk therapy." This can be traditional one-on-one sessions with a therapist. It also can mean family therapy, involving you, your spouse and possibly other family members. Cognitive behavioral therapy (CBT) is a particular talk-therapy technique that can help you learn ways to think positively and solve problems. Even if your doctor says you need to continue taking medication along with talk therapy, you may be able to lower your dose or reduce the length of time you need the medication.

You can also explore other non-drug options. For example, consider exercise (under your doctor's supervision) or mindfulness meditation to help manage your depression.

The risk to your baby from taking SSRIs during pregnancy is very small, but still real. SSRI drugs that are in your blood travel through the placenta and enter the bloodstream of your developing baby. SSRIs during pregnancy are linked to increased risk of heart birth defects, respiratory problems and withdrawal symptoms in babies. Risk of miscarriage and premature birth may also increase. The FDA has labeled paroxetine (Paxil) unsafe for use during pregnancy.

Guidelines from the American Psychiatric Association and the American College of Obstetricians and Gynecologists recommend medication for expectant mothers with severe depression. But for pregnant women with mild to moderate depression, they recommend psychotherapy.

That's probably the most important point. If in the years before pregnancy your depression has been severe, you will probably need medication along with talk therapy during the pregnancy. By "severe," I mean you have had many episodes of depression, or episodes that are quite severe and make it very hard for you to function, or both.

Particularly if you have had severe depression in the past, and your past reaction to medications has been positive, the risk to you and your baby from not taking medication is probably greater than the risk of taking medication.

(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)

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