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Pregnancy and Major Depression a Dangerous Mix


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Pregnancy and Major Depression a Dangerous Mix

Women who stopped using antidepressants suffered more relapses, research shows

By Amanda Gardner

HealthDay Reporter

TUESDAY, Jan. 31 (HealthDay News) -- Pregnancy does not appear to confer a protective effect on women with major depression, as many experts had thought.

Quite the contrary, pregnant women who discontinue their antidepressant medication are at a five times higher risk of relapse than women who don't, new research shows.

The study, appearing in the Feb. 1 issue of the Journal of the American Medical Association, argues strongly for women and their doctors to discuss medication options.

"Hopefully, we'll be less likely to see arbitrary discontinuation of antidepressants in patients with histories of major depression, which has been frequently standard fare," said study author Dr. Lee Cohen, director of the Perinatal and Reproductive Psychiatry Clinical Research Program at Massachusetts General Hospital in Boston. "This manuscript will round out part of the risk-benefit equation by offering clinicians and their patients a sense of what happens if they either chose to stay on or stop the medicine."

"This challenges a certain myth and hope that people had that a pregnant woman is going to have a quieter time with respect to her mood symptoms than when she's not pregnant," added Dr. Susan Kemker, an assistant attending psychiatrist at Westchester Medical Center and clinical assistant professor of psychiatry at New York Medical College, both in Valhalla, N.Y.

"That is just not the case," she said. "This study shows a risk for relapse which makes the decision-making process for a woman who's pregnant more complicated. It makes it more important for her to really partner with her doctor."

There have been reports that the newer antidepressants known as selective serotonin reuptake inhibitors (SSRIs), which include Prozac, Paxil, and Zoloft, may cause newborns to have withdrawal symptoms. In September 2005, the U.S. Food and Drug Administration issued a warning about possible birth defects in infants born to women taking Paxil during their first trimester. Overall, however, most studies have confirmed the safety of antidepressants taken during pregnancy.

"Our data on psychiatric drugs have been around for a while, and we're not finding increased malformation," said Dr. Jennifer Wu, an obstetrician/gynecologist with Lenox Hill Hospital in New York City. "For the patient who says she's tried coming off and had very bad depressive episodes, physicians in general recently have been starting to keep them on their medication."

Prior to that, many physicians recommended that pregnant women discontinue the medications.

This study compared pregnant women with major depression who stopped or tried to stop taking their medication near the time of conception with women who stayed on their medication. In all, 201 pregnant women at three centers participated. All were less than 16 weeks pregnant at the beginning of the study, and all had a history of major depression before becoming pregnant.

Out of the total sample, 43 percent relapsed during pregnancy, half of them during the first trimester. Sixty-eight percent of women who discontinued their medication experienced a relapse, compared with only 26 percent of women who stayed on their medication. Women who came off their medication also relapses more frequently.

There are also risks if a woman is depressed during her pregnancy.

"Untreated depression actually puts mom at risk, and puts baby at risk," Cohen said. "It is associated with compromised fetal well-being and the well-being of the newborn."

One of the authors' main messages is that women, in conjunction with their doctors, have to make an important decision, one that can't be presented in terms of black and white.

"It is a complicated picture," Wu said. "You really have to individualize care."

SOURCES: Lee S. Cohen, M.D., director, Perinatal and Reproductive Psychiatry Clinical Research Program, Massachusetts General Hospital, Boston; Jennifer Wu, M.D., obstetrician/gynecologist, Lenox Hill Hospital, New York City; Susan Kemker, M.D., assistant attending psychiatrist, Westchester Medical Center, and clinical assistant professor, psychiatry, New York Medical College, both in Valhalla, N.Y.; Feb. 1, 2006, Journal of the American Medical Association

Last Updated: Feb. 1, 2006

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  • 2 weeks later...

I am so worried about depression affecting the birth of my unborn daughter, but unfortunately my DP is dead set against drugs of any type during pregnancy and very much pro BF. I am almost certain that she will not take any type of AD/SSRI during this time.

I feel so lost, hurt and confused right now because my DP and I had such a loving relationship before this prenancy and though I can't confirm it, I strongly believe that she is experiencing a strong case of antepartum depression right now. I could actually see her getting slowly more distant towards me until we are at the point we are at now, which is hardly any interaction with one another other than a few phone calls and going to the occasional prenatal doctor/midwives appointments. She broke off our relationship saying that it has to do with her and her dealings and that it has nothing to do with me. During this whole time I have been as loving and supportive of her as possible but each day it seems she only gets even more cold and distant. I fear the day will come where she will say she doen't want me to have anything to do with even our soon to be daughter. :hearts:

I am attempting to be as understanding and supportive of her, because I know that her past history hasn't been very pleasant and it more than likely is a strong contributing factor as to why she is experiencing what she is right now. It however doesn't make an already difficult situation to deal with any easier for either of us. Right now she is experiencing financial difficulties, but refuses to accept any help from me, even though I have tried numerous times. She also is having a rough time with this being her fourth pregnancy and her not being as young when she had her others, seems to be complicating matters also. This whole situation seems to be as far from perfect as one could get.

I just don't know what to do. All that I know is that this whole experience has me slipping gradually also into a depressed state of my own, which I had a previous episode of depression before in my lifetime, when my dad passed away a few years ago. (suicide) :bump: I have scoured the entire internet and books at the local bookstore trying to educate myself and find something to help with this entire situation, but it seems like everywhere I look it really all boils down to that person admitting that they are experiencing depression and helping themselves by seeking professional help or seeking support from others around them. I wish someone could shed some light here and give me much needed help and support of my own. My family and friends really don't understand and I feel so alone in all this as I am sure she probably does too.

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((((lostguy))))

It is so hard to be in a situation where you want to help, but your partner won't accept your help!

I think the first thing you need to do is get help for YOU. Even if it is her behavior that has led to you feeling depressed - whatever the cause is - before you can be much good to anyone you need to get yourself as healthy as possible. I hope you will talk to your doctor and also check into some sort of talk therapy.

I'm sorry - I don't know what DP means! I'm guessing you are referring to your partner who is not your wife? I hope it is okay if I refer to her, until I understand better, as your girlfriend.?.?

I would STRONGLY suggest that you encourage her to talk to someone from LaLeche League. They are a breastfeeding support group, but they also have plenty of info for pregnant moms. They have a medical support staff that usually has the most current info on breastfeeding, pregnancy and medications. I was a LaLeche League leader for years when my kids were younger, and I know that sometimes my local doctors would call me to check with the LLL medical advisors about the most up-to-date info on meds for pregnant or breastfeeding women.

Of course, if you are able to, encourage her to seek help. You might show her the article above. As you've said, though, it is really up to her as far as how she chooses to handle this - at least for now.

I hope things will improve for the two of you, but I suppose if the worst happens and you can't communicate with your girlfriend at all, you do have legal options to help raise your daughter. And as far as her development, the chances are that she will be fine. All you can do is look forward to her birth; it does no good to worry about what might happen either way. Whether the baby's mom decides to take meds or to suffer through depression during this pregnancy, your daughter should be fine.

Try to stay calm and take good care of yourself. Let us know how things are going.

Karen

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Karen,

Thank you for responding to my post and cry for help. I know that I need to look out for my own well being, because if I am suffering as well, then nothing will ever get better for either of us. It is just that I can't shake this extreme sadness that has gradually started to taint all aspects of my life. For a while there were days that I just wanted to stay in bed and isolate myself from the rest of the world. I felt as though at times I just couldn't stand the heaviness that my heart felt and didn't want to feel such sadness. It feels almost as bad as the loss and feelings of loneliness I felt when I lost my dad. I know she isn't completely lost to me, but the way things are and the obscure view I have of the future concerning us, seems like there is no light at the end of this long dark tunnel.

I should be so happy and overjoyed about the soon to be birth of my daughter, but at times I feel like I resent the fact that my DP (Darling Partner/Dear Partner sorry for not clarifying I am on another forum concerning APD/PPD and they use alot of acronyms) ever got pregnant. I know this is wrong and I feel totally guilty for even having such thoughts. I have always wanted children and know that once she is born that I will love her completely and unconditionally. It is just that at this present moment I feel so much anguish and torment over how this has affected our relationship. I am being very selfish I know, but I can't help the way I am feeling right now. :broken_heart::hearts:

I just envisioned my first experience as being a soon to be dad, so much differently than it is right now. For me this seems like a nightmare and I just want to wake up and find everything to be just fine. At times I wish that I would just go to sleep and never wake up. I know that I could never do that to her or my baby though and also don't think that I really seriously wish that for myself either. It just seems like it would be so much easier and now I can see my dad's perspective of why he felt he couldn't go on. For the longest time I was angry with everyone, my dad for leaving us like that and not caring enough about our love for him, my mom for causing this to happen, myself for not being a good enough son to see how he was really feeling and for not providing enough love for him to want to stay around for us. I even was angry at God for allowing something so tragic to happen to such a good and decent man as my father. I eventually was able to sort through all of it on my own after a few years, but maybe I never truly got over it? Those feelings of anger seem to be gradually coming back again and now more than ever my belief in God seems to be wavering once again. I don't want a reason to be angry with God again in my life, I thought that he had blessed me with meeting my DP and having a chance of having a beautiful child of my own. But now it seems like he is testing me and I really don't know if I am up to the challenge.

I am sorry for going on and on. It just helps to get so much of this out of my own mind and alleviate just a fraction of the sadness that seems to be consuming me these days.

My DP is well aware of the LaLeche League and even has friends who are involved in it, probably the reasoning for being pro BF. I think that this pregnancy has affected her in a negative way and that she really isn't the person that she would normally be. I am afraid that I won't have the strength to stick it out and see her back to the way she used to be. But that is all that I desire right now and I can't even imagine myself with anyone else either. It shattered my heart when she broke things off between us and actually told me that I am a great guy and that I will find love again with someone else. But at the same time she said that she would feel weird if she ever saw me with someone else other than her. I am just so confused and lost right now.

Edited by lostguy
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Oh, gosh! I have so much I'd like to say to you!!

First of all, yes, it does sound like you still have some unresolved feelings concerning your father's death. Maybe you being an expectant Dad is pulling on some new things that didn't bother you earlier. Since you've worked on a lot of your feelings in the past, you know how to deal with these new feelings. Speak to a therapist if you need to, or do whatever has helped you before. The thing to keep in mind is that it makes sense that you would have these feelings now, and you will deal with them and feel better.

As far as LaLeche League goes, I have not been involved in the group for over 15 years, so I don't know what it is like these days. But I know that when I was an LLL leader, some people who came to the group I ran told me that they'd been in groups in other areas and they did not like those leaders and the way their groups ran. I tend to be pretty laid back and I tried to meet the needs of all members as much as possible. But I know that at least back when I was involved, there were some (many?) leaders and groups that were almost militant about breastfeeding and doing everything as naturally as possible.

I agree that is best whenever possible. I am very much into natural healing; I've also done midwife work. I am just not militant about it! (Although I could be a bit militant about the importance of breastfeeding...) :) The thing is, perhaps your DP is involved with a group that is quite radical and encourages her to avoid any sort of medications. Perhaps, since she is already familiar with and I'm presuming she's in agreement with LLL, you could contact them yourself. If you don't feel comfortable with the leader your DP knows, try a different person. You can even call their national phone number, or contact them online. Tell them you are an expectant father and you would like to speak with the medical liaison for your state. (At least that was how it worked when I was with the organization.) Let the person you speak with know what your concerns are, and ask them for the most recent info on taking ADs while pregnant and breastfeeding. Ask if they could mail you some written material about that.

Perhaps your DP would be willing to listen if you showed her positive info from LLL. Of course, whenever possible, it is best to avoid meds. But often (as the article above says) it is better to take AD meds during pregnancy than to suffer from severe depression. If nothing else, even if DP won't listen to your thoughts and any info you can get supporting your views, you could ask your LLL contact about any possible father's groups in your area. Whatever support you can get could only be a help.

You said,

at times I feel like I resent the fact that my DP ... ever got pregnant. I know this is wrong and I feel totally guilty for even having such thoughts.
Please stop feeling guilty!!! All expectant parents have times when they have doubts about the coming baby for one reason or another. What you are feeling is perfectly normal, and you are right that once your daughter is born you will be full of love for her. Don't worry about the negative feelings you sometimes have now.
With the problems of mental health and your relationship that have developed, of course nothing is going so positively as you would have expected. But try to give yourself the credit that you are working hard to do all that you can to make this a great experience for everyone involved. That is all you can do, your best. You can't change your DP. But since this is the way it is, try to find ways you can enjoy this special time. It is great that you are involved in an APD/PPD group, and perhaps you can find a group online or in real life for expectant Dads. Be sure and spend time reading books about preparing for your new baby, especially the L. Nilson (sp?) or similar that picture the baby's development at various stages.

When is your daughter expected to make her appearance, anyway? :)

I hope that in time your DP will come to her senses, and the two of you can share this time. Keep sharing with us, in the meantime!

Karen

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Hello Karen,

Sorry for ditching out of the chat room yesterday evening and possibly bringing your own mood down as well. I just had to get out, because the more time I spent typing and thinking about it only was making my mood darker and more depressed. I know that I must have been so impossible and frustrating to deal with, since most of what was typed was as the saying goes "going in one ear and out the other" I seem to be stuck in a rut, from which I feel like I can't pull myself out of right now. I am so fixiated on our failed relationship, that it seems to blind me to everything else in my life. I am praying to God that once the baby is born that possibly things will improve between us, but if not I am hoping that the love for my daughter and hers for me will be able to sustain me and want to move on and be happy again. Somehow at this point this seems like an impossibility and that I will never find the happiness again that I had before all this transpired.

I was especially depressed last evening because I was reading one of the threads about one of the members here that had been with his girlfriend for four years and he was going through something similiar to what I have been, minus the pregnancy factor. I was seeing it all being painfully replayed back to me, as if it were my own experience and saw the same demeanor and disposition his girlfriend was displaying in my own DP. She is so devoid of any type of emotion when it concerns me, even when she broke things off she didn't shed a single tear and no reaction whatsoever when I attempted to hold back the flood of emotions, but they overwhelmed me and I broke down in front of her. She just calmly sat there and told me that we must concentrate on what is important here and that is the child, anything else is of no consequence right now. This is from someone who just recently sent me a heartfelt card not so long ago, that she truly felt I was her soulmate that she had been searching for all of her life and couldn't envision not sharing her life with. I just feel so devastated.

I know that you are going to still suggest me setting up an appointment to see a pdoc, but I just can't seem to get the will to do so and still feel like I have failed myself by not being strong enough to overcome this on my own. My previous bout of depression I suffered through it on my own and was able to finally overcome it. But maybe just like certain medical conditions like bronchitis you never truly get rid of, they linger and when you get it again it seems to be worse than the first time? My friend who moved away some years ago has a father that is a psychologist and he suggested that I maybe talk to his father and see if he can give me any advice on what to do not just concerning my depression but hers as well. I think that I am afraid to hear what he has to say and that he will tell me like everyone else has that I just need to let her go for now and concentrate on me. I am so afraid of doing that because I have this feeling if I let go now, that I will never get her back then. :hearts: I can't let go.

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I think you are referring to JimboJones (Joe) - yes, I've thought that your situations sound very similar. You can probably read my posts in his thread and hear just what I want to say to you!!

As far as ducking out of the chat so quickly last night, no problem. I (we all, I'm sure) completely understand. You have to do whatever is best for you, and if talking about the depression was making you feel worse, it is good that you left. I had been just a bit worried about your mental state, but you'd already said that you did not feel you were in danger. PLEASE, if ever it gets to that point, call 911.

This is an illness. Remember that you have several more possible stressors now than you did the first time you went through depression. So, maybe some medical help would be a good thing this time. (Yeah, I'm probably going to keep bugging you... :) ) I know how difficult it is to take that first step and call a doctor. That is all a part of depression. Most all of us have been stuck where you are right now - so down that we don't even feel able to make a move to get out of the pit.

But, you CAN do it. Please, just make a phone call to a doctor, any doctor. Get an appointment, and follow through with it. Once you begin the journey to getting help, it will get easier. And you really can feel better. All your problems will not disappear, but you will be able to handle them better. You deserve to get healthier!!!

maybe just like certain medical conditions like bronchitis you never truly get rid of, they linger and when you get it again it seems to be worse than the first time?
You could be exactly right! Please call the doctor, just as you would if bronchitis was getting worse......

Karen

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Yes it was the thread about JimboJones. I wish I had never opened it and read it.

Thank you for being so supportive and listening to my rantings. I am just going to try and take things as I have been, day by day and hope that eventually everything somehow will work themselves out.

I can't do anything to change her or "fix" what is wrong with her. I have to hope that she will either find a way to overcome it on her own and hope that she comes back to me. It's going to be a tough long road ahead but either way I have to have the strength to endure it for the long haul, since we have something more precious on the way.

Thanks again for all your advice and suggestions. I won't trouble you with anymore of my problems, as I am quite certain we all have enough of our own in our lives to deal with, without having to contend with others.

Edited by lostguy
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Oh, lostguy...! You are not troubling me (or anyone else who is reading here) at all! That is what DF is here for, to give each other support. I understand if you don't want to discuss this much, because perhaps that just makes you feel worse. But if you ever do want to talk about it please don't hesitate!

Reading JimboJones thread with its similarities to your situation, must have been hard. But you do have your child that will always tie you and your DP together, so in a way you have more hope of someday restoring your relationship. On the other hand, if your DP doesn't get feeling better, the time may come when you wish you didn't have to have a relationship with her!

The thing is, at this point you don't know what will happen. Hang on to your hopes, but first of all take good care of yourself. You may find that it helps you some to focus on giving support to some other folks here who are hurting. Often I feel better knowing that at least I can help others a bit. But only do what is best for you right now.

And feel free to share here whenever you wish!!! We care!

Karen

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