This is currently a very controversial area in medicine. That's because there are very few studies of the short and long term effects of anti-depressants on unborn babies. It is an extremely important area of medicine, too, because may women of child bearing age suffer from depression.

The treatment of depression has been revolutionized in the last 15-20 years by the introduction of a new group of anti-depressants known as SSRIs (selective serotonin uptake inhibitors). SSRIs include medications such as Prozac, Zoloft and Paxil. SSRIs can dramatically improve the symptoms of depression without many of the side effects caused by earlier anti-depressants. Along with new treatments for depression has come the realization that depression is more common than thought, and often undertreated. All these factors combine to dramatically increase the number of women who are on medication for depression.

There are no well designed long term studies of SSRIs in pregnancy that show evidence of serious harm to unborn babies. There have been shorter studies that suggests that babies of women who take Paxil may have an increased risk of some forms of birth defects. There is also some evidence that babies born to women taking SSRIs during pregnancy may suffer from jitteriness and other minor symptoms after birth when they are no longer exposed to the medication.

On the other hand, it is very clear that untreated depression poses risks for both mother and baby, both during pregnancy, when the mother's health may be affected by depression, and after pregnancy. when the mother is at dramatically increased risk for developing postpartum depression.

The lack of definite information makes it very difficult for both mothers and doctors to decide on the best treatment course. There is developing agreement on a variety of circumstances, however:

• Women who have mild symptoms should probably discontinue the medication during pregnancy. Other treatments, such as talk therapy may be helpful in controlling symptoms.
• Women who have severe depression, including those who cannot function without the medication and women who have thoughts of suicide, should continue the medication throughout pregnancy.
• No woman should discontinue medication abruptly, even if she finds out that she is pregnant. SSRIs should always be discontinued gradually to prevent medical problems associated with sudden withdrawal

Women who have moderate depression should decide on a treatment plan after discussions with their obstetrician and mental health professional. Each situation is different, and there is no "one size fits all" approach to treating depression in pregnancy.

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