Topic Overview

Depression is common during pregnancy and in the postpartum period. If you have symptoms of depression during pregnancy or are depressed and learn you are pregnant, make a treatment plan with your doctor right away.

If you are being treated for depression and are planning a pregnancy, talk to your doctor ahead of time. You may be able to taper off of antidepressant medicine before your pregnancy, to see how you feel during your first trimester. It's best to be medicine-free, especially during the first trimester. But if you are severely depressed, your doctor will probably want you to stay on your medicine.

Don't ever suddenly stop taking an antidepressant. This can cause difficult emotional and physical symptoms and may also affect your fetus. Your doctor can tell you the best way to taper off of your medicine.

Depression treatment choices during pregnancy

If you are not severely depressed, interpersonal counselling or cognitive-behavioural therapy may be all that you need.

• Interpersonal counselling focuses on your relationship and life adjustments, giving you emotional support and help with problem-solving and goal-setting.
• Cognitive-behavioural therapy helps you take charge of the way you think and feel, while giving you a supportive relationship.

If counselling alone isn't enough, or if your symptoms are severe and disabling, talk to your doctor about other possible treatments:

• Light therapy uses regular doses of bright light (not full-spectrum light, which includes ultraviolet light). Typically, a person having light therapy will sit in front of a high-intensity (2,500- to 10,000-lux) fluorescent lamp, slowly building up to 1 to 2 hours each morning. (Possible side effects include eye strain, headache, feeling "wired," and trouble falling asleep when light therapy is used later in the day.)
• Antidepressant medicine, most often a selective serotonin reuptake inhibitor (SSRI), such as fluoxetine (Prozac) or sertraline (Zoloft). Fluoxetine and citalopram (Celexa) are not often used during breastfeeding, because they can pass into breast milk in high levels. If you are planning to breastfeed and are taking an antidepressant, talk about this with your doctor.

Women who take an SSRI during pregnancy have a slightly higher chance of having a baby with birth defects. But not treating depression can also cause problems during pregnancy and birth. If you become pregnant, you and your doctor must weigh the risks of taking an SSRI against the risks of not treating depression.

Health Canada and the U.S. Food and Drug Administration (FDA) have issued advisories on antidepressant medicines and the risk of suicide. Talk to your doctor about these possible side effects and the warning signs of suicide.

Additional measures you can take against depression

Whether you use counselling, medicine, light therapy, or a combination, be sure to also get regular exercise, healthy food, fresh air, and time with people who care about you. These are all important parts of preventing and treating depression and having a healthy pregnancy.

For information about depression after childbirth, see the topic Postpartum Depression.