One psychiatrist with special training in this field is Shari Lusskin, director of reproductive psychiatry at New York University. Lusskin has studied the effects of depression on pregnancy and is convinced that early intervention can be beneficial for mother, child and family.
"Exposure to maternal depression has long-term consequences on the fetus," said Lusskin, who recently authored a chapter titled "The Treatment of Psychiatric Disorders in Pregnancy" in Up to Date, an educational computer tool for clinicians. "We are beginning to understand the interplay of these factors at different points in fetal development."
(Photo Disc)
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_____Live Discussion_____
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Pregnancy and Miscarriage: Dr. John Larsen, a specialist in maternal-fetal (high-risk) pregnancy at George Washington University Medical Center, will be online at 1 p.m. ET to discuss pregnancy and miscarriage.
_____Special Family Issue_____
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Beyond Miscarriage (The Washington Post, Mar 1, 2005)
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Making Girls Fit (The Washington Post, Mar 1, 2005)
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To Eat Better, Eat Together (The Washington Post, Mar 1, 2005)
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Lusskin has identified several risk factors for depression during pregnancy, including a history of depression, a family history of mental illness, a lack of social support from spouse and friends, and anxiety about the fetus, especially if the pregnancy is unplanned. Screening for such factors is vital, Lusskin said.
"Pregnant women with severe depression can feel guilty about these symptoms and not reveal them," Lusskin said. "And doctors don't screen pregnant woman carefully enough for these symptoms."
Some studies suggest that SSRI antidepressant use in pregnancy is relatively safe, though the wider body of research shows both risks and benefits.
A small seminal study published in the New England Journal of Medicine in 1996 showed that third-trimester exposure to fluoxetine (Prozac) led to more premature deliveries and neonatal complications including poor tone, breathing difficulties and a weak cry.
But another study published in the American Journal of Obstetrics and Gynecology in 2003 reviewed records of 138 mothers on SSRI antidepressants during pregnancy and found no complications in the infants.
Other studies have demonstrated temporary increases in jitteriness and delayed development in neonates whose mothers were taking SSRIs. But no studies have shown long-term effects at up to seven years.
Postpartum Factors
The Lancet study's suggestion that withdrawal seizures are linked to withdrawal of SSRIs is too speculative to be applied to clinical practice and too preliminary to greatly alter prescribing patterns.
Ian Holzman, professor of pediatrics and chief of newborn medicine at Mount Sinai School of Medicine in New York, said he believes SSRIs are relatively safe, but he would like to see more studies over a longer period of time.
