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By Melissa Tennen, HealthAtoZ writer
A new mother's untreated depression is more likely than antidepressant use to cause underweight babies, says a study from University of California in Los Angeles (UCLA).
Exposure to antidepressants through breast milk did not lead to low weight at 6 months of age, according to the research funded by the National Institute of Mental Health.
"We found that infants of mothers who were depressed for more than two months weighed significantly less than infants of mothers who were not depressed or were depressed only briefly," says Victoria Hendrick, M.D., lead author of the study and an assistant professor at the UCLA Neuropsychiatric Institute. "We don't know if infant weight gain catches up after the depression is treated."
Nearly 80 breastfeeding mothers with symptoms of mood disorders took an antidepressant in the six months following their babies' births. The babies were full-term and the mothers had not abused substances or alcohol or smoked while pregnant. (Alcohol, drug abuse and smoking can cause birth defects and lower birth weights.) The women began taking antidepressants either during pregnancy or within four weeks of giving birth.
Study limitations noted
While the study does raise awareness, the research leaves many questions, says Kathleen A. Kendall-Tackett, Ph.D., IBCLC, health psychologist and research associate professor at the Family Research Laboratory at the University of New Hampshire in Durham.
"The study lumps all the antidepressants together, which is unrealistic since babies are exposed to a larger dose with medications like Prozac® than they are with medications like Paxil® and Zoloft®. That higher level of exposure can influence a baby's rate of growth. The difference in exposure has to do with the way it breaks down. The infant can get 10 to 17 percent of the mother's dose. In contrast, babies are exposed to less than 1 percent of the mother's dose with Zoloft and Paxil."
According to The American College of Obstetricians and Gynecologists' (ACOG), the use of selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors in pregnant women should be individualized based on their risks and benefits. ACOG also recommends that the SSRI paroxetine (Paxil®) be avoided, when possible, by pregnant women or women planning to become pregnant. It has a potential risk of fetal heart defects, newborn persistent pulmonary hypertension, and other negative effects.
Paxil may increase the risk for birth defects, particularly heart defects, when women take it during the first three months of pregnancy, according to a 2005 advisory from the Food and Drug Administration (FDA). The FDA is waiting for the results of recent studies to better understand the higher risk. Discuss with your doctor about the health risks of Paxil if you plan to become pregnant or are in the first three months of pregnancy. You may want to consider taking a different antidepressant. Do not stop taking the drug without first talking to your doctor.
Kendall-Tackett notes socioeconomic issues, which were not accounted for in the study, could affect infant weight gains. A mother might not be getting the right nutrition and may be under increased stress, taking away nutrients and the mother's ability to nurture for the baby. Poverty and depression tend to go hand-in-hand, she says.
Another factor to consider in this study was the sample size, she says. "The author's conclusions were based on data from 11 depressed women. While this is interesting, their findings need to be confirmed with a larger sample size," she says.
Treatment still better
However, despite the study's limitations, it offers a steppingstone for better awareness of postpartum depression.
"I'm really glad to see this," says Diane G. Sanford, Ph.D., a St. Louis psychologist, a women's health expert for the American Psychological Association, and co-author of Post-Partum Survival Guide. "It supports my opinion that it's better for Mom to get treated for depression than not to. A lot of women and their doctors continue to be hesitant about medications during breastfeeding and pregnancy. Doctors are worried about rising malpractice costs. This study goes a long way to opening up the discussion between women and their health providers."
While some of the taboos about depression itself are lifting, the acceptance of postpartum depression in particular is far less common. Mothers often blame themselves for not being good enough, not being nurturing enough, not being strong enough, Sanford says. They see it as a personal failing. What's worse is that health providers are missing it, too, she says.
"Some women who have significant depression might have a doctor who mistakenly labels it as baby blues rather than identifying it as major depression," she says.
Baby blues is much more common than postpartum depression, occurring in the first two weeks after giving birth and usually going away without medical help. Postpartum depression is different. It can strike 20 percent of new mothers and last longer than two weeks. Postpartum depression usually requires some sort of intervention such as medication, counseling and exercise. Researchers believe rapid changes in levels of hormones and thyroid function appear to have a strong effect.
"A lot of mothers say, 'My depression isn't that bad. I can cope. If I hang in there, it will get better,'" Sanford says. "I've seen women who may not come in until their second or third pregnancy and been depressed all these years. It's harder to treat if you wait too long. It should be a red flag to the health provider if the baby is continuing to lose weight."
Waiting too long can have long-term affects on the child, Kendall-Tackett says.
"We really need to do more research on how depression affects feeding," she says, noting a depressed mother may be less sensitive to a baby's cues for hunger and comfort.
A woman with postpartum depression usually has symptoms ranging from mild to severe with "good" days and "bad" days. Postpartum depression is not the same for everyone, and these symptoms can impair a woman's ability to day-to-day functioning.
"Depressed mothers may have low-self esteem, may think they are bad mothers, and this can make them vulnerable to bad parenting advice-some of which may encourage them to limit how often they feed their babies. They may not feel very good about how they are mothering," Kendall-Tackett says.
For example, a mother who is depressed and blaming herself for not being a "good mother" might take advice from a well-meaning relative or friend to let the baby simply cry it out instead of responding to the baby's cues for hunger, comfort and sleep. Such nurturing or even the depression itself may affect the mother-child bond, even influencing physical development.
"Many studies have shown that maternal depression during a child's life can be harmful to the child's growth in all kinds of ways, including success in school and social development," Kendall-Tackett says. These studies have shown a mother's depression really impacts her child.
"By taking care of your health, you are taking care of your family's health," she says.
What are the symptoms of postpartum depression?
- Sluggishness, fatigue, exhaustion
- Sadness, depression, hopelessness
- Appetite and sleep disturbances
- Poor concentration, confusion
- Memory loss
- Overly concerned for the baby
- Uncontrollable crying, irritability
- Guilt, inadequacy, worthlessness
- Lack of interest in the baby
- Fear of harming the baby or yourself
- Fear of losing control or "going crazy"
- Exaggerated highs or lows
- Lack of interest in sex
- Insomnia
Children, teens and adults being treated with antidepressants, particularly people being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior. Close watching may be especially important early in treatment or when the dose is changed - either increased or decreased. Bring up your concerns with a doctor.
In addition, the FDA has warned that the use of Paxil during the first trimester of pregnancy may increase the risk of birth defects, particularly heart defects.
This article was reviewed and updated June 2007.
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