抗抑郁药和怀孕:专家的建议

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大多数孕妇都想为自己的宝宝做好一切, 包括正确饮食, 经常锻炼，做好产前护理. 但如果你是许多有情绪障碍的女性之一, you might also be trying to manage your psychiatric symptoms as you prepare to welcome your new baby.

It’s common for doctors to tell women with mood disorders to stop taking drugs like antidepressants during pregnancy, leaving many moms-to-be conflicted about giving up the medications that help keep them healthy.

劳伦·奥斯本，M.D.他是该组织的副主任约翰霍普金斯女性情绪障碍中心, talks about why stopping your medication may not be the right approach. She explains how women can — and should — balance their mental health needs with a healthy pregnancy.

抗抑郁药与怀孕

服用抗抑郁药的女性, 比如选择性血清素再摄取抑制剂, during pregnancy may worry about whether the medications can cause birth defects.

在这方面有好消息. Osborne says that there is generally no need to taper off medications during pregnancy. “We can say with strong confidence that antidepressants don’t cause birth defects,奥斯本说。. She adds that most studies finding a physical effect on babies from antidepressants taken during pregnancy fail to account for the effects of the mother’s psychiatric illness.

In fact, untreated mental illness itself poses risks to a developing fetus. 一个抑郁的女人不太可能变好产前护理 and more likely to engage in unhealthy or dangerous behaviors, like smoking and substance use. Osborne also says mental illness has direct effects on newborn babies.

“Untreated 抑郁症 may increase preterm birth or cause low birth weight,她说。. “Babies of depressed moms have higher levels of a hormone called cortisol. 这会增加婴儿发育的风险抑郁症晚年的焦虑和行为障碍.”

权衡风险

而医生不相信抗抑郁药会导致出生缺陷, 它们仍然有可能影响到婴儿. 对于一位母亲和她的医生来说，了解风险是很重要的.

关于 30 percent of babies whose mothers take 选择性血清素再吸收抑制剂 will experience neonatal adaptation syndrome, 哪一种会导致紧张情绪增加, 易怒和呼吸窘迫(呼吸困难), 还有其他症状. Doctors aren’t sure whether this effect is due to the baby’s withdrawal from the SSRI after birth or exposure to the drug itself before birth.

“这可能令人痛苦，并导致儿科医生进行检查, 但它会消失的,奥斯本说。, pointing out that these symptoms also sometimes occur in babies whose mothers don’t take 选择性血清素再吸收抑制剂.

女性经常询问的常见药物包括:

选择性血清素再吸收抑制剂一些研究将SSRI的使用与一种非常罕见的缺陷联系起来持续性肺动脉高压这是一种婴儿肺部不能正常充气的情况. “最近的研究着眼于3.8 million women and showed there was no increase in risk to their babies,奥斯本说。.
帕罗西汀: Early studies on a small number of patients connected the SSRI paroxetine with cardiac defects in babies. 然而, 这些研究没有考虑到吸烟, obesity and other risk factors that are more common in women who have 抑郁症. Osborne says larger, more recent studies show no such link with cardiac defects. She doesn’t recommend switching medications if paroxetine is the only one that works for you.
苯二氮平类药物女性应避免使用镇静剂, 比如安定, 阿普唑仑和氯硝西泮, in high doses during pregnancy because they can lead to sedation and respiratory distress in the newborn. 你仍然可以在短时间内小剂量使用它们. 然而, Osborne will typically try to get mothers on intermediate-acting options like lorazepam. These medications don’t linger in the baby’s bloodstream like longer-acting forms and aren’t associated with higher risk of substance use disorder like shorter-acting forms.
丙戊酸这种药可以治疗癫痫双相情感障碍对发育中的胎儿有很大的风险. Taking valproic acid during pregnancy carries a 10 percent risk of neural tube defects — birth defects that affect the brain or spinal cord, such as spina bifida — as well as risks to the baby’s cognitive development, 比如低智商. “丙戊酸 is the only one I’d never prescribe for pregnant women unless all other treatment had failed,奥斯本说。 .

看生殖精神科医生

如果你有情绪障碍, you may benefit from speaking with a reproductive psychiatrist when you are pregnant or thinking about becoming pregnant. Ideally, this should happen when you are planning for pregnancy, although this isn’t always possible. 怀孕后去看医生还不算太晚.

Osborne says her approach with patients is to limit the number of potentially harmful exposures to the baby. This means considering the number of medications a mother is on, as well as her psychiatric illness.

“If a woman takes a low dose of many medications and we have time to plan, 我们会尝试用更少的药物，使用更大的剂量,她说。. “If a woman is on a low dose and it’s not controlling her illness, 然后她的孩子就会暴露在药物和疾病中. In that case, I would increase the medication dosage so her baby isn’t exposed to the illness.”

如果你的病很轻, your doctor might recommend getting off medication and replacing it with treatments such as psychotherapy, 产前瑜伽或针灸改善你的情绪.

最终, Osborne says women should weigh the risks of medication against the risk of untreated illness.

“如果某种副作用非常罕见, 即使你把风险增加一倍，这也是非常罕见的,她说。. Medication risks are typically not greater than those of untreated mental illness. “Switching a woman’s medication is something I do very carefully and reluctantly.”