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There is a controversy regarding the safety of taking antidepressants while pregnant, but Sunnybrook is developing a guide to help patients and clinicians make informed decisions about how to proceed.

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By the time she reached the second trimester of her pregnancy, Lisa was sliding into despair. This was supposed to be a time of excitement and joy. Instead she was overcome by anxiety and sadness.

She loved her job as a high-school teacher, but the increasingly severe depression forced her to stop work by her third trimester. Some days she couldn't even leave her bed. At the same time, it was difficult for her to get treatment, fearing the possible effect of any medications on her child, and she was unable to concentrate in therapy sessions.

After her baby was born prematurely, "she just hit rock-bottom," recalls Dr. Sophie Grigoriadis, a psychiatrist at Sunnybrook Health Sciences Centre, whom Lisa finally sought out. "She didn't want to take care of herself and was anxious about caring for her newborn. She was convinced she was a bad mother."

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Dr. Grigoriadis, who is head of the Women's Mood and Anxiety Clinic: Reproductive Transitions at Sunnybrook, says that such cases of depression are all too common among pregnant women. The clinic, which is part of the hospital's Brain Sciences and Women & Babies Programs, was established in 2011 to diagnose, treat and research mental illnesses across a woman's reproductive lifespan, from the menstrual cycle to pregnancy, postpartum and perimenopause.

 

 ‘We need to find good treatments — with few or no
side effects.’


Dr. Sophie Grigoriadis,
head of the Women’s Mood and Anxiety Clinic: Reproductive Transitions at Sunnybrook Health Sciences Centre

The clinic today is carrying out groundbreaking studies and developing guidelines for the use of antidepressant medication in pregnancy, and future research will look at treating women in transitions with alternative therapies.

The link between depression and women's reproductive transitions has been recognized since the time of the ancient Greeks, who called it "uterine melancholy." Hippocrates in the 5th century BC first used the term "hysteria" to describe a mental disorder that was related to the abnormal movement of the uterus in a woman's body.

Today there is growing awareness of the prevalence of mood and anxiety disorders during pregnancy, and Sunnybrook is forging the future of health care with an innovative and integrated "team" approach within the hospital, Dr. Grigoriadis says. "It's often difficult to diagnose depression during pregnancy because many of the physical symptoms mimic pregnancy itself…. It can be difficult to tease apart what causes what."

Indeed, she notes that symptoms such as moodiness and restlessness that are often attributed to "baby brain" can be symptoms of depression. Appetite, sleep changes and fatigue can be part of this.  Symptoms common as part of "baby blues" are now seen as possible risk factors for postpartum depression.

According to one study, 18 per cent of pregnant women experience depressive disorders of some kind, with 13 per cent of cases involving major depression. In the postpartum period, 19 per cent of women suffer from depressive disorders, with 7 per cent of them experiencing major depression.

"Pregnancy and new motherhood is supposed to be a wonderful time, but for some women it's not, and that leads to terrible feelings of guilt and hopelessness," Dr. Grigoriadis says. "We need to find good treatments – with few or no side effects – to help these women."

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The four psychiatrists in the Women's Mood and Anxiety Clinic: Reproductive Transitions centre work closely with staff of the Mood and Anxiety Program as well as the obstetricians, midwives and nurses from Women & Babies at Sunnybrook to come up with effective strategies for pregnant women with depression.

For example, through a combination of psychotherapy and medication, Lisa, whom Dr. Grigoriadis treated, improved and became the mother she wanted to be.

The research done on the safety of taking antidepressants while pregnant, Dr. Grigoriadis says, has not been based on randomized controlled studies; this creates uncertainty in conclusions reached.

She and her team have done a study summarizing the often conflicting research on antidepressant use among women in pregnancy. They are developing a reference guide, now being piloted at Sunnybrook, to help physicians, patients and their families make informed decisions about how to proceed in each individual situation. "There is no one-size-fits-all."

The team is also looking at mental illness in other stages of the reproductive cycle. For example, some 4 per cent of women suffer from premenstrual dysphoric disorder, which can cause depression with each menstrual cycle. The time leading up to menopause also often brings severe mood disorders.

After childbirth, symptoms of the "blues" and exhaustion are typical in as many as 80 per cent of women, Dr. Grigoriadis notes. But if such feelings become severe or persist for longer than two weeks, they can herald postpartum depression. "Sometimes it's more serious," she says.

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Dr. Grigoriadis is working to expand the clinic and its groundbreaking research in order to help women as they make these reproductive transitions. They are also looking at the prevalence of suicide in the perinatal period and plan to study alternative treatments for depression in pregnancy and postpartum.  These include using light therapy or natural substances found in our diet, for example.

Looking after mental health
during pregnancy
 

What should you expect when you’re expecting? Feelings of moodiness, appetite changes, exhaustion and even aches and pains can be typical in pregnancy. Yet they can also be possible indicators of prenatal depression, says Dr. Sophie Grigoriadis, a psychiatrist and head of the Women’s Mood and Anxiety Clinic: Reproductive Transitions at Sunnybrook Health Sciences Centre. She says that it’s important for pregnant women to get the rest they need, to manage stressors and to do things they enjoy.
 

According to Health Canada, pregnant women should speak with a doctor if they experience any of these symptoms for two weeks or more:

•  Feelings of restlessness and a lack of energy

• Difficulty concentrating

• Changes in sleep or appetite

• Withdrawing from other people

•  Guilty thoughts or feelings of worthlessness

• Crying spells

•  Depressed moods and/or extreme sadness.


This is the second in a six-part series on the future of brain sciences.
Look for the next one on Thursday, February 5.
For more information, visit sunnybrook.ca/brain.


This content was produced by The Globe and Mail's advertising department, in consultation with Sunnybrook. The Globe's editorial department was not involved in its creation.


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