The question: My daughter suffers from depression and has regularly relied on antidepressant medications to keep on an even keel. She recently got married and wants to start a family, but she is worried about taking drugs while pregnant. How concerned should she be?
The answer: Many women with this common mood disorder share your daughter’s worries. In recent years, numerous studies have tried to clarify the effects that antidepressants might have on a developing fetus.
Over all, “we don’t see a lot of signals for a significant increase in problematic outcomes for babies,” says Dr. Simone Vigod, chief of psychiatry at Women’s College Hospital in Toronto.
That doesn’t mean antidepressants pose zero risks, she adds. For instance, some research suggests the drugs may slightly elevate the chances of the baby having certain heart malformations. They may also boost the odds of a preterm delivery and reduced birth weight. As well, some newborns experience “neonatal adaptation syndrome” – a temporary period of increased irritability as the drug is cleared from the infant’s body.
Although the risks of serious complications are considered to be relatively small, many women still “feel terribly guilty” taking a medication that could potentially harm their child, Vigod says.
Yet, untreated depression can also cause problems. “A pregnant woman who is severely depressed may not be taking proper care of herself,” says Dr. Sophie Grigoriadis, a psychiatrist at Sunnybrook Health Sciences Centre in Toronto.
“She might not be getting adequate nutrition. She may be engaging in behaviours – like smoking or using certain substances – that could have adverse effects on the baby."
To further complicate matters, access to psychotherapy – a potential alternative to medication – is limited in Canada for a variety of reasons.
So, there is a need for new therapies that pregnant women find acceptable, Grigoriadis says.
Fortunately, promising research suggests one option might be a relatively simple treatment that delivers an electrical stimulus to the brain.
The treatment is known as transcranial direct current stimulation or tDCS for short. A compact battery-powered device – which can fit in the palm of a hand – provides current to electrodes that are strategically placed on the scalp. In particular, the painless current is directed to a region of the brain called the dorsolateral prefrontal cortex, which plays a role in depression.
Previous research indicates that tDCS may provide an effective way of treating some cases of depression, and electrical stimulation is increasingly being studied for numerous brain disorders.
“Because the tissues in our brain communicate via electrical signals, the direct electrical current can change what is happening in the brain,” says Dr. Daniel Blumberger, a brain stimulation psychiatrist at the Centre for Addiction and Mental Health.
“It can promote the brain to change. We think tDCS tips the [brain] circuits into not having depressed patterns of thinking.”
Buoyed by encouraging results from earlier studies, a team of Toronto researchers – led by Vigod – recently conducted a trial that included 16 women who were followed during their pregnancies and up to a month after delivery.
Half of them received 30 minutes of stimulation five days a week for a period of three weeks, while the others got a placebo or sham treatment that lacked the full duration of current.
The women, who chose not to take antidepressants, were closely monitored in a hospital clinic while they received the real or fake treatment. The study indicated that tDCS improves mood, while suggesting it has no apparent negative impact on the developing fetus.
“Almost all the women in the tDCS group didn’t have symptoms [of depression] one month postpartum, while almost all the women in the sham group did have symptoms,” Vigod says.
The researchers are planning to do a much larger trial and hope to recruit 150 women who will be followed for a year after they give birth to help determine the longer-term effects of tDCS on mother and child. The pregnant women will be instructed on how to use the portable devices in their own homes for the three-week treatment period, thereby eliminating time-consuming trips to a medical clinic.
“Ideally, women want something that is readily available and easy to use,” Grigoriadis says.
The researchers don’t expect the therapy will work for everyone. But, even if only some benefit, it may at least increase the possible treatment choices for women such as your daughter.
Paul Taylor is a patient navigation adviser at Sunnybrook Health Sciences Centre. He is a former health editor of The Globe and Mail. Find him on Twitter @epaultaylor and online at Sunnybrook’s Your Health Matters.