Of all the many dimensions of depression, what to do during pregnancy is the most complicated as illustrated by the following letter

Q: Dear Dan My family has the depression gene. My daughter has had depression on and off since she was 16. She got off her meds last summer because her husband said she couldn't take them the rest of her life.. Then it came back with a vengeance. Her Dad and I couldn't talk to her, she would get angry Well she wants to become pregnant. Her GYN told her it is better to take medication than to be a depressed pregnant woman and advised her to see her to revisit her psychiatrist. I have had depression since I was 13 off and on, but it got worse through the years. I know what she is going through but her husband doesn't. She goes to work and then goes to bed. This of course has made my own depression worse I blame myself. I don't know how to handle this situation. She is a very intense person and whatever I say she gets angry. So I try not to say much. But she can talk to her Dad much easier than me. I guess I really asking how to help her. Thank you for your time.

Well my first reaction to this very complicated situation is that she should talk with her dad and not you. Makes sense because emotions are contagious and I am sure your anxiety and depression makes hers worse (and vice versa). It sounds like everyone could use a dispassionate and clear minded education about what depression is and what it is not. How to do that is complicated given her anger and her husband's lack of understanding. But whatever is done, I like to see your husband and initiate.

Before I even comment about the medication controversy, you should know I am not a physician and have no medical training. So what I will share it is my professional experience and some of the literature.

There was no clear path about whether a pregnant woman should take medication. Her Gyn is right that in addition to a child being at risk genetically, the depression itself could have an impact on the fetus. At the same time there is also a risk if one takes medication.

As a matter of fact, a study just released last week published in the March issue of the American Journal of Psychiatry showed that women taking SSRIs (antidepressants in the Prozac family) throughout their pregnancy had an increased risk of premature birth. A 20% risk. On the other hand, women with depression who were untreated throughout their pregnancy also had a 20% risk of premature birth.

In an interview, Kathryn Wisner, M.D. one of the study's investigators said that the similarity in outcomes may suggest that the problem is the underlying depression with both groups of women. But that is conjecture on her part.

And this study did not look at other families of antidepressants or what happens if a woman takes medication during one term but not another. Like I said, much more information is needed and because the stakes seem so high, a dispassionate discussion with a professional person seems the place to go at this point.

And whether she takes medication or not, she should strenuously pursue other treatments available including psychotherapy, exercise, group support etc.. She might also want to contact a doctor specializing in integrative medicine to explore non-western approaches.