The Corpus Callosum

It is never easy to make decisions about the use of medication by women
who are pregnant.  For the vast majority of drugs, the
manufacturer’s statement says something to like this: ‘Product X should
only be used if the benefit outweighs the risk.’  But there is
never any specific guidance about how to weight the risks and benefits.
 It is hard to do when the risks are not known.  

In the case of treating maternal depression in pregnant women, the
situation is complicated by the possibility that leaving the depression
untreated could have a negative impact on both the mother and the
fetus.  

So far, there is only preliminary evidence that untreated depression is
harmful to the fetus, but now there is a bit more evidence to support
that notion.  A University of Michigan researcher, href="http://www2.med.umich.edu/departments/mott/index.cfm?fuseaction=Peds.facultyBio&individual_id=14422">Sheila
Marcus, reported in a recent meeting of the American Academy
of Child and Adolescent Psychiatry:

href="http://www.medpagetoday.com/Psychiatry/Depression/tb/4379">AACAP:
Not Treating Depression During Pregnancy Affects Baby

SAN DIEGO, Calif., Oct. 26 — Although antidepressants may have an
effect on fetuses in utero, so may the lack of the drug during
pregnancy.

Babies born to women with untreated major depressive disorder had
significant changes in neurobehavioral function, were born at an
earlier gestational age, and had elevated stress hormones, according to
a small study reported at the American Academy of Child and Adolescent
Psychiatry meeting here.

“The question is, does bathing an infant in an intrauterine environment
where the mother’s stress hormones are high affect the baby?” said
Sheila M. Marcus, M.D., of the University of Michigan in Ann Arbor.

Unfortunately, the study was small, and by itself, it does not really
tell us what should be done in any particular clinical situation.
 What it does do is to highlight the likelihood that there is
no risk-free option.