Recent studies have raised concern about the safety of antidepressants in women who are, or hope to become, pregnant. The type of antidepressants in question are SSRIs--selective serotonin reuptake inhibitors. Serotonin is a neurotransmitter. Although scientists are not exactly sure how SSRIs work, they appear to block the body's ability to reabsorb serotonin, which improves mood.

Some research links SSRIs to increased risks for newborns. In one recent study, researchers found that SSRIs taken early in pregnancy posed a small, but significant, risk for a defect in the wall between the upper two chambers of the heart.

Another reported that SSRIs during pregnancy increased risk of preterm birth, 5-minute apgar scores, and admission to the neonatal intensive unit. Apgar scores help physicians assess a baby's vital signs immediately after birth. Preterm deliveries are serious and the leading cause of infant sickness and mortality.

What these studies don't identify is the risk to the infant if the mother does not receive treatment for depression. There is little research on the subject. However, experts conclude, "Although warnings [of SSRI risk during pregnancy] demand attention and careful consideration, research has also shown that exposure to mental illness in pregnancy has deleterious short-term and long-term effects for exposed mother and fetus."

Depression during late pregnancy is associated with poor obstetric and neonatal outcomes and may affect a child's IQ and language development. For example, pregnant women who took SSRIs throughout their pregnancy were 21 percent more likely to have a preterm delivery. However, those with untreated depression had a 23 percent risk. It appears that not treating depression poses just as great a risk of preterm delivery as treating it. Researchers suspect that depression during pregnancy may influence levels of hormones in the placenta and may be a risk factor for preterm births. Furthermore, women who discontinue taking antidepressants during pregnancy are five times more likely to suffer a relapse.

Women planning to start a family should discuss this important subject with their physician. The American College of Obstetrics and Gynecology and the American Psychiatric Association guidelines advise that women with major depressive disorders can continue taking antidepressants during pregnancy. Some women find that psychotherapy, light therapy and alternative treatments, such as exercise, acupuncture and herbal supplements, may be effective alternatives to managing mild to moderate depression.