Women who've had one episode of postpartum depression have a 50% risk of getting depression again with a subsequent pregnancy, says Ruta Nonacs, MD, associate director of the Center for Women's Health at Massachusetts General Hospital in Boston. You and your doctor need to keep this condition on the radar if you decide to get pregnant again. Also keep in mind that your risk of depression, even if you're not pregnant, is higher than normal.
She felt gypped out of motherhood
Katherine Stone, 38, of Atlanta, elected to stay on her medication between pregnancies.
Approach a second pregnancy with your eyes wide open and remember that it's almost never as bad the second time as it is the first.
—Ruta Nonacs, MD, Psychiatrist
When she found out that she was pregnant a second time, she actually enrolled in a study of women with pregnancy-related mood disorders.
Stone was on medications during her entire pregnancy and had careful monitoring. "This time it was a 180-degree difference. I realized that I'd been gypped the first time. This was what it's really supposed to feel like to have a baby," she recalls.
When to consider preventive antidepressants
Postpartum depression can happen the second time around, even if great care is taken to prevent it. Amy Sky, 47, of Toronto, recalls that her second pregnancy, like her first, was fairly easy: She had a supportive husband and family, she hired full-time help in the house, and her career as a songwriter was in full bloom.
"But I still had postpartum symptoms," Sky says, "which lends more evidence to the fact that in some women the hormonal changes of the pregnancy and delivery alone can also simply be the catalyst for a mood disorder."
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In one study of women who'd had postpartum depression in the past, the benefits of preventive drug therapy were great. Of those who received an antidepressant during pregnancy, only 7% had postpartum depression. Of those who got a placebo during pregnancy, 50% had postpartum depression.
And if you need antidepressants when you're not pregnant, going off them during pregnancy can be risky. In a recent study only about 25% of women who stayed on their medication had a depression relapse during pregnancy. Among those who went off the meds during pregnancy, 68% relapsed before the baby was born.
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The risks and benefits of meds
Psychiatrists who specialize in the treatment of postpartum psychiatric disorders generally agree that, for patients at the highest risk of depression, the benefits of antidepressants tend to outweigh the risks during pregnancy and after. This is true for both SSRI antidepressants as well as older tricyclic antidepressants, though the decision to medicate should always be made carefully, in consultation with one or more medical experts.
"Approach a second pregnancy with your eyes wide open and remember that it's almost never as bad the second time as it is the first," says Dr. Nonacs, who adds that women who've had severe PMS may be at higher risk for postpartum depression. "You can't stop that genetic or hormonal ball from rolling, but having your ducks lined up in advance can be protective."