Alternative Treatments for Depression in Pregnant Women

There has recently been a lot of discussion in the news about the potential hazards of taking antidepressants while pregnant. Some are concerned that they increase the risk of birth defects. Proponents of antidepressants point out, correctly, that depression during pregnancy is also risky and can lead to premature delivery and other complications.

Health care providers often make treatment decisions by balancing the risks and benefits of a medication. Is the risk of using the medication less than the risk of the mother getting depressed again? In most cases, the risk of using the medication is less than the risk of possible depression, so clinicians will prescribe it. But are antidepressants the only choice?

Curiously, while people debate about antidepressant use in both research studies and the popular media, non-drug treatments for depression are largely absent from the discussion. Fortunately, antidepressants are not the only choice for treating depression and may offer a safe “third choice” for treating depression during pregnancy. Physicians and other health care providers may not consider these non-drug treatments, assuming that they cannot address more severe depression.

But recent research paints a very different picture. There are a number of non-drug treatments that are effective for even major depression. Non-drug treatments include Omega-3s, exercise, bright light therapy, psychotherapy, and St. John’s wort. Many of these can be combined with each other, and are sometimes used in addition to antidepressants (only St. John’s wort cannot be combined with medications). What all these treatments have in common is that they are all specifically anti-inflammatory. In the next few installments, I’ll explain that in more detail. But it’s important to know that there are alternatives, and these are especially important to consider during vulnerable times, like pregnancy.

Depression and Inflammation: The Surprising Link

Depression is risk factor for depression. Researchers have known that for many years but couldn't really explain why—until now.

In the past 10 years, researchers have firmly established that a lot of common diseases--such as diabetes, cancer, Alzheimer’s, and yes, even heart disease--are due to inflammation. For example, physicians have noted that elevated levels of an inflammatory marked called C-reactive protein is an early harbinger of heart disease.

But here’s where the plot really thickens. Depression is also caused by inflammation, and specifically by elevated levels of molecules called proinflammatory cytokines. In fact, by specifically treating people with cytokines, as they do for conditions such as MS, doctors have actually caused depression. The more cytokines patients received, the more depressed they got. When the patients started to taper off of the cytokines, the depression got better too.

Depressed people have significantly higher levels of the cytokines in their plasma than non-depressed people. And this is where the disease-depression link comes from. High levels of proinflammatory cytokines damage blood vessels, and elevate other factors in the blood that increases the risk of clots.

And in another interesting twist, we now know that most of the effective treatments for depression have one thing in common: they are also anti-inflammatory. In fact, that knowledge has fueled some very interesting discoveries. For example, antidepressants lower inflammation levels in cardiac patients. And they’ve been added to steroids for treating asthma, leading to the use of fewer steroids in these patients.

This discovery has also led to some novel ways of treating depression. For example, anti-inflammatory medications, such as ibuprofen, which is not an antidepressant, have been added to antidepressants to make them more effective. Adding Omega-3 fatty acids to a treatment regimen helps with depression for the same reason.

Knowing about the anti-inflammatory connection also gives us a framework for understanding why non-medication treatments for depression would also work.