My husband and I have discussed having a child.  Should I go off my antidepressant medications before I become pregnant?

This is a decision which should involve not only prospective parents but their obstetrician and psychiatrist.  Parents must weigh the risks of the medications versus the risks of relapse.  If a woman develops a severe relapse, she may be likely to get poor prenatal care as a result.  If  not, parents may be exposing their child to medication unnecessarily.

Antidepressants, if taken during pregnancy, are considered teratogenic agents.  Any chemical, drug or condition, including an infection or a deficiency, is considered teratogenic if, upon fetal exposure, it can alter or interfere with the normal development process.  There are three types of risk.  A fetus may have structural defects in organs or other parts of the body, toxicity may cause physical or behavioral symptoms shortly after birth (like withdrawal symptoms), or a fetus may suffer from long-term neurobehavioral abnormalities.  The tricyclics and SSRIs are preferred over MAOIs and newer medications as there is more data available.  Studies suggest that tricyclics and SSRIs do not pose a significant risk of birth defects or long-term neurobehavioral effects.  A few studies suggest MAOIs may present an increased risk for birth defects but insufficient data exists.  Studies suggest that all classes of medication may pose some toxicity risks.

Untreated illness may pose risks.  Poor prenatal care has been mentioned. A recent study has raised a growing concern that an untreated psychiatric condition may affect fetoplacental integrity and fetal central nervous system development.  Antepartum and postpartum disorders may also inhibit mother-infant bonding. Talk to your doctors and decide what is best for you, given your risk profile and family and medical history

What about after the child is born; will I be able to breast feed?

Once again, this is an area about which we have limited information, but preliminary studies look promising.  New mothers should consider their situations.  The actual amount of medication present in the milk and in the baby's blood can be measured.  Careful monitoring of both can guide parents and obstetricians.   Women who choose to remain medication free in order to breast feed must consider the impact of relapse and the possibility of exacerbating symptoms.