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Tara Smith

An estimated 10 to 15 per cent of pregnant women are depressed, but recent studies provide no clear answers on whether it is safe to take antidepressants during pregnancy.

"It's a difficult climate, a difficult time," said Dr. Shaila Misri a psychiatrist with B.C. Women's Hospital. "The way we are actually advising women is to say, 'Look, if you really need to be on these medications, you need to be monitored closely and the baby as well.'"

It was once thought that depression only began postpartum, and that pregnancy somehow protected women from psychiatric or emotional problems.

But an estimated one in four pregnant women takes antidepressants, meaning more than 10,000 women in Canada are pregnant and taking antidepressants at any one time.

Tara Smith of Kelowna, B.C. is one of them. Two months into her pregnancy and off her medication, Smith suffered a severe relapse.

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Dr. Donna Stewart

"Almost like a desperation," she said. "Extreme sadness, really [a] lack of desire to do anything or to engage."

With her doctor's guidance, Smith has resumed her antidepressant regimen. She now feels the best thing for her baby is a mother who is mentally healthy. Her baby is due in July.

Without treatment, women who are depressed are less likely to eat properly and to take prenatal vitamins, doctors say. Depressed women who stop taking their medication during pregnancy are at more than twice as likely to relapse than women who continue to the drugs, research shows.

It may also be more difficult to get postpartum depression under control.

But treating depression with Prozac and Paxil also carries risk.

Babies born to mothers who took antidepressants during pregnancy can develop withdrawal symptoms like crying and tremors.

There is also a concern the drugs may be linked to a rare but serious breathing problem in newborns.

The latest research has caused psychiatrist Dr. Donna Stewart at Toronto General Hospital to consider prescribing alternatives.

"We know that some kinds of psychotherapy are helpful, we know that social support is helpful," said Stewart. "I would suggest that for the woman who is not seriously depressed ... those should be tried first."