There’s a great post on MGH’s Center for Women’s Mental Health Blog on proper dosing of antidepressants during pregnancy. What may seem like good intuitive thinking (to lower dose during pregnancy) — may not be in everyone’s best interest.
Many women and clinicians alike presume that a lower dose of SSRI’s during pregnancy makes sense, if possible. However, this article suggests that in order to prevent a relapse it is important for a woman to remain on the dose of antidepressant that was helpful during past depressions. They note that the change in pregnancy metabolism may affect the dosing, lowering the serum levels of the antidepressant, increasing risk of relapse. In addition, they suggest that lower antidepressant doses do not appear to lower the risk to the fetus, while it does further increase the risk of relapse of depression.
Women are understandably anxious to get off meds during pregnancy or negotiate a reduced dose on behalf of their pregnancy. But this information is enlightening and clinicians need to be alert to the potential risks. A thoughtful and informed dialogue is advised.