I’ve often wondered what doctors tell pregnant women who take medication for high blood pressure, diabetes, or other illnesses that are potentially life threatening if left untreated by medication.

From Dealing With Depression and the Perils of Pregnancy:

About 75 to 80 percent of women who go off antidepressants will relapse during the pregnancy, said Dr. Lee Cohen, director of the Perinatal and Reproductive Psychiatry Clinical Research Program at Massachusetts General Hospital. Some pregnant women with major depression have reported having suicidal thoughts or were unable to function at work or take care of their older children.

Depression in pregnancy is associated with poor eating, missing prenatal appointments and use of substances like tobacco and alcohol, Dr. Cohen said.

Missing prenatal visits alone is a strong predictor of problems, among them premature babies and low birth weights.

Depressed women also have a higher rate of obstetrical complications and preterm deliveries, and a review of 11 studies has shown that they have 45 percent more miscarriages, said Dr. Gideon Koren, a pediatrician and the director of the Motherisk program at the University of Toronto, a risk-counseling service for pregnant women.

In addition, being depressed during pregnancy is a strong predictor of postpartum depression, which can lead to poor mother-infant bonding and has been linked to emotional, behavioral and learning problems in the child.

In one study, Dr. Koren’s group followed women who called the Motherisk hot line, which receives about 5,000 calls a year regarding the use of psychiatric drugs. Of 34 women who called and said they had stopped taking an antidepressant, a benzodiazepine (used to treat anxiety) or both, all reported withdrawal symptoms and psychological problems. Eleven reported suicidal thoughts, and four of them were admitted to hospitals.

Estimates from various studies indicate that about about 12 percent to 20 percent of pregnant women are depressed, yet the diagnosis may go undetected. About 12 percent of women in the general population suffer a depressive disorder each year.

According to one recent study published in The Journal of Women’s Health, 20 percent of women screened in the waiting rooms of obstetrical clinics scored in the depression range, with fewer than 15 percent of those in that category indicating that they had received any formal treatment for depression, like psychotherapy, medication or counseling.

Some mental health experts believe that doctors set a much higher threshold to medicate pregnant women suffering depression than they do for pregnant women suffering other diseases like high blood pressure, peptic ulcer disease, bronchitis and other infections.

“I think the categorical belief is that depression is something you get over rather than something you take medication for,” said Dr. Zachary N. Stowe, director of the Women’s Mental Health Program at Emory University in Atlanta.

“We have more research on the safety of antidepressants in pregnant women than any other class of drugs in the world,” Dr. Stowe said.

I would be interested in hearing from women who cope with depression who have been pregnant and faced with this decision. What was your experience? How did you make your decision? Would you make the same choice again?