Antidepressants can be a life-saving tool for people with anxiety and depression. But, for those who are pregnant, the choice may seem to be between their mental health or that of a child's future.
"Some patients and providers really believe that psychiatric medications are not compatible with pregnancy," said Dr. Allison Deutch. She is the director of reproductive liaison-consultation psychiatry for NYU Langone Health, and clinical assistant professor of psychiatry in the New York University Grossman School of Medicine.
Deutch stated that 'Batting this misconception is one of most challenging aspects in doing this work. This applies to both the patient and provider perspectives.
Blake, a patient, told Blake that she and her husband had sat down with Deutch to discuss whether she should continue taking the medication she began during the pandemic in order to get back into equilibrium.
The questions they asked included 'Would the baby be affected? Was there a withdrawal effect on the baby? Does the baby have developmental problems? Will the baby be physically ill? What could possibly happen to the child? Blake said, only wanting to be called by her first initial.
Blake chose to continue taking her medication.
She said, "I am certain that it was the best thing for me, because to be the best mom you can be you have to be at your best."
Dr. Maria Sophocles, who has been an obstetrician-gynecologist for 28 years, said that one thing she saw repeatedly was her patients' willingness put others before themselves -- even at their own expense.
Sophocles is the medical director of Women's Healthcare of Princeton, New Jersey.
Sophocles says that with the stigma surrounding mental health, and the pressures on parents to be, it's important to discuss how nuanced the discussion is about medication to treat depression and anxiety while pregnant.
Deutch stated that treating mental illness during pregnancy is just as important as any other condition. When done correctly with a high degree of vigilance, many women are able to have healthy, successful pregnancies while taking these medications.
Risks and risks
In many medical situations, people weigh the benefits and risks. Deutch explained that deciding to continue taking antidepressants while pregnant is more like weighing the benefits versus the risk.
She added, "We are weighing the risks of maternal mental illness untreated to mom and the baby against the risks of exposure to medication."
Rubiahna Vaughn, MD, Director of Consultation-Liaison and Emergency Psychiatry, Jack D. Weiler Hospital, Bronx, New York. This hospital is part of Montefiore's Health System.
Deutch said that the most common medications to treat depression, selective serotonin reuptake inhibits (also known as SSRIs), are largely reassuring in their safety to be used while pregnant.
According to a study conducted in 2022, antidepressant usage during pregnancy is not linked with autism, attention deficit hyperactivity disorder (ADHD), developmental speech, language and learning disorders, coordination disorders, or intellectual disabilities.
Vaughn added that the risk of giving a child birth defects when taking SSRIs was lower than the baseline.
Sophocles also added that SNRIs are considered an option for pregnant women.
She said that some medications within the same category may have a lower risk than others. Talk to your doctor about which one is right for you.
Sophocles stated that the risk of complications from antidepressants is very low. However, nothing is risk-free when it comes down to the outcome of a pregnancy.
Vaughn stated that he does not take the treatment of pregnant women by medication lightly. We must also consider the risks associated with not treating depression, including the impact on the mother and her fetus.
Untreated depression in pregnancy is associated with a lower birth weight, and even preterm birth. Vaughn, an assistant professor of psychiatry, behavioral sciences, and of obstetrics, gynecology, and women's healthcare at Albert Einstein College of Medicine, Bronx, New York, also said this.
Deutch says that patients who have had depression prior to pregnancy are more likely to experience postpartum depression. Patients should consider this risk when discussing with their doctor whether or not they want to continue taking their medication.
Take care of mom and you will take care of the baby
Deutch explained that some of the antidepressant fear may be due to stigma or misinformation. However, a lot of it is based on caring for a child in the future.
She added, "This is one area where women feel that if they had the option of white-knuckling it, they would rather suffer, than do harm to their baby." It may also not be safe to tough it out.
Vaughn stated that 'I believe we all intuitively understand that in a household where there is a mom, if she is not functioning properly, then the entire household will not function well'. There are literally reams upon reams to back up this idea.
If the parents are in financial difficulty, it makes sense that a healthy pregnancy would be more difficult.
Vaughn continued, 'You can imagine how difficult it would be to get to a doctor appointment when you are depressed and pregnant. It's also hard to remember to take your prenatal vitamins, or to ensure that you have enough nutrition to support the pregnancy.
There is also a risk to the baby's health after birth. Deutch says that infants need parents who are engaged and available. But this is hard to do when people are depressed and anxious.
We understand that no parent would want to make a choice that could harm their child. She added, 'We are sympathetic to this perspective. A healthy mother makes a healthy child.
Speak to your doctor
Deutch says that it can be difficult to identify depression or anxiety in women who are experiencing them for the first-time during pregnancy or the postpartum phase.
She said that many of her patients thought it was normal to worry about the child's development stages, and not get enough sleep or miss showers when a baby is born.
Vaughn suggested that if you start to feel hopeless, helpless or worthless, or if your worry is affecting your daily life, then it's time to talk to your doctor.
"I think that the question to ask is how much time we spend each day worrying?" She added, 'And to what extent does it affect our ability to function?
Sophocles encourages you to have regular conversations with your doctor and hopes that medical professionals will be proactive about discussing mental health.
She added that just getting into the room and having a conversation could help lead to a healthier pregnancy.
Vaughn says that it's never too early to discuss the pregnancy implications with your doctor, even if you haven't yet conceived but are thinking of taking antidepressants.
She said that'most American women will experience at least one pregnancy during their lifetime, and about 50% of all pregnancies are unplanned in the US.' Ask: "Can I get pregnant with this? Can I breastfeed my child on this product? What are my options if I can't breastfeed?
Not all anxiety and depression is the same. Vaughn says that some people will benefit from medication while others may do well with psychotherapy, cognitive behavioral therapy and other options.
She added that the primary advice was to speak with your doctor about your choices and to give yourself permission to do so.
Vaughn stated that 'it's not the same story for everyone'. "But for women with depression, I believe you should really prepare yourself to have a positive experience during pregnancy and postpartum. It's difficult to achieve this if you are depressed.
Blake's advice to you is 'trust your doctors and your instincts'