Should I take medications for depression or anxiety when pregnant or breastfeeding?

Deciding whether or not to start or continue medications when you are pregnant or breastfeeding is a very personal decision.  You should work closely with a doctor who is familiar with perinatal mental health to help you make the best decisions for yourself and your baby.  This might be your OB-GYN or a reproductive psychiatrist who specializes in PMADs (perinatal mood and anxiety disorders).

 

The biggest question that you and your doctor will need to answer is:

Which is greater— the risks of medicating or the risks of not medicating?

 

When considering medications during pregnancy, there are two patients to consider— the mother and the baby.  The baby will either be exposed to the illness (depression or anxiety) or the medications. Studies have shown that when depression, especially if severe, is left untreated during pregnancy, there may be increased risks for negative effects on the mother and the baby. Only you and your health care provider know your medical history and can best determine whether or not you should stop taking medications during pregnancy.

What does the research say?  The American Journal of Obstetrics and Gynecology (2012) reported:

“When a psychiatric condition necessitates pharmacotherapy (medications), the benefits of such therapy (medications) far outweigh the potential minimal risks.”

Here are some things to consider when you’re talking to your doctor about this important decision:

• Is your depression or anxiety problem significant enough that it could harm your child?
• Do you have thoughts of harming yourself or committing suicide?
• Have you experienced a lack of appetite leading to weight loss or inadequate weight gain during pregnancy?
• Does your depression or anxiety problem significantly interfere with your ability to care for yourself or your baby?
• Have you had trouble complying with pre- or post-natal care recommendations?
• Do you use alcohol or other substances to manage depression or anxiety?
• Do you have symptoms that worry you or those who know you?

Questions to ask your doctor:

• What are the risks of medication to me or my baby?
• Are there any other treatment options, such as therapy?
• What are the risks to me or my baby if my illness is left untreated?
• How do these risks compare with general rates of pregnancy complications of birth defects?

If you decide to take medications during or after pregnancies, keep in mind these few tips:

• When first starting antidepressants, it may be necessary to start at a lower dose and increase your dosage after about a week.  This lowers the chance of having side effects.
• With certain antidepressants, you may be able to tell a difference in your mood within 3-5 days, while other antidepressants take longer to work.
• When you feel 100% back to normal, wait 9-12 months before discontinuing the medication or you could have a relapse of symptoms.  Always taper slowly under the direction of your doctor; do not discontinue abruptly.

 

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Resource for you:

mothertobaby.org– search by medications to find out facts and advice about using that medication during pregnancy or breastfeeding

Resource for your OB-GYN:

PSI Psychiatric Consult Line

1-800-944-4773

Medical prescribers can call this free consultation line.  Within 24 hours of calling you will be connected with an expert perinatal psychiatrist who can provide advice on diagnosis, treatment, and medication management for preconception, pregnant, and postpartum women.

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Research supports a combination of medication and therapy for depression and anxiety.  I would love to be a part of your support team as you journey through pregnancy and the postpartum period.  Contact me today for an intake session.