(CNN) — For those whose anxiety or depression is controlled with antidepressants, pregnancy can seem like a daunting choice between mental health and the well-being of a future child.
“Some providers and patients come from the perspective that psychiatric medication use is incompatible with pregnancy,” said Alison Deutsch, MD, director of reproductive consultation-liaison psychiatry at New Langone Health and clinical associate professor at York University Grossman. Medical school.
“Combating that misconception from the patient perspective and the provider perspective is one of the most challenging aspects of doing this work,” Deutch said.
Blake, a patient, said she and her husband sat with Deutch for a long time, weighing her to get her back on track with the medication she started during the outbreak.
Like “will it affect the baby? Will the baby have a bowel movement? Does the child have any developmental problems? Does the child have any physical problems? What can the baby be? ” said Blake, who only wanted to be identified by her first name.
In the end, Blake decided to stay on her medication.
“I firmly believe that it’s better for me because to be the best mom you can be, you have to be your best self,” she said.
One thing Dr. Maria Sophocles has seen over and over in her 28 years as an obstetrician is her patients’ willingness to put others first — even to their own detriment.
Sophocles, MD, director of women’s health care at Princeton, said deciding how to treat depression during pregnancy is no easier than choosing one’s well-being. New Jersey.
And with the stigma around mental health and the pressure it puts on expectant parents, it’s important to talk about how much more complicated the conversation around medication to treat anxiety and depression is during pregnancy, Sophocles said.
“Treating mental illness is just as important as treating any other illness during pregnancy,” Deutch said. “If done correctly with a careful level of vigilance…many women can have a very healthy and successful pregnancy, and with these medications, they are often very important to their safety.”
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Few drugs come with zero risk during pregnancy, but SSRIs have a very low risk, says gynecologist Dr. Maria Sophocles.
In many medical situations, people make decisions by weighing the risks and benefits. When deciding whether or not to stay on antidepressants during pregnancy, it’s like analyzing the risk of harm, Deutch said.
“We are weighing the risk of drug exposure to mother and child against the risk of untreated maternal mental illness for both mother and child,” she added.
Risks when taking the drug include low birth weight, premature birth, problems with growth and birth defects, said Dr. Rubiana Vaughn, director of consulting and emergency psychiatry at Jack D. Wheeler Hospital in the Bronx, New York is part of the Montefiore Health System.
The most common medications used to treat depression are serotonin reuptake inhibitors, known as SSRIs, and data support that they are safe to use during pregnancy, Deutch added.
A 2022 study Antidepressant use during pregnancy has not been associated with autism, attention-deficit hyperactivity disorder (ADHD), conduct disorder, developmental speech, language, learning and coordination disorders, or intellectual disabilities.
And the risk of having a baby with birth defects while on SSRIs is lower than the baseline risk, Vaughn said.
Serotonin And norepinephrine reuptake inhibitors (SNRIs) are considered an option during pregnancy, Sophocles added.
Some drugs in the same category may have less risk than others, so talk to your doctor to find the right one for you, she said.
The risk of problems with antidepressants during pregnancy is small, but nothing is without risk of poor birth outcomes — even acetaminophen, Sophocles said.
“We don’t take drug treatment of pregnant women lightly,” Vaughn said. But we have to balance that with the real risks of leaving depression untreated and how this affects not only the mother, but the fetus and the baby’s development. ”
Untreated depression during pregnancy is associated with an increased risk of low birth weight and preterm birth, said Vaughan, assistant professor of psychiatry and behavioral sciences and obstetrics and gynecology and women’s health at the Albert Einstein College of Medicine in the Bronx, New York.
Because people with depression before pregnancy are more prone to postpartum depression, patients should consider the risk of relapse with the newborn when talking to their doctor about continuing their medication, Deutch said.
Some of the fear surrounding antidepressants may come from stigma or misinformation, but much of it comes from caring for an unborn child, Deutch says.
“This is one place where women really feel. She added: ‘If I have the option of getting a knock-on white later, I’d rather suffer than cause undue harm to my child.’ But strengthening it may not be the safest option.
“I think we all know intuitively In a family system where there is a mother, if the mother is not doing well, the whole family is not doing well,” Vaughn said. “There are reams and reams to support this idea.”
If the parents are struggling, it makes sense that having a healthy pregnancy would be very difficult.
“If you’re depressed and you’re pregnant, you can imagine how hard it is to go to a doctor’s appointment… It’s hard to take that prenatal vitamin, it’s hard to make sure you’re getting good nutrition to support you. Pregnancy,” Vaughan added.
And there is danger for the baby after birth. What babies need are responsive parents — and it’s hard to bond and connect when people are stressed and anxious, Deutch said.
“No parent wants to make a decision that hurts their child, and we understand that. We fully sympathize with that view. But “a healthy mother makes a healthy child.”
For those who experience depression or anxiety for the first time during pregnancy or postpartum, it can be difficult to identify, Deutch said.
She thinks it’s normal for many of her patients to worry about their baby’s developmental stage, not getting enough sleep, or not showering with a newborn.
But when that anxiety starts to get in the way of your life or you start to feel hopeless, helpless or worthless, it may be time to talk to your doctor, Vaughn says.
“I think the question is, how much time in a day do we spend worrying? And How much it is affecting our ability to work,” she added.
Sophocles recommends talking to your doctor regularly, and she hopes medical professionals are proactive in talking about mental health.
Just getting in the door and starting the conversation paves the way to a healthy pregnancy, she said.
And even if you’re not yet pregnant but considering taking an antidepressant, it’s never too early to talk to your doctor about the implications for pregnancy, Vaughn said.
“Most American women will have at least one pregnancy in their lifetime and nearly 50% of pregnancies in the US are unplanned,” she said. Ask: “Is this something I can conceive of? Is this something I can breastfeed my baby? And if not, what are my options? ”
But just as every pregnancy is not the same, not all anxiety and depression are the same. Some may benefit greatly from medication, some do well with medication and other options such as psychotherapy and cognitive behavioral therapy, Vaughn said.
The top tip is to talk to your doctor and give them permission to make choices that are best for you and your baby, she added.
“The story isn’t for everyone,” Vaughan said. But I think for women who really suffer from depression, you really want to prepare yourself to have the best possible experience during pregnancy and postpartum. And if you’re worried, it’s hard to do that.”
Blake’s advice is to “trust your doctor and trust your instincts.”