(CNN) — For those who have managed anxiety and depression on antidepressants, pregnancy can seem like a scary choice between mental health and future child well-being.
“Some providers and patients alike come from the perspective that psychiatric drug use is actually incompatible with pregnancy,” said Reproductive Consultation Liaison Psychiatry Director at New York University Langone Health. Alison Deutch, Ph.D., associate clinical professor of psychiatry at New York University.York University Grossman Faculty of Medicine.
“Combating that misconception, both from a patient’s perspective and a provider’s perspective, is one of the most challenging aspects of doing this research,” said Deutch.
Patient Blake said she and her husband sat down with Deutch to discuss whether she should continue taking the medications she started during the pandemic to return to equilibrium.
They discussed questions such as “Will it affect my baby?” Will my baby have withdrawal symptoms? Does the baby have developmental problems? Does the baby have physical problems? what could happen to the baby? Blake said she wanted to be identified only by her first name.
In the end, Blake decided to stick with the drugs.
“I strongly believe it was the best thing for me, because to be the best mother, you have to be the best you can be,” she said.
Maria Sophocles, M.D., says that in her 28 years as an obstetrician-gynecologist, one thing she has seen time and time again is patients willing to sacrifice their own interests to put others first. rice field.
Sophocles, who is also the medical director of women’s health care at Princeton University, said deciding how to treat depression during pregnancy isn’t as simple as choosing one health over the other. new jersey.
And with the stigma around mental health and the pressure on pregnant parents, Sophocles said it’s important to discuss how nuanced the conversation about drugs to treat anxiety and depression in pregnancy is. said Mr.
“Treatment of mental illness is just as important as treatment of other conditions during pregnancy,” Dr. Deutch said. “With due diligence and proper care, many women can continue to have very healthy pregnancies while taking medicines that are essential to their health.”
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Few medicines have zero risk during pregnancy, but the risk of SSRIs is very low, says obstetrician-gynecologist Maria Sophocles, PhD.
In many medical situations, people weigh risks and benefits when making decisions. Deciding whether to continue taking antidepressants during pregnancy is like doing a risk-risk analysis, Deutch said.
“We are weighing the risks of drug exposure to both mothers and children against the risks to both mothers and children from mental illness in untreated mothers,” she added.
Risks of low birth weight, premature birth, developmental problems and birth defects are concerns about drug use, said Dr. Rubiana Vaughan, director of counseling and emergency psychiatry at Jack D. Kennedy Hospital. Wyler Hospital in the Bronx, New York is part of the Montefiore Medical System.
The most common drugs to treat depression are selective serotonin reuptake inhibitors, also known as SSRIs, and the data are very reassuring that they can be used safely during pregnancy, Deutch said. added.
a 2022 survey Antidepressant use during pregnancy was not associated with autism, attention-deficit/hyperactivity disorder (ADHD), behavioral disorders, language development, language disorders, learning disabilities, coordination disorders, and intellectual disabilities bottom.
Also, the risk of having a baby with a birth defect while taking an SSRI is lower than the baseline risk, Bourne said.
Serotonin Norepinephrine reuptake inhibitors (SNRIs) are also considered options during pregnancy, Sophocles added.
Talk to your doctor to find the one that’s right for you, because some drugs in the same category may have lower risks than others, she said.
Sophocles said the risk of complications from antidepressants during pregnancy is low, but even acetaminophen is not without risks if the birth outcome is poor.
“We never take the drug treatment of pregnant women lightly,” Bourne said. “But we also understand that, and the real risks of leaving depression untreated, and how it can affect not only the mother but also the developing fetus and baby. have to consider.”
Vaughn, who is also an assistant professor of psychiatry and behavioral sciences, obstetrics and gynecology and women’s health at the Albert Einstein College of Medicine in the Bronx, New York, said depression during pregnancy increases the risk of birth weight loss and premature birth if not treated. said to be related to
Deutch said women who had depression before pregnancy are at higher risk of developing postnatal depression, so when discussing whether to continue taking the medication, patients should also consider the risk of recurrence in the newborn. Stated.
Some of the fear of antidepressants may come from stigma and misinformation, but much of it comes from caring for future children, Deutch said.
“This is one of the places where women really feel.” “If I had the choice to do something terrible, I would rather suffer the baby than cause it undue harm,” she added. But getting over it may not be the safest option.
“I think we all know that intuitively In a family system where there is a mother, if the mother is not functioning well, the whole family is not functioning well,” Vaughan said. “There’s a lot of data to support that idea.”
It’s no surprise that having a healthy pregnancy can be difficult if your parents are struggling.
“If you are pregnant with depression, you can imagine how difficult it is to get to the doctor in time…it is very difficult to take prenatal vitamins, and there are a lot of things you can do to support your pregnancy. It’s very difficult to make sure you’re getting enough nutrition when you’re pregnant,” Vaughan added.
And the baby after birth is also at risk. What young children really need is a responsive parent, Deutch said, and it’s hard to be proactive and connect when people are anxious and depressed.
“No parent wants to make a decision that harms their baby, and we understand that. We totally sympathize with that mindset,” she added. But “healthy mothers give birth to healthy babies.”
For those experiencing depression or anxiety for the first time during pregnancy or after giving birth, it can be difficult to recognize, says Deutch.
Many of her patients think it’s normal to worry about their child’s developmental stage, have trouble sleeping or not shower with their newborn, she said.
But when those worries start to interfere with your life, or when you feel hopeless, helpless, or worthless, it may be time to see a doctor, says Vaughan.
“I think the question is, how much time do we spend worrying each day?” To what extent does it affect our ability to function,” she added.
Sophocles recommends regular conversations with your doctor, and hopes that medical professionals will be proactive in talking about mental health.
She added that just walking in the front door and starting a conversation paves the way for a healthier pregnancy.
And if you’re not pregnant yet but are considering taking antidepressants, it’s never too early to talk to your doctor about their effects on pregnancy, Bourne said.
“Most American women have been pregnant at least once in their lifetime, and nearly 50 percent of American pregnancies are unplanned,” she said. “Could this be pregnant?” she asks. Is this ok to breastfeed my baby? If not, what options do I have? ”
But just as not all pregnancies are the same, not all cases of anxiety and depression are the same. Vaughan said some people benefit greatly from medication, while others do very well with other options such as psychotherapy and cognitive-behavioral therapy.
The main advice is to talk to your doctor and give yourself permission to make the best choices for you and your baby, she added.
“This is not a story for everyone,” Bourne said. “But I think women who really struggle with depression want to be really prepared to have the best possible experience during pregnancy and postpartum. It’s hard to do.”
Blake’s advice is to “trust your doctor and trust your intuition.”
