Should You Take Medication for Mood In Pregnancy?
Navigating Psychotropic Medications During Pregnancy: Prioritizing Well-being of Mom and Baby
Pregnancy is a unique journey filled with excitement and anticipation, but it can also be a time of heightened emotional and physical stress. For those managing mental health conditions, the decision to continue psychotropic medications during pregnancy is complex and deeply personal. The primary goal is to ensure both mother and baby are well cared for, and it's crucial to navigate this decision with informed guidance.
The Importance of Maintaining Maternal Health
Maintaining maternal mental health during pregnancy is of paramount importance. The risks of untreated mental health conditions typically outweigh the risks of most medications. In addition, the risk of discontinuing a medication during pregnancy that was working for you puts you at increased risk for a relapse in symptoms. For many people, the best option is to stay on a medication regime that is working.
Understanding the Safety of Psychotropic Medications
Although I think research on medication in pregnancy is quite lacking, most of the research that is available shows a relatively low risk to mother and baby. Here’s what you need to know:
SSRIs: SSRIs, such as sertraline (Zoloft) and fluoxetine (Prozac), are often prescribed to manage depression and anxiety. Studies have shown that the risks associated with SSRIs during pregnancy are relatively low. While there may be some concerns about potential risks such as mild neonatal adaptation issues or very rare instances of persistent pulmonary hypertension of the newborn (PPHN), these risks are generally outweighed by the benefits of treating maternal mental health conditions. It’s important to remember that just because a study shows a statistically significant elevation in risk on a medication, does not mean that the risk is clinically significant. For instance, a study on PPHN in newborns showed there was an increased risk from 1.2/1000 to 3/1000 for those that used SSRI. So the study may say, “risk is more than doubled,” however, the overall risk is still very, very low.
Mood Stabilizers: Maintaining a stable mood for those with bipolar disorder is of upmost importance. Those with bipolar disorder are most susceptible to postpartum psychosis, which can be debilitating, scary, and require hospitalization. Mood stabilizers, such as lithium, can be crucial for managing bipolar disorder. Lithium use requires careful monitoring, as it can affect kidney function and thyroid levels in both the mother and baby. However, with proper management and monitoring, many women with bipolar disorder can safely use mood stabilizers during pregnancy. There are also other medications that can treat bipolar mood that have low risks, such as lamotrigine.
Antipsychotics: The majority of studies do not show associations with major malformations and antipsychotic use in pregnancy, with the possible exception of Depakote. Depakote is not recommended due to the increased risk for neural tube defects. However, there are other medications that can be used that have been found to have lower risks, such as Seroquel or Aripriprazole.
The Risks of Being Unmedicated
While there are risks associated with using psychotropic medications, the risks of being unmedicated can be even more concerning. Untreated mental health conditions can lead to:
Increased stress and physical health complications
Poor adherence to prenatal care
Higher likelihood of substance abuse or risky behaviors
Negative impacts on bonding and caregiving post-birth
Negative impacts on child, such a pre-term birth, increased activation of fight-or-flight response, and developmental delays
These factors can have significant repercussions for both maternal and fetal health. Therefore, managing mental health conditions effectively with medication, when appropriate, can often be the safer choice.
Collaborating with Healthcare Providers
Navigating the use of psychotropic medications during pregnancy should involve close collaboration with a healthcare provider. Finding a provider who is well-versed in perinatal mood disorders and psychotropics will be helpful. It’s important for you and your provider to have:
Open Communication: Discuss all concerns and preferences with your healthcare provider to tailor a treatment plan that best suits your needs.
Regular Monitoring: Frequent check-ups and adjustments to medication may be necessary to balance efficacy with safety.
Weighing Risks and Benefits: Together with your provider, assess the risks of continuing versus discontinuing medication based on your specific situation.
Make sure you feel like your provider has given you good information about any possible risks and benefits to both medicating and non-medicating. If you feel you have questions, speak up, it’s your providers job to educate and support you through this journey. If you would like to talk more about this or feel like you need more support during your perinatal journey, reach out. I’m here to help!
