Medications and mental health: what’s safe in pregnancy?

Learning you're pregnant brings with it a whole new set of emotions, questions and concerns. One area of focus for many mothers-to-be is whether it's safe to continue using previously prescribed medications during pregnancy and postpartum. This is a particularly sensitive issue for women taking medication for mood disorders, such as anxiety, depression or bipolar disorder.

Though the impulse may be strong to stop taking medication so it doesn't affect the baby, that can be a mistake. Quite often, mental health needs take a back seat in pregnancy, and psychiatric medications are treated as if they were vitamins that can be stopped without a second thought.

Studies have shown that women with a history of psychiatric problems are up to five times more likely to relapse after quitting their medications than women who continued treatment in pregnancy. What’s concerning is the relapse happens very quickly, with more than 50 percent of women experiencing worsening of depression within the first trimester. Unfortunately, restarting medications later in pregnancy doesn’t seem to protect against depression. For women with a prior history of mood disorders, relapse of depression or anxiety may present a greater risk than continuing with medication.

Studies also show that untreated depression in pregnancy has serious consequences for the mother, her baby and family. Risks to the mother include higher rates of preeclampsia, C-section or preterm birth. Untreated depression during pregnancy may also result in long-term detrimental effects on the developing child’s emotional, behavioral and cognitive development. Infants born to mothers with untreated perinatal depression often have poor sleep and difficult temperament. Older children who were exposed to maternal depression during pregnancy are at increased risk for anxiety, ADHD, behavior and conduct disorders, which appear to persist into teenage years and early adulthood.

So what's an expectant mom to do?

Consider the following as you weigh your options:

1. If you have a long history of severe anxiety or depression that requires treatment with medication, know that abruptly discontinuing those meds puts you at increased risk of relapse during pregnancy, which can affect the physical and mental health of both you and your baby.

2. Although most current antidepressant medications have a favorable safety profile during pregnancy, there are some nuances that need to be considered before deciding whether to continue or discontinue use.

3. Delay any decisions about use of psychiatric medications in pregnancy until you consult with your OB/GYN and/or a reproductive psychiatrist.

How a reproductive psychiatrist can help

Reproductive psychiatrists offer expertise in the latest treatments for women who are expecting (or plan to be), as well as new and nursing mothers. Your psychiatrist will review with you the risks and benefits of various types of treatment for mood disorders in pregnancy, including psychiatric medications. You’ll learn which drugs have been studied in pregnancy, what alternative treatments are available, and which treatment options may work best for you.

SLUCare Women’s Reproductive Mental Health Clinic can help you make the right decision for you and your baby.

In our clinic, we provide a thorough evaluation of your medical history, your risk profile, and goals for pregnancy. Our objective is to develop an individualized treatment plan, which may include psychotherapy, medications or other treatments using an evidence-based approach. Every decision about your care will consider the risks and benefits of treatment, as well as the risks of untreated psychiatric disorders on maternal and infant health.

Find out more about the SLUCare Women’s Reproductive Mental Health Clinic. Or call 314-617-2000 to schedule an appointment.

By: Rushaniya Khairova, MD, PhD

SLUCare Psychiatry and Behavioral Neuroscience

Disclaimer: The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment.