The Truth about Psychotropic Medications in Pregnancy

Pregnant BellyThe debate rages on over the safety of psychotropic medications during pregnancy. Those who oppose the use of antidepressants can produce scores of articles and scattered studies illuminating the dangers and challenging the effectiveness of these medications. I think what we have here is a classic case of “splitting,” a psychological term for the inability to recognize that there can be good and bad attributes about a person or object. Many with strong opinions label psychiatric medications either “bad” or “good” and can accept only information that fits in with their view.

The reality is that there ARE incompetent psychiatrists and some who just plain make mistakes. Medications may also be overprescribed or even wrongly prescribed for some. However, there are individuals who benefit greatly from the use of antidepressant and antipsychotic medications. Thus, the need for accurate information about their use in pregnancy and while breastfeeding are crucially important.

Many who oppose antidepressant use advocate instead for natural and holistic alternatives for the treatment of depression and anxiety. I am a believer in holistic medicine. I’ve tried acupuncture, chiropractic, homeopathy, cranio-sacral massage, and herbs at times with good results. However, I would not have survived childhood without life-saving asthma treatment, and I have never found a holistic remedy that cured my asthma. I think we can all agree that the body sometimes has flaws (type 1 diabetes is a good example) where mainstream medical intervention is necessary to maintain health and life.

In my case, many years ago, holistic treatments and psychotherapy did nothing to touch my severe postpartum panic, which caused months of insomnia, dizziness, and nausea, making me incapable of caring for my children or myself. I was hospitalized for major depression when I no longer had the will to live. Within six weeks on an antidepressant, I was functioning again and beginning to benefit from psychotherapy. I know that an antidepressant helped to save my life, and I know many other women who have had similar experiences.

Research is starting to show that there are genetic differences affecting many women who experience perinatal mood and anxiety issues which cause some women to be oversensitive to the impact of changes in estrogen levels. My work with postpartum women has demonstrated to me that women with severe depression, anxiety, and obsessive compulsion that begins in the perinatal period often benefit from antidepressants, along with psychotherapy, improved self-care, good nutrition, sunshine, and moderate exercise.

Some mothers choose not to take medication, and sometimes they do recover with psychotherapy and improved social support and self-care, but sometimes they still end up taking medication later and regretting the time they lost with their baby while they were too depressed or anxious to bond effectively.

The truth is that some new mothers are unable to muster the energy and will to engage fully in therapy and cannot improve self-care adequately to recover from debilitating depression or anxiety without medication. The majority of those women in my experience (and the experience of my experienced colleagues) do improve once they receive the right medication. That is a reality that supersedes intellectual debates about the benefits and risks of medication. Those mothers need balanced information and not scare tactics, shaming, or political agendas. Their lives, and the well-being of their babies, depends on it.

© Copyright 2014 GoodTherapy.org. All rights reserved. Permission to publish granted by Meri Levy, LMFT, therapist in Lafayette, California

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Glenda

    September 25th, 2014 at 11:35 AM

    I know that the first thing that my ob did when I learned I was pregnant was to take me off of the anti depressant that I was taking. Pregnancy was ok but I fully think that it would have been so much better had I been allowed to stay on some sort of medication. I guess that there are so many different opinions out there that it can be hard to know who to trust and what the right and wrong decisions will be but I think that if there is no harm done then women should be allowed to stay on these meds that for many, like me, have given them back the life that they long to have.

  • Meri Levy, MFT

    Meri Levy, MFT

    September 25th, 2014 at 9:03 PM

    Hi, Glenda. I’m sorry to hear about your experience. The current wisdom of the most knowledgeable reproductive psychiatrists these days is that it is better for most women to stay on medications that are working when they get pregnant rather than going off them. The risks to going off of medication are thought to be greater than the risks of staying on them. But OBs are not psychiatrists, and even some psychiatrists don’t know that much about medications in pregnancy and while breastfeeding. I’m glad that you got through your pregnancy OK and I hope you’re enjoying your baby.

  • adrienne

    September 25th, 2014 at 2:18 PM

    Do you have any thoughts about finding out more about more alternative treatments?
    Everywhere I turn there seems to be the stone wall effort to convince me that these things don’t work and that the only things that do work are chemicals that I would have to put into my body.
    I am pretty vehemently opposed to this as I know that even though this is the right choice for many people, it is not the right one for me and I want to try other avenues for treatment before committing to something like that. I just don’t know where to get enough information or even a provider who is willing to help me on that treatment path.

  • Meri Levy, MFT

    Meri Levy, MFT

    September 25th, 2014 at 8:58 PM

    Hi, Adrienne. There are some alternative approaches and non-medication treatments that show promise. To start with, moderate exercise, daily sunshine, increased support from friends and family, good nutrition (avoiding sugar and caffeine) and increased time devoted to sleep are essential if you want to avoid taking medication. Bright light therapy has been shown to improve mild to moderate depression, so a light therapy box may be worth trying (and they’re pretty inexpensive online).

    Mindfulness exercises (as distinguished from relaxation exercises, which can make you feel worse) can help you get perspective on negative emotions and stay present rather than getting caught up in disturbing thoughts. Cognitive-behavioral or Interpersonal Therapy with a mental health professional knowledgeable about perinatal issues can help a great deal. You should make sure your doctor rules out a thyroid or other hormone imbalance, and checks your iron, B-vitamin and vitamin D levels.

    If you feel comfortable working with a Naturopathic Doctor or Acupuncturist, that may be worth trying as well. But remember, the most important thing here is your safety and the well-being of your family. If you do end up needing medication after exhausting other options, you need to know that you did everything you could and this illness is not your fault and getting better is what matters most.

  • Claire

    September 26th, 2014 at 5:20 AM

    This is a pretty important decision that many women have to make and I would hope that they are making that decision with the help of a great doctor who helps them to undersatnd and explore all of their options. I do think that when it is prudent to do so then you should take as little as possible while pregnant, because although there is research out there you just never know what could effect the baby. But I also understand that for manyh women this may not be an option so finding out what those options are would be in their best interest.

  • bryson

    September 27th, 2014 at 8:18 AM

    I would be very nervous unless my wife was working with someone that we trusted and really valued their opinion on the issue. The mom has to be protected and should feel at their optimum to have the healthiest pregnancy possible, but you don’t want to do anything that would put the baby at risk either.

  • Anne

    September 28th, 2014 at 8:05 AM

    Just like with most anythign else you have to weigh out the pros and cons and then come to the decision that you know is going to be the best one for you. There will be people who support you and then there will be those who are against the decisions that you are making. Big deal. If you honestly think that it is the wisest one for you, then I think that this is the one that you have to go with. I think that you rely on your physician to help lead you in the right direction and then you go from there.

  • april clay

    September 29th, 2014 at 3:49 AM

    There are going to be pros and cons to everything out there… there are some things that I am convinced that there will never be 100% agreement. That’s life. What I do know is that of course there are going to be times in all of our lives where we need medical intervention and many times this will include the need for medications.
    What I also know is that as a pregnant female I would hope against hope that I wouldn’t need to take anything pharmaceutical wheil expecting. That’s just em… I would want to introduce as few chemical things like that into my body while pregnant in the fear that I would hurt my unborn child.

  • Davis

    October 1st, 2014 at 3:58 AM

    I think that there is a choice out there that is right for everyone and that we all need to respect and trust that this person is making the choice that it is the best one for themselves.

  • harv

    October 4th, 2014 at 10:32 AM

    What are you supposed to do? Go through your entire pregnancy being depressed? That doesn’t seem too healthy either. Surely there has to be something available that is safe enough to take by pregnant women or even those nursing.

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