Taking Antidepressants While Pregnant Still Has A Stigma. That Has To End.

When it comes to taking antidepressants during pregnancy, I knew I wasn’t the first person to wonder whether it was safe, or if I could continue taking my medications while trying to conceive. But my exhaustive Google searches left me empty-handed and feeling like no moms-to-be actually choose to remain on their medications. All I found online were resources telling me why it’s best to taper off medications before getting pregnant.

It never occurred to me that women like me — who have anxiety, depression, and a lil’ sprinkle of OCD — probably aren’t shouting decisions like these from the rooftops, let alone on the internet. I’ve been on two medications, an SSRI, and an anti-anxiety drug for two and eight years respectively. Along with cognitive behavioral therapy, they make my brain a lot easier to live with.

While I recognize there’s some privilege in having anxiety and depression — they’re less stigmatized than conditions like bipolar disorder, schizophrenia, or psychosis — the stigma surrounding them gets much, much bigger when you pair them with pregnancy. Good moms wouldn’t take medication, right? They’d endure anything, even the nightmare of unchecked mental illness, for the health of their baby. And I just wanted to be a good mom.

So, I made an appointment with my psychiatrist to discuss getting pregnant and how to taper off my meds. He told me that while my specific prescriptions can be taken while pregnant, they have loose links to birth defects like cleft palate and congenital heart issues. We made a plan to ease me off my medications starting the next day.

Brittney Pohler, PA-C, MPH, at Baylor Scott & White Medical Center – College Station, cares for pregnant women with mental health issues regularly. She tells Romper in an interview that there’s just not enough data available about taking medications while pregnant, which is why many providers say tapering off is the best way to ensure zero risks.

“Some studies have shown associations between meds and birth defects or growth issues in baby, but I would say they’re small and very limited. Most don’t show evidence of malformations or issues. Zoloft is probably the most studied since it’s been around the longest,” she says. “We try to steer away from things like Ambien, but even that is kind of mixed. You’re going to see that come down to provider preference.”

Veerle Bergink, M.D., Ph.D., is director of the Women’s Mental Health Institute at Mount Sinai. She focuses on research about medication use during pregnancy. In an interview with Romper, she said whether or not to take meds is not a one-size-fits-all conversation.

“The risks for congenital abnormalities are well investigated for antidepressant medications, and there is not an increased risk. There are some psychiatric medications that increase risk — the most commonly known is valproic acid, which could lead to birth defects. Most psychiatric medications do not give congenital malformations, but the long-term effects on the physical and mental health of the children are less investigated. Whether it’s an antidepressant, sleep medication, or antipsychotic medication, all medication passes the placenta.”

That uncertainty is why so many women, myself included, try to taper off. But Bergink says it’s important to have a discussion about how tapering may affect the mom-to-be and take her history into account. “Almost all moms prefer not to use meds during pregnancy. The true question is, what happens if you taper or stop these medications? What is your risk for relapse? How large is the chance you will be ill or unwell? We know, for example, for women with manic depression, the relapse risk is very high, especially after delivery, but for women with depression and anxiety, it is not so high, but we do not know that chance very well,” she says.

Two weeks after reducing my dosages, I found myself crying uncontrollably, without reason, for two days in a row. In familiar places around family members, I felt overcome by anxiety symptoms, like a tight chest and shallow breathing. My thoughts raced, and for the first time in years, some of those thoughts were about self-harm. When I heard those thoughts turning into a plan without my permission, I knew it was time to call my husband. He was out of town, so he called my mom to come stay with me while a friend headed over to keep me company until she arrived.

When my husband got home, we feverishly researched the effects of untreated mental illness on a fetus. We learned that the medical community simply can’t quantify that risk, but many sources prove there is risk (low birth weight, preterm birth, and sleep disturbances to name a few). After my experience, our conversation became less about what was best for our (still hypothetical) baby’s physiological best interest, and more about the overall health of both of us, of us as a family.

We worried my anxiety and depression could be amplified by the hormone changes pregnancy causes, and that my misery would be equally as harmful to our unborn child as any medications I could take. I was afraid, knowing I have risk factors for postpartum depression and anxiety, that I would sink deeper into one or both of those conditions after birth without the stability medication provides me.

“The risk of uncontrolled mental illness, you have to weigh that in, and it is a hard, unquantifiable risk to give a patient,” says Pohler. “It’s a risk-benefit discussion. Do you have counseling and good social support? It’s a personal choice and there is no wrong choice. It’s doing what’s best for you so you can be a healthy mom when baby comes.”

I made an appointment with my therapist to get extra support, and went to see my psychiatrist later that week with my husband in tow. We told him about research we’d read, the lack of firm data tying my medications to birth defects, and how poorly I’d reacted to tapering off.

He said the risk of birth defects is 3% to 4% in an average pregnancy, but there were no solid numbers on how much that risk increases when a woman is on medication. Meanwhile, the likelihood my future baby would be affected by my mental illness was unknown, too. So, as a team, we chose to keep me on my medications while TTC and throughout my pregnancy, whenever it comes.

The support from my husband, my psychiatrist, and later my obstetrician, was wonderful. I’m sure they would have been that supportive of me remaining on medication all along had I ever expressed that desire, or even felt like it was enough of an option to ask about. But, because of the stigma surrounding mental health, and feeling like a good mom would endure anything for her baby, I didn’t let myself explore that option until I was sobbing on my sofa, my friend literally babysitting me because I couldn’t trust myself alone.

That version of me couldn’t take care of a newborn baby; she couldn’t take care of herself. Stigma got me to that place, which is why I’m vocal about my decision now. The kryptonite for stigma is talking about the problem until it becomes a normal topic of conversation. I’m here to tell you: It’s OK to stay on your medication, with your doctors’ guidance and approval, throughout pregnancy.

“Mental health as a whole has a stigma, and if you add in pregnancy, that gets amplified,” says Pohler. “It’s important to have a good relationship with your provider who can normalize it for you. Have a conversation about your specific symptoms and the best way to handle them, like maintaining your meds or starting counseling."

“I think it’s good to try to be a good mother, but the problem in our society is there’s just too much focus on the perfect mother. She does not exist,” says Bergink. “Let’s be realistic about what we expect of ourselves. I think what a good mother does is make the best decision you can. Make a decision together with your partner and provider, and stick to it. If you decide to stay on meds, that is the best plan for you. You should not feel guilty during your pregnancy or later in life.”

If you or someone you know is experiencing depression or anxiety during pregnancy, or in the postpartum period, contact the Postpartum Health Alliance warmline at (888) 724-7240, or Postpartum Support International at (800) 944-4773. If you are thinking of harming yourself or your baby, get help right away by calling the National Suicide Prevention Lifeline at 1-800-273-8255, or dialing 911. For more resources, you can visit Postpartum Support International.

If you or someone you know is considering self-harm or experiencing suicidal thoughts, call the National Suicide Prevention Hotline at 1-800-273-8255 or text HOME to the Crisis Text Line at 741741.

Experts:

Veerle Bergink, M.D., PhD, is director of the Women’s Mental Health Institute at Mount Sinai

Brittney Pohler, PA-C, MPH, at Baylor Scott & White Medical Center – College Station