Read this book if: you want to learn more about prenatal and postpartum depression & anxiety. It’s important to be educated (as pregnant women, partners, and those who care for pregnant women) as 20% of women or 70,000 affected each year.
If you like the summary, purchase the book here
Preface: In U.S, over 3.5 million women give birth each year. Perinatal depression rate is ~20% so 70,000 will become ill. Rate of gestational diabetes is bw 1 and 3% and rate of down syndrome in 35 yr old mother is 3%. Screening routine for diabetes and down syndrome, but not perinatal depression (pregnancy through 1st year postpartum), which occurs in 1 in 5 mothers.
Introduction of authors and their stories
Perinatal Psychiatric Illness – perinatal mood and anxiety disorders (PMADs) occur during pregnancy and first year after a woman gives birth. Triggered mainly by hormonal changes, which then affect brain chemicals called neurotransmitters. Life stressors (moving, illness, poor partner support, financial problems, social isolation) affect mental state. Strong emotional, social and physical support will help her recovery. Can occur at different times of day and can feel very different from other depression.
Perinatal Mood and Anxiety Disorders: 6 main ones: depression, OCD, panic disorder, psychosis, PTSD, bipolar disorder I or II (AKA bipolar spectrum disorder).
Psychiatric Issues of Pregnancy: 15-23% experience depression. Higher in teenagers and poor women. Risk factors include life stress, history of depression, lack of social support, domestic violence and unplanned pregnancy.
26.5% had histories of depression before pregnancy, 33.4 % had first occurrence during pregnancy and 40.1 % developed postpartum as first depression.
Pregnancy vs Depression
Pregnancy: mood up and down, teary, self esteem unchanged, can fall asleep, physical problems may waken (bladder, heartburn), can fall back asleep; tires easily, rest refreshes and energizes; feels pleasure, joy and anticipation; appetite increases
Depression: mood mostly down, gloomy, hopeless; low self-esteem, guilt; may have trouble falling asleep, may have early morning wakening and difficulty falling back asleep; rest does not help reduce fatigue; lack of joy or pleasure; appetite may decrease
Depression and Anxiety in Pregnancy: when difficult to function on a day to day basis, need treatment – can be traditional (counseling/meditation) or nontraditional (yoga/acupuncture). Use whatever works best. Depression during pregnancy associated with low birth weight (less than 5.5 lbs) and preterm delivery. Severe anxiety may cause harm to a growing fetus because cortisol (hormone released during stress) can place constriction of blood vessels in placenta. Rate of relapse for major depressive disorder in women who discontinue medication is between 50 and 75%. Depression/anxiety occur in 15-23% of pregnant women; higher rates in teens and women of color; can occur anytime during pregnancy. Symptoms: sad mood, irritability, lack of joy/pleasure, not looking forward to future; guilt; excessive worry or fear; social withdrawal; appetite and sleep disturbances. Risk factors: personal/family history; lack of support; stopping psychiatric medication; history of abuse, domestic violence; history of pregnancy loss
“Baby Blues” – not a disorder – used to describe milk mood swings that occur after first few weeks of birth (begins first week postpartum; should be gone by 3 weeks postpartum). Not considered a disorder since majority of mothers experience it (80%). Symptoms: moodiness, crying, sadness, worry, lack of concentration, forgetfulness, feelings of dependency. Causes: rapid hormonal changes; physical/emotional stress of birthing; physical discomforts; emotional letdown after pregnancy and birth; awareness and fear about increased responsibility; fatigue and sleep deprivation; disappointments including the birth, partner support, nursing and the baby.
Depression & Anxiety Postpartum – 15-20% of mothers; onset usually gradual but can be rapid and begin any time in first year. Symptoms: excessive worry/fear; irritability/short temper; feeling overwhelmed and unable to cope; difficulty making decisions; sadness; hopelessness; feelings of guilt; sleep problems (often can’t sleep or sleeps too much); fatigue; physical symptoms or complaints without apparent physical cause; discomfort around baby or lack of feeling toward baby; loss of focus/concentration (miss appointments); loss of interest of pleasure; lower sex drive; changes in appetite, significant weight loss or gain. Risk Factors: 50-80% risk if previous postpartum depression/anxiety; depression or anxiety during pregnancy; personal or family history; abrupt weaning; social isolation or poor support; history of PMS or PMDD; negative mood changes while taking birth control or fertility medication; thyroid dysfunction; stopping psychiatric medication
Obsessive Compulsive Disorder (OCD): up to 9% of new others; of those – over 38% have depression. Symptoms: intrusive, repetitive, and persistent thoughts/mental pictures; thoughts often about hurting/killing baby; tremendous sense of horror and disgust about these thoughts; thoughts may be accompanied by behaviors to reduce anxiety (hiding knives); counting, checking, cleaning or other repetitive behaviors; fear of germs; fears about own health. Risk Factor: personal/family history of OCD (diagnosed or not)
Panic Disorder: 10% of postpartum women. Symptoms: episodes of extreme anxiety; shortness of breath, chest pain, sensations of choking or smothering, dizziness; hot or cold flashes, trembling, rapid heart beat, numbness or tingling sensations; restlessness, agitation or irritability; during attach the woman may fear she is going crazy, dying or losing control; panic attack may wake her up; often no identifiable trigger for panic; excessive worry or fears (including fear of more panic attacks). Risk Factors: personal/family history; thyroid dysfunction
Psychosis: serious – person loses touch with reality. 1-2 per 1000 perinatal woman. Onset usually within first 2 weeks after birth. 5% suicide and 4% infanticide rate. Symptoms: seeing, hearing, feeling thing that others do now (voice of God, devil, secret messages from TV); delusional thinking (infants death, denial of birth, or need to kill baby); mania; confusion; paranoia; symptoms that come and go (normal one minute, hearing voices the next). Risk Factors: personal/family history of psychosis, bipolar disorder or schizophrenia (diagnosed or not); previous postpartum psychotic or bipolar episode
Post-traumatic Stress Disorder (PTSD) – occurs following life-threatening or injury producing events such as sexual abuse or assault or traumatic childbirth. Occurs in up to 6% of women; rates are higher (up to 30%) for parents who have a child in NICU. Symptoms: recurrent nightmares; extreme anxiety; reliving past traumatic events. Risk factors: past traumatic events; traumatic birth; severe physical complication or injury related to pregnancy/childbirth; baby in NICU
Bipolar Disorder I or II (sometimes referred to as Bipolar Spectrum Disorder): AKA manic depression, bipolar disorders are characterized by mood swings from very high (mania) or high (hypomania) to low mood (depression). No data about how often this occurs. Women usually seek help during episode of depression and commonly misdiagnosed as depression rather than bipolar. Symptoms: mania (bipolar I)or hypomania (low level of mania in bipolar II); depression; rapid and severe mood swings. Risk Factor: personal/family history
Consequences of Untreated Parental Depression on Children: placed on top of list affecting children’s readiness for school. Impact may continue through childhood and into teen years. 50% of kids who have depressed moms will have depression by end of adolescence. At least 10% of fathers are moderately or severely depressed. Less than 50% of these dads report regularly reading to their 1 year olds. Children of depressed parents more likely to suffer from childhood psychiatric disturbance, behavioral problems, poor social functioning and impaired cognitive or language development. Suicide is the second leading cause of death in new mothers during the first year. Get treated right away to help ensure a healthy family.
Perinatal Loss: miscarriage occurs in 20% of pregnancies, but women don’t talk about it. Important to find support and know you are not alone. Women who’ve have had any neonatal loss need to be monitored carefully for distress in future pregnancies and postpartum period. Both parents suffer. Moms go through immediate psychological and emotional reaction; partners feel the need to be strong. 36% of dads suffer severe anxiety at 6 weeks after a pregnancy loss. Dads found to have more depression than moms at 13 months after the loss. Sometimes women interpret partners initial stoic response as a lack of caring. Couples need to communicate. Support plan should include nutrition, sleep, social support and possible medication.
Chapter 3: Women with Perinatal Disorders
No one is immune –doesn’t matter your profession. No matter the educational, socioeconomic level, culture, religion or personality, statistics remain consistent.
Finding a Therapist or Medical Practitioner: Postpartum Support International (PSI) at 800-944-4PPD or postpartum.net. Do not assume someone with expertise in depression or anxiety knows about perinatal mood disorders. Most insurance companies have coverage for mental health. If you can only see a doctor on their list, use these screening questions (or ask a support person to do this for you). Medical practitioners should be asked if they are comfortable prescribing psychiatric medication to pregnant/breastfeeding mothers: specific training in perinatal disorders; belong to any organization dedicated to education about perinatal mood and disorders (PPI, Marce Society, North American Society for Psychosocial OB/GYN); books recommended; theoretical orientation (research shows most effective types of therapy are cognitive-behavioral and interpersonal – you are experiencing a life crisis; long term intensive psychoanalysis is not appropriate). If can’t find, look for someone compassionate and willing to learn. Shop around until you feel satisfied that you are in capable hands.
Remind Yourself: I will recover (they have never met a women who didn’t’ after proper treatment)!; I am not alone! (1/5 women); This is not my fault (it’s a real illness); I’m a good mom (getting help shows you are taking care of family); It is essential for me to take care of myself (to get back to family). I am doing the best I can (you are taking steps, regardless of how small they seem). Depression may interfere with ability to believe these statements so say them frequently.
Basic Mom Care: many women uncomfortable asking for help since we are supposed to be supermom. It takes a village.
Myths About Nursing:
Recovery: Whatever helps you get better quickly is what is recommended.
Antidepressant Questions and Answers
Chapter 4: Partners
Support for partner. The sooner you become involved in the recovery process, and the greater your involvement, the more you both will benefit – together and separately. The more you understand what she is experiencing, the better supported she will feel. That will speed her recovery.
Having a baby changes things; attention that had gone to partner now goes to pregnancy/baby. we hear little about mental health of partners.
More often told glowing side of parenthood – you will feel instantly bonder and fall madly in love. There are losses associated w becoming a parent. Normal for relationship to change. If she’s been drooled on, spit up on, sucked on all day, she may be touched out and you may feel rejected. Remind yourself its not a personal rejection. You can no longer jump into bed, take off to movies or go out to dinner on a whim.
15-23% of women suffer from mood/anxiety problems during pregnancy. Some come with past/current history and others develop. 1/5 will have postpartum mood or anxiety disorder.
Some partners may have history or be experiencing mood/anxiety disorder during pregnancy. Depression and anxiety disorders (in part. OCD) worsen during times of stress and sleep deprivation.
Can’t tell by looking. When mom is experiencing a disorder, her partner is at increased risk of suffering as well. 10% of dads showed moderate to severe depression 9 months after birth. Paternal mood/anxiety disorders in first 2 months in 25%. Highest rates seen 3-6 months postpartum. When mom is depressed, rate of depression in partner significantly higher -24-50%. If partner has history, this is a high risk factor w or w out depression in mom.
Not all depressed men/women experience extreme sadness. In men, may be seen as irritability, aggression and hostility. May distance themselves, find distractions to avoid family or check out. This contributes to relationship or marital distress. Other common symptoms – falling or staying asleep, appetite changes, racing thoughts or constant worry, lack of joy/pleasure in things that used to be enjoyed. Some feel helpless and hopeless. Having new baby and increased financial burden can contribute to feeling of being trapped. Like having dark glasses on – everything gets filtered/distorted; only negative things get through.
Depression in partners affects childhood behavioral and emotional development. Children 3.5 yrs old found to have problems, boys more than girls. 4 yrs old more likely to be treated for speech, language, and behavioral problems. Associated w psychiatric disorders in children 7 yrs later, in part oppositional defiant/conduct disorders in boys.
Get support! Get educated! Find a professional. Talk to partner, friends, family. Find nonjudgmental support.
Things to Keep in Mind:
What to Say, What Not To Say
Do Not Say:
From a Dad Who’s Been There – for years came home to house w wife in tears, baby crying, house a mess, no dinner. Can’t ask wife about day. He focused on his daughter and kept telling himself he’d be there for her. Slowly his wife recovered and they have the happy home they’ve always wanted. It will get better.
Chapter 5 Siblings, Family and Friends
The more educated you become, the more supportive you can be. Many changes in household after birth of baby. older children will not be expecting mom to be different. Children too young to understand but will notice mom’s behavior not normal. They notice if mom has been crying or yells/gets angry over little things. Stays in bed more, does not have energy to take to park, or does not seem to laugh much lately. Staring blank into space.
Communicating w Children
Peoples reactions to new mom’s depression can critically affect her recovery. Sometimes mom feels too scared to tell partner about feelings, feeling disapproval and rejection.
When women become mothers, even if aren’t depressed, often crave company and approval of other moms. If woman’s mom deceased, extra important to have another woman who can fill that void. Depressed moms need extra reassurance, esp from adult females.
New moms in general sensitive to criticism. Compliment on mothering and avoid negative comments, esp related to parenting.
Things to Keep in Mind:
What to Say, What Not to Say
Do Not Say:
What You Can Do To Help
Chapter 6 – Health Practitioners
Important not to underreact or overreact to these women’s symptoms. Treat them as matter-of-factly as any other common perinatal experience such as gestational diabetes.
Warning sings of distress not always obvious for a variety of reasons – shame, guilt or fear of judgment may cause woman to hide her feelings. She may present more socially acceptable complaints such as fatigue, headache, marital problems or a fussy baby. Just bc she is smiling or well groomed, don’t assume she feels good. Although risk factors to help predict PMADs, no particular type of person who becomes ill. Standardized screening improves detection.
She might feel accused of being a bad mom w questions and become defensive. Once she understands no shame should be attached to issues of mental health, she’ll accept info.
Culture and Language – reactions to disorders vary among cultures. Where shame is a great personal threat, women may be more reluctant to discuss symptoms and need reassurance.
Sociocultural factors and literacy levels should be considered. Coping styles differ across cultures. Will affect woman’s response to recommendations regarding treatment methods.
Do not assume an educated woman will automatically understand her condition better than a woman w less education.
What to Say, What Not to Say:
Do Not Say:
Screening – use standardized screening surveys specifically designed for perinatal use such as PPDS and EPDS (Postpartum Depression Screening Scale; Edinburgh Postnatal Depression Scale). PHQ-9 (Patient Health Questionnaire) more widely used and many familiar w it.
Prenatal Screening – if time too limited to use screening questionnaires, questions in risk assessment should be asked. At minimum, questions relating to personal/family history of mental illness, previous postpartum mood disorder and severe premenstrual mood changes should be asked (those w asterisk below).
Prepregnancy and Pregnancy Risk Assessment –
If she answers yes to any questions, she’s an increased risk of perinatal mood/anxiety disorder
Postpartum Screening – EPDS developed in 1987 by Dr. John Cox. 10 question self-report screening tool translated into many languages and used all over world. Effective w teens and dads. Can be found on many internet sites. Also shortened 3 question version.
PDSS developed in 2002 – accurately screens both postpartum depression and anxiety. Can use short or long format. Elevated score in particular symptom indicates greater amt of distress than avg. Symptom scales are Sleeping/Eating Disturbances, Anxiety/Insecurity, Emotional Lability (mood swings), Mental Confusion, Loss of Self, Guilt/Shame, Suicidal Thoughts.
PDSS more likely to identify women w symptoms of sleep disturbance, mental confusion and axiety. Refer her to perinatal specialist.
PHQ9 originally designed for family practice not more widely used in perinatal settings.
Postpartum Risk Assessment – those not screened prenatally, ask first 6 questions from PrePregnancy and Pregnancy Risk Assessment as well
Warning Signs in Mom:
Warning Signs in Baby
Questions to Ask:
Psychotherapists, Psychologists or Social Workers – critical element and being a part of her preconception planning and perinatal safety net. Be familiar w risk factors and most current info on how to reduce risk factors. Be familiar w research regarding relapse and current medication recommendations. Help monitor symptoms. Have info in resources section available.
Primary Care Providers – evaluate pre-pregnancy risk. Have info from resources available as well as referrals to local professionals trained in perinatal mood and anxiety disorders. Woman taking psychotropic medications who are pregnant/planning a pregnancy should be encouraged to consult psychiatrist specializing in perinatal disorders in order to determine whether to continue meds. Women on medication for bipolar disorder or psychosis should be referred to perinatal psychiatrist to develop medication plan. Need careful monitoring throughout pregnancy and postpartum.
Pediatricians and Neonatologists – well documented that mental health of parents has tremendous impact on development of children in home. If mom has been on meds during pregnancy, reassure parents that baby is fine and not experiencing any withdrawal or neonatal complications. Support mom if she wishes to feed her baby breast milk while taking antidepressant. Mothers w depression or anxiety nurse or pump for shorter durations; they give up. Moms on medications feed their babies breast milk for longer duration then those untreated.
OB/GYNs, Midwives and Other Women’s Healthcare Providers – many women will not be forthcoming w negative feelings or concerns unless specifically asked. Women w history of neonatal loss need monitoring and extra support.
Psychiatrists – research findings and recommendations about medications in pregnancy and lactation constantly changing. Make sure give patients name of psychotherapist trained in PMADs. Essential to have list of local resources and referrals.
Birth Doulas – studies show use of doula contributes to reduction of postpartum depression. Can screen prenatally/watch for early warning signs of emotional problems. If when doing prepregnancy and pregnancy risk assessment, you discover woman has suffered previous traumatic delivery or childhood sexual abuse, she may experience flashbacks during birth.
Postpartum Doulas and Visiting Nurses – can observe home and social environments of mom, which can given crucial info about her well-being and that of family unit. If notice lack of partner support or signs of marital conflict, she’s at greater risk for PMAD. If house unusually neat/clean, want to find out who is doing housework; if she’s obsessively cleaning or awake in middle of night vacuuming, this is not normal.
Lactation Consultants – may be first professional to see the mom/baby during initial postpartum weeks. Can observe/listen for potential emotional problems. Postpartum moms listen carefully to what you advise and are quite trusting of you.
Childbirth Educators – so often heard “why didn’t we learn about this during pregnancy?” have a responsibility and opportunity to educate couples about perinatal mental illness.
New Parent Group Leaders – statistically 1-2/10 will have PMAD. Rarely will woman disclose since she most likely will be experiencing guilt and shame. Will be aching for someone to open door and give her permission to express how she’s really feeling. If partners present, ask them how they themselves are doing. Dads/partners may have preexisting mood or anxiety disorders. Stress of pregnancy can also worsen symptoms. Dads and partners need and deserve support too.
Adjunct Professionals – many others who touch lives of pregnant and postpartum women. Physical therapists, instructors in prenatal and postpartum exercise should mention possibility.
Chapter 7 – Treatment
Why is Treatment Necessary?
Research about perinatal mood and anxiety disorders has taught us new things. In past, ppl thought didn’t exist, or if they did, women didn’t need treatment and should suffer through them, and that they would eventually recover on their own. Now know that’s incorrect. Untreated illness in pregnancy will most likely lead to postpartum illness. At 7 months postpartum, depression continues in 25-50% of women who aren’t treated. They may go away after a time, but increase likelihood of another episodes or episodes later in life. The brain is at least as important as any other part of the body.
Untreated mood/anxiety illness in pregnancy associated w:
Moms who have untreated postpartum illness may:
Treating parents not always enough to repair mother-child relationship; activities that involve physical touch (infant massage) shown to be helpful.
Untreated illness affects whole family. You need and deserve to be well!
Research – doesn’t always tell whole story
Prevention – ultimate goal. Study – Women at high risk offered extended postpartum hospital stay (5 days) in private room. Babies slept in nursery at night so moms could sleep w out interruption. Less likely to suffer from PPD and for those who did, it was milder.
Psychotherapy can be used effectively for prevention.
Women at high risk who started sertraline (Zoloft) w in 15 hrs of delivery reduced incidence.
All new moms need wellness plan bc all moms need nurturing. Need uninterrupted sleep, food/eating arrangements, breaks away from baby during week.
Treatment Guidelines – pregnant and postpartum women need to be as symptom-free as possible. Pre-conception it may be reasonable to find/change medication that’s low risk in pregnancy and of low concentration in breast milk. If woman discovers she is pregnant and is doing well on meds, fetus ahs been exposed. Risk of illness due to changing meds is high. Risk of med must always be weighed against risks of illness – on mom, fetus, infant and family. Always rule out bipolar disorder before giving antidepressants. Goal of treatment is that woman feels like herself again as quickly as possible.
Psychotherapy – talk therapy. Need perinatal mental healthcare provider – training in general population not enough. Should be familiar w local resources as well as those on web and in print. Can be done w individual, couple, family members or group setting.
Treatment involves crisis mgmt. Treatments most effective are short-term or brief psychotherapies focused on symptom reduction and improvement in functioning. Not time for long-term psychodynamic or psychoanalytic therapy. 2 models studies and effective for prevention/treatment – Interpersonal Psychotherapy (IPT) and Cognitive-Behavioral Therapy (CBT). Therapist plays active role facilitating and directing discussion and teaching problem-solving skills. Psychotherapy has been shown to have long-lasting positive impact.
IPT works to help clients address role changes, transitions and conflicts and loss and grief and build interpersonal skills as well as support resources.
CBT works by helping monitor and change thinking and behavior through education and skill building; helps clients develop new ways to think/evaluate life experiences and teaches practical skills to use immediately.
When woman unable to process/apply psychotherapeutic strategies, medication often indicated.
Social Support – provides nonjudgmental empathetic emotional support, feedback, active listening and info. Creates environment where women see they are not alone or to blame. Often uses specially trained women who have recovered. Includes support groups, telephone support, home visitors, email and online groups, faith communities and family/friends.
A variety effective in helping women recover. Contact Postpartum Support International.
Complementary and Alternative Therapies – studies being conducted on treatment that doesn’t involve meds. Therapeutic effect of massage beginning to emerge. Morning bright light therapy (natural sunlight or special light boxes) already being used either as alternative or in addition to meds. Effectiveness of omega-3 essential fatty acids DHA and EPA in prevention & treatment apparent. APA recommends 1 gm EPA plus DHA daily. From fish oil, not plant sources, which are different. Recommended to enhance, but not replace, standard treatment. Talk w care provider before taking supplements of any kind. If take omega-3s while nursing, baby’s neurological development may also be enhanced (these lipophilic acids have been added to many baby formulas).
~5% of pregnant women report using marijuana; detectable in placenta, amniotic fluid and fetus. Found to be associated w poor fetal growth in mid/late pregnancy, w effects on low birth weight being most noticeable. Even w legal medical marijuana, no safe dose has been established. Increasing concerns about long-term neurodevelopment, behavioral and possibly even metabolic consequences.
Marijuana also found in breast milk and may be higher than that found in mom’s blood. May affect brain development in children under 1. If using on regular basis, talk to care provider; there are other well-research ways to treat nausea, depression and anxiety.
A new nonmedication treatment is repetitive transcranial magnetic stimulation (TMS). Uses noninvasive brain stimulation and is showing great promise in treatment of major depression. Approved by FDA for treatment of major depressive disorder in adults and a few small studies have been done on depressed pregnant women. Depression was reduced significantly w/in 3 weeks and no ill effects were seen on mom/baby. not yet widely available. May be effective therapy for women who choose not to go on meds.
Acupuncture might be helpful treatment for treating depression in pregnancy. Some insurance companies will pay for alternative treatment.
Use whatever is known to be safe and works.
21% of pregnant women smoke, 19% use alcohol and 6% use illegal drugs as a way to alter moods.
Herbs can be wonderful, but also dangerous. Poisonous mushrooms are natural and digitalis, the heart medicine, is from a plant. Little research has been done on effectiveness of herbs during pregnant/nursing.
Very few studies on St. John’s wort during pregnancy or in breast milk. No research that shows its an effective treatment for anxiety or OCD. St. John’s wort interacts w a # of meds, including meds for heart disease, depression, seizures, certain cancers and birth control (makes less effective). You can’t tell quality/quantity of active ingredient in each dose.
No gov. regulation on herbal remedies and measured amts of active ingredients varied considerably from those claimed on labels – 0-109% for capsules and 31-80% for tablets. Like an antidepressant, SAMe, St. John’s wort and bright light therapy can all trigger hypomania or mania in women w bipolar illness.
Placenta – articles claim prevents postpartum blues and possible protects against PPD and anxiety. Part of cultural rituals around the world. No one has measured emotional health of women or animals that eat placenta. As of mid 2015, still no studies on effectiveness or benefits of placenta ingestion and mood in humans. 30% of people will feel better when given placebo.
For many years, FDA used confusing and misleading rating scale for safety labeling of meds during pregnancy – A, B, C, D, or X. meds w less research often labeled as safer, while meds that had more research sometimes labeled less safe. As of 6/2015, that system will be discarded and replaced by more informative safety labeling of meds used during pregnancy and breastfeeding.
Immediate goal is to alleviate suffering as quickly as possible. Start meds at low dosage and increased as rapidly as possible to whatever right dosage is for that woman. Undertreating can lead to chronic problems/suffering and increases risk of relapse.
All treatment must be individualized. See psychiatrist w expertise in perinatal illness. If one provider or medication/treatment doesn’t work or feel like a good fit, try another. Goal is to feel like you again. Feeling OK or better is not good enough.
Pregnancy and Medication – use of meds in pregnancy has evolved in past few years. Shift has focused on harmful effects on fetus when maternal mental illness untreated. All normal pregnancies have 3-5% of birth defect. Pregnancy causes changes in metabolism and blood volume; higher doses may be required to achieve adequate reduction in symptoms. In order to remain symptom free, 2/3 of women needed increase in dosage at 6.5 months pregnant.
American Journal of Ob/Gyn stated when psychiatric condition requires meds, benefits of med far outweigh potential minimal risks of medication. American Journal of Psychiatry published article stating that not prescribing antidepressants to woman who is depressed or likely to become ill again during pregnant may cause more risks to mom/fetus than risks of exposure to meds.
Commonly used prescription meds for perinatal/anxiety disorders:
Postpartum – birth of baby may bring about need to change med treatment plan. While growing fetus exposed to higher doses of maternal meds, a few medications can be problematic for infants receiving breast milk. Some women choose to restart or begin meds after birth. Most found in low levels in breast milk and most considered very low risk to infant.
Meds & Breast Milk – for some women, breast milk may feel like only positive thing they have to offer. Most meds found in very low amts in breast milk and babies. A few are not recommended/must be used w caution.
Medical Protocols – treatments should be followed in sequence. Effective for depression, psychosis, OCD, anxiety and panic. SSRIs are first choice in treatment of OCD, anxiety and panic. Use lowdose antianxiety or antipsychotic meds on short term basis for anxiety and panic. Often high doses SSRIs need for longer periods of time.
Pregnancy (including 1st trimester)
Prevention of Postpartum Depression in Women w History of Depression, Anxiety, Other Mood Disorder or Prior Postpartum Illness
Websites and Helplines:
Resources for Neonatal Loss