Are Medications “Optional” During Pregnancy?

This is an incredibly interesting post from MGH. The author, Helen Kim, MD, reflects on the dilemma of medicating psychiatric symptoms during pregnancy. I hope you take the time to read it. She does an amazing job simplifying an extremely complex situation. She refers to the notion that we have somehow made taking psychotropic medication “optional” for a pregnant woman, when, in fact, it should not be during certain circumstances.

Clinicians and moms should both take the time to read this. I would love to hear what you think about it.

It’s complicated, to be sure. And it seems that everyone is on the same page, for the most part. Everyone agrees that we should postpone the use of medication during pregnancy whenever possible or whenever symptoms are not severe enough to warrant it. But that’s where it gets murky. And that’s when judgement are made: “It would be better, if…”., “you will feel better, if….”, “it is safe, under these specific circumstances,” “You will be fine, if…”

The problem is, conditions vary. Individuals vary. Environmental stressors vary. Predispositions and risk factors vary. Expert perspectives vary.

It can feel as if making the decision to medicate during pregnancy is a risk too great to take.

But many of us know that the risk of not treating a significant depressive episode can also lead to less than favorable outcomes. Marriages are strained, symptoms can exacerbate, pregnancies are compromised. These, and other negative events can lead to devastating consequences.

Healthcare providers and women who are pregnant, or considering pregnancy, who are at risk for depression, should carefully review the literature so they can, in collaboration with partners and other involved healthcare practitioners, agree to a treatment plan that reduces symptoms and increases the probability of a successful experience all around.


3 Responses to Are Medications “Optional” During Pregnancy?

  1. I’ve always approached this subject with using functionality as a yard stick. If a pregnant woman is so depressed or anxious that she’s having trouble leading day to day life, it seems like a no-brainier to medicate. But of course, pregnant women are usually terrified to take meds. So…it indeed is a toughie.

  2. I find this article interesting, though I was expecting more information. As a PPD/PPA survivor, I am trying to conceive another child. I have discussed at length with my Psychiatrist and OB/GYN about the need to continue my medication. During my first pregnancy, I quit all my meds, as most MD’s like you to do. But, I put myself at a higher risk for PPD. Yes, I suffered. I was advised not to have any other children. But, with therapy and medication, I am at a place that I feel comfortable with my decision. I have the full support of both of my MDs. Anti-depressants are getting a lot of negative though, because, “there is an increased risk for heart related symptoms in the unborn”. Did you know this was on mice and in very high doses? The risk, in my opinion, far out ways a lab test on mice. More information needs to be presented in a fair and balanced way.

  3. Stacey, yes, functionality is one of the best measurements, indeed. Which, of course, varies from woman to woman, even if they were to have similar symptoms.

    And Brooke, you raise an excellent point. Sometimes, the research can be misleading and even though science may lean in one direction or refer to statistical probabilities, we know that nothing is absolute and statistics do not always translate well in the real world. 😉

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