Medication & Pregnancy

Before you read further: This article is intended to be informational and educational- This is not medical advice and should not be used to replace healthcare with an informed medical prescriber. We hope this information will facilitate a productive conversation with your provider. Each year all healthcare providers attend continuing education in a variety of topics, not all OBGYNs and midwives have advanced training in reproductive mental health/reproductive psychiatry. If your provider is uncomfortable managing medications that help you stay well through a pregnancy [and/or lactation!], they can collaborate with a specialist who does have training and expertise in this area- Your medical provider can use either Access for Moms [CT] or the PSI Perinatal Psychiatry Consult Line linked at the bottom of this page- they are FREE expert resources!

We believe that:

You deserve to feel well.

You deserve an informed discussion that includes exploring both the pros and cons of using and not using medication as a tool for your mental health.

You deserve a provider who considers your wellness from head to toe- your mental health is part of your overall health!

You deserve adequate time with a provider to discuss your symptoms, your concerns, and what steps you want to take to address the whole picture of your health and wellness.

If you do start medication you deserve a timely follow up so you don’t feel cast off to sea- it’s reasonable to expect to see someone on your healthcare team a little more frequently when starting a medication and finding the right dose.

If you are already on a medication that works well for you, it’s often the safest for all to stay on that medication, Dr. Lauren Osborne at Johns Hopkins speaks to that topic in this great article, Antidepressants and Pregnancy: Tips from an Expert

Therapists do not prescribe medication but we have some training in this topic, we can help you prepare for a visit and plan some thoughtful questions to ask a prescriber [such as your OBGYN, midwife, a family medicine or primary care provider]

Medication & Pregnancy

It’s very common for people trying to become pregnant, who are pregnant, or those who are lactating to be concerned about exposures- what am I putting into my body? How does that impact this other [future] person? We take in powerful messaging around the shoulds and should nots of pregnancy… it can be overwhelming and incredibly anxiety-provoking! You should take a prenatal, you should not eat deli meat or sushi, you should drink plenty of water, you should not drink coffee [or too much!], avoid this, run from that- it’s so stressful! One topic that comes up often in our therapy work is the topic of medication, interestingly it’s not ever blood pressure medication clients are struggling with emotionally, not heart medication, or IBS medication, or insulin-regulating medication, nope- no one comes in panicked about those! I’m sure it’s not surprising that the medications folks come in worried about, unable to get clear answers about tends to be mental health medication. I’m not a prescriber, but I am here to tell you that your mind and brain are just as important as your blood pressure, your heart, your gut, and your pancreas. If anything I’d argue that your mental health impacts all of them because how you are able to function impacts how consistently you take those other possible medications, or take care of those other body systems. Your mental health matters to you and anyone you may be nurturing/growing, too!

Reproductive psychiatry is a sub-specialty in the medical discipline of psychiatry, which specializes in prescription of mental health medications- most psychiatrists do not provide therapy so it’s a complement [ideally!] to talk therapy with a perinatal therapist. Since the development of antidepressants and anti-anxiety medications, the research has consistently supported that when medication is necessary, medication in combination with therapy is the most effective treatment. Not everyone in therapy needs medication, but if your symptoms are significantly disrupting your functioning and quality of life, enjoyment, and how you like to take care of yourself and just be in the world, therapy will probably help, too! If you want to read more about the neuroscience on that topic, feel free to check out this article by Dr. Rebecca Price, Associate Professor of Psychiatry and Psychology, University of Pittsburgh titled Medication can help you make the most of therapy − a psychologist and neuroscientist explains how.

So we know that medication and therapy can each make the other more helpful and effective, but what about in pregnancy and postpartum, our specialty here at Growing Well Counseling?

When I started Growing Well Counseling nearly a decade ago the sort of conservative/cautious consensus was “it depends, it might help pregnancy out comes, we don’t think it’s harmful to baby often…” more tentativeness than we have today and no surprise, not all of medicine has caught up with the growing reassurances around anxiety and depression medication [and some mood stabilizers, too!]. We have also learned more about the risks of not treating a mental health condition in pregnancy- when someone does not treat mental health symptoms their whole body has more cortisol, which does pass to baby, and increases inflammation in the whole body. Inflammation is connected to hypertension [and you guessed it, pre-eclampsia], pre-term birth, low birth weight, and a host of other complications… there are many reasons we do not want extra inflammation in a pregnancy. Does that mean everyone who has stress anxiety or low mood needs medication in pregnancy? Nope, absolutely not. Does that mean if you have something upsetting or traumatic happen in a pregnancy you’re doomed? Absolutely not. Also, side note, just like blood pressure, none of this is your fault. You are not to blame.

Part of this decision-making process includes assessing what you CAN control, accepting what you CANNOT control, and doing what you can about the whole picture. You may not be able to control that you have trauma or depression or anxiety, but you can decide what to do about it- you can start with therapy, maybe some evidence-based complementary options like increasing your DHA/EPA (fish oil/Omegas, but more about that on another page!), and when things are harder than they should be, medication could be an appropriate option, too! It’s not a magic cure all, but it’s a tool to add to your tool box.

It’s important to note that many of the concerns that medical researchers had earlier on have dissipated with ongoing research. A 2023 study at Harvard offered great reassurance about health and well-being long-term observations of children exposed to medication in pregnancy [through age 14]. You can read more about the risks of not treating perinatal mood and anxiety disorders on offspring in this Mass General Center for Womens Mental Health article, What Has a Greater Effect on Children’s Behavior: Prenatal Exposure to Antidepressants or Maternal Depression?

At Growing Well Counseling we of course believe that talk therapy can be incredibly helpful for addressing symptoms of depression, anxiety, trauma and grief around reproduction, we also support you using the tools you need to in order to feel well, and it’s okay if that includes medication.

If you want to learn more about a specific medication or exposure, you can look it up on the Mother To Baby website on pregnancy and lactation exposures. You can call, text, or email to speak with their information specialists and Genetic Counselors

Some of our Favorite Resources on Medication:

Access Mental Health for Moms (CT-based) https://www.accessmhct.com/moms/

Access MH for Moms provides resources and consultation- prescribers (including OBGYNs and midwives) can call for medication advice and referrals.

Postpartum Support International (PSI) Perinatal Psychiatry Consult Line- A free service for prescribers to consult with a reproductive psychiatry specialist
https://www.postpartum.net/professionals/perinatal-psychiatric-consult-line/

Mass General (MGH) Center for Women’s Mental Health has so many wonderful articles on their site https://womensmentalhealth.org/posts/category/medications-and-pregnancy/

Please don’t hesitate to talk further with your therapist about medications, preparing to have a conversation with your providers, partner, and those who care about you and baby.