Anne-Marie Lindsay

One year ago, my partner and I decided to have a child. Because I have suffered from anxiety and depression for as long as I can remember, and have managed my conditions with medication for over five years, I knew I had to educate myself before we started trying to conceive. I spent many months trying to “taper” my medications, but it became clear that I was not going to function without them. I was going to therapy twice a week, but even so, I began having such frequent panic attacks that leaving the house became terrifying, and I was fired from a much-loved job for not showing up often enough. It was bad. I knew I could never function as a mother, feeling that way. My tedious journey down the rabbit hole and into the world of perinatal mental health has finally produced a decision that my partner and I feel confident will promote the best possible health for me and any fetus I eventually carry, as well as our family as a whole.

Reliable Sources of Information about Medication and Pregnancy

These are shockingly difficult to find. If you can find one, I highly recommend consulting with a perinatal mental health expert — a psychiatrist who specializes in treating women who want to become pregnant, are pregnant, or have had children. The specialist we consulted was expensive ($400 an hour was our discounted rate), and our insurance only reimbursed us later. Even if you think you cannot afford it, call a women’s mental health center and tell them about your situation. They are remarkable people who tackle perhaps the most difficult aspect of psychiatry; they want to help.

Why is it so difficult to treat a pregnant woman with, for example, a severe anxiety disorder? Because there is no clear, clean, scientific data about the safety of medication during pregnancy. By this, I mean that it is considered unethical to run a drug trial on pregnant women in order to find out what will harm a fetus. The only studies scientists can do collect what is called observational data. They ask women to tell them about any medications they took during pregnancy and about the health of their babies. One such study recently found a link between SSRI (a common class of antidepressants, including Prozac) use during pregnancy and an increased risk of pulmonary hypertension in infants. We cannot know from this study, however, whether the SSRI use caused the increased rates of this serious illness. Because we cannot measure depression with a blood test, we cannot know how many women in these studies were successfully treated. They may have both taken SSRIs and also have experienced major depression. As KJ Dell’Antonia explains in the New York Times parenting blog The Motherlode,

“… other research suggests that untreated depression during pregnancy has its own risks, including pre-term birth and low birth weight. Given that, how should a pregnant woman and her doctor weigh the competing risks? The answer to that may depend on whom you’re talking to.”

Dell’Antonia talks to a Dr. Ariela Frieder, psychiatrist at the Montefiore Medical Center, about using research to make a decision. She says that,

“the problem [with research] is always that you cannot separate the risks of the severe depression itself with the risks of the medication. And the risks here are still small. Women who have lived with severe depression know how hard it is to live with.”

Do you trust the animal studies that show few problems when pregnant rabbits and rats are given 150 times the dose of whatever you’re taking? My OB does. Do you sift through the observational data and mull the one or two cases of clef-lip and palate that point to a potential risk for your future child? My specialist psychiatrist does. The scariest part of this journey may be that the answer to any and all of these questions is: it’s up to you. I have so often wished for a definitive answer. All I ever hear, even from the expert is,

“So, now that you know [insert information here] what do you think you want to do?”

Ms. Dell’Antonia discovers precisely what I learned after talking to experts and reading material similar to the experts I talked to and the material I read. She concludes her piece with this statement from Dr. Kimberly Yonkers, perhaps the most famous researcher in this field:

“There’s not a one-size-fits-all answer, … that advice still stands. No generalizations apply. Treatment decisions must be made on a case-by-case basis. A case-by-case basis that’s a new struggle for every patient, every time.”

What You Can Do

You may end up disagreeing with your OB or disobeying a direct order from your general practitioner. You may have to find a new psychiatrist. But you’re the one who has to live with your decision, so get informed and do the best you can. Then, assemble a team of professionals and loved ones who support that decision. No matter what.

My psychiatrist said at the end of our first meeting,

“You’ll be at a higher risk for some problems, but that’s not the same as a high risk. It really remains quite low, and they’re risks that already exist for the general population. The problem is, if you are the family with the child who has developed a birth defect or other problem, those statistics disappear. It won’t matter that the risk was small. You should ask yourselves now, ‘If something goes wrong, can we handle knowing that our decision may have contributed to that?’”

My husband and I feel strongly that we will be able to remember that there is always a risk that something will go wrong. We will remind each other that something could happen no matter how perfect a pregnancy I have. We will remind each other that, for us, un-medicated depression and anxiety pose a greater risk to the health and safety of our family than any risk posed by my medication.

Resources for Patients

The Organization of Teratology Information Specialists — This is a wonderful organization devoted to helping women make educated decisions about what we put in our bodies during pregnancy. There is a toll-free number that you can call to talk to an expert, for free, about your medication and any risks it may post to a developing fetus. That number is: (866) 626-OTIS, or (866) 626-6847. Note: If you are pregnant and taking medication, please participate in one of their studies as well to do your part in helping gather more information.

Motherisk – Information on specific medications.

The Food & Drug Administration For Women – section for information specific to women.

Emory University’s Women’s Mental Health Program

Columbia University, The Women’s Program

UCLA’s Mood Disorder Research Program

Massachusetts General Hospital’s Women’s Mental Health Program

Pregnant on Prozac — by Dr. Shoshana Felman. I found this book extremely helpful, which was a relief because it is the only book that thoroughly covers how to plan for pregnancy when you struggle with mental illness. My mother found the copy I sent her extremely helpful, as well, in trying to understand my journey. I even emailed Dr. Felman and received a response to my question within two days.

Depression in Pregnancy – article from Dr. Hale’s Infant Risk Center at Texas Tech University Health Sciences Center.

For Health Care Professionals

ReproTox is a database available by subscription to health care providers. Each article contains a summary of all available scientific data on any given medication or potential teratogen (chemical potentially toxic to fetus). My psychiatrist and I have found its articles extremely helpful!

MommyMeds smartphone app from the Infant Risk Center

Anne-Marie Lindsey

Anne-Marie is a child care provider and mental health blogger. After attending Barnard College (‘07) in New York City, she spent a few years as a graduate student at the City University of New York Graduate Center. When her slow path towards a PhD in English literature hit a brick wall called Unhappy, she realized that caring for children, then a part-time job, was the career for her. She is married to her best friend and the kindest man she has ever met. They live in New Haven, CT with their dog, and they hope to add a child to their family before the end of 2012.

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