Pharmacologic Treatments for Perinatal Depression/ Anxiety
Medications are used by many pregnant and breastfeeding women experiencing perinatal depression and anxiety. Though there are certain known risks, research over the last twenty years suggests that the benefits of taking medication outweigh the risks of not treating the illness. For example, effects of maternal depression or anxiety can be more harmful to the fetus or the infant than the effects of medication that cross the placenta during pregnancy or transfer via breast milk. There is an abundance of research showing that untreated maternal depression can have both short and long term negative consequences both for the mother and the child.
Every woman who considers taking medication for depression and/or anxiety while pregnant or breastfeeding should consult a health care provider who is well informed about the very latest research. She also should be empowered to make the decision to take medication or not on her own and with her family. The decision to take medication or not, or to continue or discontinue nursing must be made by the patient, following a cost/benefit analysis between provider and family. This results in an empowering decision by the mother and reduces the likelihood of trauma around unwanted cessation of nursing and/or medication which has helped her in the past. The evidence suggests that rates of relapse are very high when women discontinue their medication during pregnancy or while nursing. Abrupt discontinuation of medication is generally contraindicated as is abrupt weaning. Women may be encouraged to pump while making this decision. If a provider suggests that any medication for emotional health is absolutely not compatible with pregnancy or nursing, she should ask for the evidence to support this suggestion and/or ask for a second opinion. Below is a list of resources for both clients and health care providers for the safety of medication use in pregnancy and during breastfeeding.
- The Perinatal Mental Health Consultation Service at the University of Illinois provides free clinical consultation to providers regarding all aspects of diagnosis and treatment, including the use of psychotropic medications, during pregnancy and lactation. They can be reached via their website, psych.uic.edu/research/perinatalmentalhealth/ or at 1-800-573-6121.
- Thomas Hale at Texas Tech University is a world reknown expert on lactation and medication and is the author of Medications and Mothers’ Milk: www.ibreastfeeding.com. His other website, http://neonatal.ttuhsc.edu/lact/, provides an open forum for healthcare providers only, and has a searchable database on this subject.
- The book Postpartum Mood and Anxiety Disorders: A clinician’s guide by Cheryl Tatano Beck and Jeanne Driscoll (2006) includes a medication guide summarizing the safety of a variety of psychotropic medications used during lactation. http://www.amazon.com/Postpartum-Mood-Anxiety-Disorders-Guide/dp/0763716499