Before a baby even enters the world, momhood comes with a myriad of decisions from the get-go. Home birth or hospital birth? Doula or no doula? Find out the sex of the baby or keep it a surprise? Determining these answers opens the floodgates to the opinions of outsiders, most of whom can’t predict what’s best for you and your baby unless they’re a doctor.
One issue on which people are particularly eager to weigh in is mental health, but if someone has never been through pregnancy anxiety or postpartum depression, they are likely to brush these conditions aside, worrying solely about the health of the baby. They may suggest prenatal yoga, essential oils, and other natural de-stressors (which are great, too!), but they won’t be as quick to suggest psychiatric medications when those options don’t work out.
Pregnancy aside, people are generally afraid to take psychiatric medications because of things like stigma and possible side-effects. The most obvious reason, though, for pregnant women to eschew medication is because they don’t want to hurt their baby or chances of getting pregnant, even if that means harming themselves. People often assume psychiatric medication is part of the laundry list of foods and products women shouldn’t use or ingest while pregnant.
Asking the Experts
When I went to see a psychiatrist, the first thing we discussed was the safety of my medication. “It’s so safe,” he said, “that you can continue taking it if you’re trying to conceive and possibly while you’re pregnant.”
Finding the right medication and dosage while you’re pregnant has its difficulties. “The more pregnant you are, the thicker your blood is and the slower it takes for the medication to get to your brain,” Ruthy Zalta, MHC -LP, says.
According to Dr. Robert Grossman, M.D., mothers should be concerned with what they put in their bodies during pregnancy, as some medications, psychiatric included, are clearly known to cause birth defects or complications during pregnancy. “On the other hand, if someone needs to be on psychiatric medications, safe medications for pregnancy need to be found. There is emerging evidence that if the mother has severe psychiatric symptoms during pregnancy, it can then put that baby at increased risk for depression or anxiety conditions when they grow up.”
Felice Gersh, M.D. OB-GYN founder and director of the Integrative Medical Group of Irvine, and author of PCOS SOS agrees. “The risk-benefit ratio must be considered. Untreated psychiatric conditions themselves have a serious impact on the baby and so the medications are a better option than an untreated psychiatric illness.”
So, how does one find the right prescription? The FDA implemented B, C, and D labels on pharmaceuticals that assess whether or not a medication is safe to use during pregnancy. Read about each category according to the U.S. Department of Health and Human Services, below.
Category A: No Risk Drugs
“Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters). For all practical purposes, there are no category A drugs.”
Category B: Safe Drugs
“Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women.” According to Dr. Grossman, categories B and C are relatively safe and should be used if there is a clinical need. These medications include commonly used medication like prenatal vitamins, acetaminophen (Tylenol), and Amoxicillin (antibiotics for bacterial infections). Psychiatric drugs include antidepressants like Wellbutrin and Ludiomil, and Clozapine to treat schizophrenia and schizoaffective disorder.
Category C: Relatively Safe Drugs
“Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.” Since risk cannot be entirely ruled out, this is where things get tricky. It’s up to you and your doctor to decide whether or not the reward is greater than the risk. These medications include Adderall (ADD/ADHD), Zetraline (Zoloft), Luvox (Fluvoxamine), Escicitalopram (Lexapro), Fluoxetine (Prozac), most antipsychotics and stimulants. SSRIs, like Lexapro, Prozac, Zoloft, and Fluvoxamine, are the most commonly used drugs women use during pregnancy because it directly treats depression, which in turn can treat anxiety disorders.
“We can say with confidence that antidepressants don’t cause birth defects,” says Lauren Osborne, M.D., assistant director of the Johns Hopkins Women’s Mood Disorders Center. Even though they don’t cause birth defects, they can still affect your baby. Approximately 30 percent of newborns will experience neonatal adaptation syndrome, which can cause increased jitteriness, irritability, and difficulty breathing. It’s not clear to doctors whether this outcome is due to the baby’s withdrawal from the SSRI after birth or exposure to the drug itself before birth. However, typical NAS symptoms are mild and generally resolved within 2 to 3 weeks of delivery.
Doris, age 29, took 50mg of Setraline for her severe anxiety. “Even whatever slight risk there may be, to have an anxious or depressed woman not treated over the course of her pregnancy, is far more dangerous,” she says.
Category D: At-Risk Drugs
“There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.” This category of medications is not advised, but if your mental illness is extreme, a doctor may prescribe these medications which are mostly Benzodiazepines like Xanax, Klonopin, and Valium.
Studies have shown that Lithium can raise the risk of cardiac anomalies, particularly of Ebstein’s anomaly (albeit, with close monitoring, it can be safely used). Ruthy, age 25, was first on Lexapro because she felt that was the most well-studied medication in relation to pregnancy, but when she started experiencing severe panic attacks and suicidal thoughts, her doctor prescribed her Klonopin. “I was taking Klonopin morning and night and then I got on Zoloft, and it finally gave me balance.” Her baby girl was born healthy.
Because taking psychiatric medication during pregnancy is not one size fits all, you should consult a reproductive psychiatrist or a doctor who values your mental health above anything else, about what the best decision is for you and your baby.