Navigating Mental Health Medications During Pregnancy and Breastfeeding

In Pregnancy

People often have the wrong conversation when it comes to taking medications in pregnancy and breastfeeding. Often we are only discussing the risks associated with medication but forget to consider the risks associate with untreated mental illness in pregnancy. 

Take depression for example. Untreated depression can absolutely affect the health of both the person carrying the pregnancy and the developing baby. Studies show an increased risk of both preterm delivery and preeclampsia with depression in pregnancy. Depression can also affect your appetite and ability to care for yourself fully. It can be hard to maintain a healthy pregnancy if you're already struggling to take care of yourself. 

It is a very different conversation when we compare the risks of untreated depression in pregnancy compared to medications in pregnancy. Let's look at sertraline (Zoloft) which is a medication commonly prescribed for depression. People have been after antidepressants in pregnancy for years and have yet to really show any good evidence that it causes harm. 25,000 cases of people taking sertraline while pregnant have been examined with most studies showing no increased risk of birth defects. While this often gets interpreted as an unknown risk, we can see that if we compare it to a known risk of depression in pregnancy it becomes a different conversation. 

There are some mental health medications that have been shown to have a known risk in pregnancy. For example, depakote (a mood stabilizer) can cause a birth defect known as neural tube defects. Lithium (a mood stabilizer) can carry some risks to the baby's heart. Due to these risks, people often abruptly stop mental health medication when they learn they are pregnant. It is always important to have a conversation with your doctor to understand the risks. Make sure you also ask your doctor about the risks associated with not taking any medication in pregnancy. There are often safe alternatives that can help you maintain stability and also maintain the health of yourself and the baby. 

People often expect perfection from women in pregnancy. They expect women to not have any medical needs. This is absurd. You also regularly see defensive medicine practiced where people would rather not have the liability and so they don't give pregnant people the care they deserve. A healthy parent = a healthy baby. Please get the mental health care you deserve. 

In Breastfeeding

Essentially all of the same priciples from above apply in the case of breastfeeding. The body is incredibly skilled at filtering out most medications for breastfeeding. Often, even when there is a medication detected in the breastmilk, it is in minute doses. Of course, this is not always the case so it's good to understand the risks and make an educated decision. 

Resources

There are a few really helpful resources when it comes to navigating these decisions. 

Mothertobaby.org is a great website that offers summaries of the risks associated with both pregnancy and breastfeeding for individual medications. 

E-lactancia is a similarly great website for risks associated with breastfeeding. This one is available in both english and spanish and also lists a number of herbal medications and supplements. 

Lactmed is a website affiliated with the national institute of health. It has great information and is great for providers who need a good reference.