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Mental Health
Taking care of your mental health is one of the most important priorities of the perinatal period. Yet, there is no shortage of myths surrounding mental health in pregnancy and postpartum—in particular, around taking anti-depressant or anti-anxiety medications in this time period. As a psychiatrist specializing in women's mental health and perinatal psychiatry, I’m an expert in how to treat and prevent conditions like postpartum depression and postpartum anxiety (also called Perinatal Mood and Anxiety Disorders, or PMADs for short). I take care of patients who are struggling with these conditions using talk therapy, and sometimes, medications. I’m sharing some of the misconceptions that I see in my practice around the use of SSRIs (selective serotonin re-uptake inhibitors), which are the most common medications prescribed for depression or anxiety, and providing some clarification. Please note this information is for education only — always make sure to talk to your OBGYN, midwife or mental health professional in order to get personal medical recommendations! Treatment Risks and Benefits Untreated depression or anxiety in pregnancy and postpartum comes with risks. When we are considering prescribing medication in pregnancy or during breastfeeding, we are balancing the risks of untreated depression or anxiety in pregnancy or postpartum with the risks of exposure to the medication. Research shows that untreated depression and anxiety during pregnancy can be associated with preterm birth, low birth weight, difficulty bonding and other issues. Untreated depression and anxiety in mom has been associated with difficulty with attachment, higher levels of cortisol in baby, and emotional and cognitive issues. It’s important to understand that untreated mental health conditions are an exposure to the baby. This is one reason why a mother’s mental health is so important during the perinatal period. Are SSRIs Dangerous for Baby? In general, taking SSRIs in pregnancy and breastfeeding is low risk. To be clear, none of my patients love the idea of taking medication during pregnancy or breastfeeding. Of course, in an ideal world, nobody would suffer from these conditions and we would not need to prescribe medications. However, the reality is that about 10-15% of people who give birth will suffer from a mood or anxiety issue during pregnancy or in the first year postpartum (this number is higher for women of color, for people living in poverty, and for women who struggled with infertility). For this reason, in general, when there is moderate to severe depression present in either pregnancy or postpartum, experts recommend treatment with psychotherapy, and, if needed, SSRIs. SSRIs are the most commonly prescribed and most well studied group of psychiatric medications in pregnancy. They include medications like Lexapro, Zoloft, Prozac and Citalopram. For evidence-based information about medications in pregnancy, you can read more here. For evidence based-information about medications during breastfeeding or pumping, you can read more here. Postpartum Depression Meds Aren't Forever Just because you take a medication for PPD or PPA doesn’t mean you will need to take it forever. Many of my patients worry about becoming “addicted” to antidepressant medication. Let me reassure you that you cannot become addicted to an SSRI — that’s not how these medications work in the brain. And, the good news is that treatment with medication and psychotherapy is very effective for PMADs. Taking these medications is not a life sentence, though, it is important to make the decision under the care of your doctor. - Dr. Pooja Lakshmin MD is a board-certified psychiatrist specializing in women’s mental health and the founder of Gemma, a digital education platform focused exclusively on women’s emotional well-being, impact and equity. This content is for informational and educational purposes only and does not constitute individualized advice. It is not intended to replace professional medical evaluation, diagnosis, or treatment. Seek the advice of your physician for questions you may have regarding your health or a medical condition. If you are having a medical emergency, call your physician or 911 immediately.
2 years ago
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