The Tough Choice Pregnant Women With Depression Have to Make

The Tough Choice Pregnant Women With Depression Have to Make

Amy* is a blogger and teacher who lives in Ohio. She was also diagnosed with bipolar disorder in 2003. Since her diagnosis, she has become the mother of three children.

"[During] my second pregnancy I didn't really have any problems, but when I got pregnant the third time ... it wasn't planned, [and] I was on Lamictal," she told Mic. Lamictal is an anticonvulsant often used to treat epilepsy which has proven effective in treating bipolar. 

During the first trimester of her third pregnancy, Amy was told to go off her medication. "Everyone [was] like, 'Oh if you stay on it they'll be hurt for life!'" she told Mic. She looked up Lamictal and found out it was a Category C drug, meaning the FDA determined that animal reproduction studies "have shown an adverse effect on the fetus," causing potential health risks for pregnant women. 

Amy wanted to stop taking the drug, but she wasn't able to get in touch with her doctors. "My mood pretty much just plummeted," she told Mic. Three weeks later and still in a state of despair, she finally got in touch with her psychiatrist's office. "They said, 'Well, you shouldn't have gone off of that,'" she recounted, with palpable frustration.

Later in her pregnancy, Amy said she struggled with some of the more severe symptoms of her mental illness. "I was doing a lot of self injury, cutting," she told Mic. After being turned away from one mental health facility, she ended up in the medical side of a psychiatric ward. "I still wasn't good, but I was more stable," she said.

Pregnant women living with mental illness face monumental struggles. According to the World Health Organization, approximately 10% of pregnant women experience a mental disorder during pregnancy, primarily depression. (In developing countries, that number is higher: about 15.6%.) For Amy and other mothers who fall in this category, pregnancy isn't a picture-perfect experience of satiating ice cream cravings and emitting a radiant glow.

Although the symptoms of postpartum depression are well-understood, as the New York Times reported in May, "far less recognized is an equally troubling condition: antenatal depression, or depression suffered during pregnancy." In addition to depression, researchers have found that 5 to 16% of women struggle with an anxiety disorder during their pregnancy.

Traditionally, many doctors have warned against patients taking antidepressants while pregnant. But the truth about whether it's OK to take such medication during pregnancy is more complicated than we think. Pregnant women with mental illnesses must make critical decisions about treatment — not just for their own health but for their baby's. 

"I took fluoxetine for the whole pregnancy," Jess*, a mom blogger living in New Zealand who has been diagnosed with panic disorder, told Mic. "I was very concerned about it and was willing to stop taking [the meds], but at the same time, the risks of me becoming extremely unwell were far too high. You need to weigh the risks and benefits." Jess' daughter was born healthy in 2013.

"You need to weigh the risks and benefits." 

Grappling with stigma: Women struggling with mental illness often experience extreme guilt and fear if they choose to take a medication during their pregnancy. And unfortunately, there aren't many reproductive psychiatrists to help them make decisions about their treatment. 

"It's challenging because there are a lot of psychiatrists who are very uncomfortable treating pregnant patients, just because there isn't a lot of training on that. And then there's a lot of [obstetricians] who aren't as comfortable treating mental health issues," Dr. Anna Glezer, a psychiatrist in San Francisco who specializes in reproductive psychiatry, told Mic.

Glazer told Mic that the answer to whether a woman should take medication during pregnancy largely depends on the medication and the woman taking it. "I think it will be really hard for anyone to say that a particular medication, treatment, supplement, anything, is 'absolutely safe' in pregnancy. But there are definitely some that are safer than others," she said.

Some medications, such as the selective serotonin reuptake inhibitor (SSRI) antidepressant Paxil, are shown to cause harm to a fetus. (That said, other SSRIs, such as Prozac and Celexa, are generally considered to be OK to take during pregnancy.) Other types of antidepressants, such as tricyclic antidepressants like Tofranil and serotonin-norepinephrine reuptake inhibitors like Cymbalta, have been determined to not have any serious effects on a fetus and can be safely used during pregnancy.

Yet, as Glezer explained, deciding which meds to take during pregnancy isn't as simple as finding out what's OK and what isn't via a Google search. "I would say that apart from a couple of select medications, I don't say that you absolutely can't be on something. Otherwise, it's absolutely a risk-benefit [analysis]," Glezer said.

This decision-making process is more complicated than people might think. In some instances, the mental illness itself poses more risks to a fetus's health than the medication the mother might be taking.

"Depression in and of itself has consequences during pregnancy," Glezer told Mic, citing increased risk of self-harm, as well as less serious conditions like sleep loss, as examples. "Furthermore, if you're depressed and unmotivated while pregnant, you might not have the energy to do some of the things your doctors are recommending. Then there's the illness of depression itself, and studies have found that['s] associated with things like smaller babies [low birth weight] or preterm deliveries."

These days Amy is doing well, as is her daughter, who was born healthy in 2011. But the lack of information on psychiatric disorders and pregnancy is prompting professionals like Glezer and women like Amy and Jess to work to spread awareness. 

"That was a big factor in me starting my blog," Jess said. "I was so sick of having to act like nothing was wrong. I really hope that by sharing my experiences, maybe one person will benefit. Then it would all be worth it."

Ultimately, some women with mental illness are going to want to live as pharma-free as possible during their pregnancies. But others are going to find that they benefit from medication, even in small doses. "I've actually found that pregnancy-related depression responds really well to even really low doses of medication," Glezer said.

If taking even small doses seems too risky, Glezer recommends purely non-pharmaceutical approaches are available, such as psychotherapy, massage, light therapy, acupuncture and exercise. Prenatal yoga has been shown to help with anxiety and depression.

"Women who do yoga during pregnancy and postpartum are better able to fight anxiety and depression because yoga lowers the stress hormone cortisol and helps develops a stronger relaxation response," Dr. Marlynn Wei — author of The Harvard Medical School Guide to Yogapsychiatrist and certified yoga teacher — told Mic.

That said, the guilt and shame that comes from dealing with a mental illness and opting for treatment during pregnancy is the last thing an expectant mother needs.

"I want women to be aware that [depression] is a significant condition that can occur during pregnancy, and it isn't always this magical, harmonious time," Glezer said. "Unfortunately, I think I find a lot of women feeling alone and isolated when they're going through that. [We should] encourage them to reach out, whether it's to their OB, primary care, psychiatrist, therapist, whoever."

But whatever choice a pregnant woman makes, it's important they know they're not alone and they don't have to feel guilty for it. 

"I've tried to stop medication a number of times, but have always relapsed," Jess told Mic. "Now I no longer feel bad about taking it. For me, it's like a diabetic needing insulin."