Psychiatric meds in pregnancy: yes or no?
Pregnancy can be a time of heightened emotions, tears and even depression. And if you're already on psychiatric meds before you fall pregnant – should you continue or stop?
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There's a lot of information and advice surrounding the subject of becoming a mom. Being pregnant can seem like a lot of hard work – lots of do’s and don’ts, rules to follow, and instructions to take. Such as, eat lots of grain, eat your vegetables, don’t use scented body lotion avoid new cars and air fresheners. Well-meaning aunts and scare-tactic websites aside, there’s a lot of information out there.

There’s also a lot of misinformation – and many unanswered questions. One of them is the question of whether to stay on your psychiatric medication during pregnancy. Following the Thalidomide tragedy in the 50’s, concern over what a woman may expose her unborn child to during pregnancy has sometimes verged on the extreme. Nowadays there’s a mass of information to support the fact that substances can affect unborn or breastfeeding babies. “We know that things can harm the foetus and women should not be exposed to substances while pregnant or breastfeeding,” says mother of 3, Zanele.

Common sense should tell us that the truth is somewhere in the middle. If a woman is being treated successfully with medication for a mental illness before she becomes pregnant, her treatment should continue throughout her pregnancy. “Untreated depression and other mental illnesses can harm both the mother and her baby”, says SADAG’s Director Cassey Chambers.

Many women stop taking their psychiatric medication when they become pregnant for fear of harming their unborn baby. But this may not be the best decision. Your first meeting must be with your doctor. In the treatment of pregnant women, who are on medication for mental health, it is important to remember that the health of the mother influences the health of her child. “A depressed mother is more detrimental to the development of a child than any medication”, says Psychiatrist Dr. Rykie Liebenberg.

While so many pregnant celebrities, baby-on-board royals, and baby-bump neighbours look relaxed and glowing, studies suggest that up to 20% of all women may suffer from mood or anxiety disorders during pregnancy. And for women with an existing mental health condition, pregnancy can trigger a roller-coaster of emotions. So what to do? Should a pregnant woman stop her treatment and “go it on love alone” or does she stay on her medication and risk complications for the unborn baby.

Pat (36) was concerned about the effects of psychiatric medication on an unborn baby’s development. “I heard about babies that were born addicted to drugs or who were badly deformed because their mother used medication during pregnancy”, she shudders. “And I didn’t want that for my baby. So I went off my bipolar medication to protect my unborn child.” Consequently, Pat had a very difficult pregnancy emotionally; her moods were unstable and she almost lost her child.

Many women are concerned about the impact of a pregnancy on their illness and about the potential effects of medications they take on their unborn child. “Of course the ideal would be for no women to be on medication during pregnancy, particularly during the first trimester, but realistically the risk of relapse is very high for women who suffer from a mental illness and who stop their medication, always speak to your doctors first”, says Dr. Liebenberg.

Studies have shown that the risk of relapse is as high as 68%. Lauren (31) has suffered from depression for most of her life and for her, the decision to stay on medical treatment when she fell pregnant was never an issue. “There is no way that I would be able to cope with the emotions and hormone changes of pregnancy everything else that new motherhood entails without staying on treatment”, she says.

She, her husband, her gynaecologist, and her psychiatrist consulted, even before she conceived, to discuss the possible risks involved. “I have always stayed up-to-date with my illness and treatments and the research so I knew that women who stop medication when they get pregnant have a high risk of getting ill again. I have fought for so long to be stable and happy.”  

From the beginning, Lauren disclosed her psychiatric history with her team of doctors so they could work together to achieve the best possible outcome for mother and baby. “My daughter’s paediatrician knows I suffer from depression too, that way he knows what warning signs to look for when she visits”.

Many women with mental illnesses like depression, anxiety or bipolar, are diagnosed in young adulthood and many of these women plan to start families at some point in their lives. It is vital that healthcare professionals work together as a team to manage the illness throughout pregnancy and inform women what their options are.

“Managing any illness during pregnancy is a delicate balance of the risks and benefits of the illness versus treatment, and should be done in close collaboration with both Psychiatric and Obstetric professionals,” says Johannesburg-based Psychiatrist Dr. Dora Wynchank.

Carefully planning a pregnancy is always important, even more so when the mother-to-be has an existing mental illness. The first three months after conception are vital to a baby’s development, and this is when most problems occur. “Planning a pregnancy is best and consulting with your medical team is important for your health as well as your baby’s – not only during pregnancy but also postpartum”, says Dr .Wynchank.

Since many pregnancies are unplanned, all women should talk to their Psychiatrists about their treatment options and how to manage their mental health during pregnancy. “By the time an unplanned pregnancy is discovered, it is usually already well into the first trimester, and stopping medication serves no real purpose”, says Dr. Liebenberg.

There are some medications that can be used safely during pregnancy, and some that should not be used. But while research into the risks of using psychiatric medication is incomplete, doctors do have some research - “it seems that most anti-depressants are not teratogenic, and will therefore not harm the foetus.”

There are certain medications like mood stabilisers and certain benzodiazepines that are not advised during pregnancy.

Some drugs, like Lithium, have been re-analysed and now are believed to be less risky than was previously thought. “The SSRI'S seem to be the best bet in pregnancy. Their density in breast milk is also very low”, says Dr Liebenberg.

It’s important to remember that an untreated psychiatric illness in a mom-to-be may cause significant risk to both the mother and her child, and discontinuing medication during pregnancy is not always the safest option. Apart from the risks involved in self-medication in women who suffer from psychiatric illness during pregnancy, a number of studies have shown that children born to depressed mothers may suffer growth retardation in the womb, have a lower birth weight, and a higher risk of premature delivery.

Pregnancy can be a difficult time - hormonal changes, emotional stress, personal and social changes can make expectant mothers, anxious and depressed. Existing mental health problems can be exacerbated. The consequences of pre-natal exposure to psychiatric medications have been debated over many years. In the end, there is no definite right or wrong answer, but rather information, communication with a team of experts, and careful planning are the keys to successfully managing a mental illness both during and after pregnancy.

Regular exercise, stress management, sleep, proper diet and support are vital. “Knowing the early warning signs of your illness and getting help as soon as possible is an important part of maintaining mental wellness”, says Chambers. SADAG offers support, advice and referral for patients and loved ones suffering from a mental illness. “Symptoms can differ from one woman to another, and sometimes enlisting the help of friends and loved ones provides important and life-saving feedback.”

Every case has to be judged on its own merits. Today, both Pat and Lauren talk openly about their experiences and support other prospective moms with mental illnesses like bipolar and depression. At the end, informing people of all the facts and giving recommendations and resources is all they can do. Ultimately, everyone must make their own decision. 

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