A recent study in the scientific journal Human Reproduction claims that there are risks — and no clear benefits — associated with taking certain antidepressants during pregnancy. Mainstream news outlets have written about the findings.
As a clinical social worker who regularly counsels women with perinatal mood disorders, I am concerned that this study sends a potentially harmful message for pregnant women and mothers. It also runs the risk of scaring women struggling with depression and/or anxiety who could benefit greatly from medication.
Several experts have said that they feel the study is problematic. “With regard to this one article, it neglected to include key studies which demonstrate the effectiveness overall of [antidepressants] in treating depression as well as the literature which shows the harmful effects to mom and baby if depression in pregnancy is left untreated,” said Dr. Barbara Byers, a psychiatrist specializing in reproductive mental health who formerly served as the medical director of the Women’s Mental Health Program at Georgetown University Hospital.
Choosing to take any sort of medication is, of course, a personal decision between a woman and her doctor. But how can medication help a pregnant woman or new mom who may be struggling with symptoms of depression and/or anxiety?
“According to societal standards, pregnancy is supposed to be a time when women feel positive and joyful,” Byers said. “The field of mental health practitioners who take care of these women know that often this is not the case.
“If women have struggled with depression or anxiety pre-pregnancy, they have a 60-80% chance of having symptoms during either pregnancy or postpartum. These women feel ashamed that they feel down instead of joyful and are very reluctant to admit that there is a problem, much less seek treatment or take medication to address what can be a life threatening illness for themselves and the baby.”
“I felt a cloud descend on me the minute I had my daughter. She was healthy and perfect... and I wanted nothing to do with her,” Monroe said. “I felt overwhelmed and cried multiple times a day for months. I assumed it was just that I was a bad mother and that I had gotten myself into something I couldn’t handle.”
Monroe returned to work after four months of maternity leave. She said that she would cry for no reason and told her boss that she was going to quit her job. Monroe’s boss recommended that she talk to a doctor.
The doctor initially prescribed Lexapro. “I vividly remember sitting on the couch after about seven days of being on the medication and having a sudden realization that I felt okay, for the first time in over a year,” Monroe said. “The cloud had lifted. It validated the fact that I had a true chemical problem, and this specific chemical fix [the medication] had helped it.”
Monroe is currently taking Zoloft and plans to continue taking it throughout her pregnancy and postpartum. “I could not be more confident in my decision,” she said. “I feel like a healthy and happy person — unlike the last pregnancy — and I know that what I am doing is the right thing for my baby and my family.”
Dr. Caroline Ahlers, a psychiatrist who practices at Inova Health System and is a member of the clinical faculty at George Washington University School of Medicine said, “A phrase I often hear from depressed pregnant women in crisis is, ‘I don’t think I can live like this’ even for a few months. I have seen many patients who have suffered through their pregnancies without medications, only to end up in life-threatening acute crises in postpartum requiring hospitalization to protect themselves and/or their babies from harm. Medications can prevent the needless suffering and negative impact on both mom and baby during the critical periods of pregnancy and postpartum.”
Another DC-area mom, 35-year-old Meredith Dresner, has two children ages 3 and 6 years old. Her PPD symptoms, which included sadness and sleep difficulties, struck when she was pregnant with her second child.
“Women need to be given all options with a description of risks when it comes to maternal mental health,” Dresner said. “Medication as part of my treatment plan helped me be the best mom I could be. I would like all women to have that same chance.”
Jennifer Kogan is a clinical social worker in Northwest Washington who works with kids, teens and parents.