BOLD Blog, Therapy

By Dr. Katie Hirst

Depression and anxiety disorders typically have their onset between the ages of 18-35yo, which are the same as women’s peak childbearing years, so it is no wonder that studies have found up to 8% of women take antidepressants at some point during their pregnancy.¹ Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed class of medication, and also the most studied for use during pregnancy and breastfeeding. Women frequently receive mixed messages about whether it is “safe” to continue these medications during pregnancy and while breastfeeding (if they choose to do so), and may also feel internally conflicted about whether to do so. 

The decision to continue or stop a medication before or during pregnancy is a complex one, which (ideally) takes into account 4 factors: 

1. The risk(s) of taking medication: What is the risk of birth defects? Effects on fetal growth and development? Effects at/after delivery? Effects on child development?
2. The benefits of taking medication: How does this impact/help the mother’s mood or anxiety? What has happened when medication was stopped in the past?
3. The risk(s) of not taking medication: If the mother becomes depressed or has anxiety symptoms, what is the risk to the mother, fetus, infant and family?
4. The benefit of not taking medication: This is often the easiest to answer, as it means no concern about risk of medication exposure for the fetus or infant.

This gets complicated pretty quickly, but a trained reproductive psychiatry provider can help women (and their partners, when appropriate) sort through the information in a clear and concise discussion.

Most importantly, the discussion about continuing or stopping antidepressants during pregnancy often ignores the tremendous benefit that psychotherapy can have in treating depression or anxiety during pregnancy and postpartum. Providers are very quick to recommend medications in many settings, and women often don’t have access to appropriate psychotherapy, which is as effective (if not more so) than medications for many women. Supporting women who choose to stop antidepressants before or during pregnancy with psychotherapy is an important component of maternal mental health care.

At BOLD Health, we have a team of highly trained Reproductive Psychiatry Providers and Therapists who work together to help women sort through conflicting information and make the right decision for each individual woman. We provide care ranging from one-time consultations to comprehensive care beginning at preconception and continuing through the postpartum period. Our team meets weekly to review patient cases, talk through complex questions and examine new journal articles in the field of maternal mental health. This collaboration allows us to ensure that our patients receive the highest standard of care possible. We believe strongly in providing up-to-date information in an easily understood format, with the goal of empowering women to make informed choices.

1. Andrade et al. Use of antidepressant medications during pregnancy: a multisite study. Am J Obstet Gynecol. 2008 Feb;198(2):194.e1-5. Epub 2007 Oct 1.