The Myth of Antidepressant Use in Pregnancy

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“Only weak personalities take medication for depression during pregnancy.” It has become accepted that “you take the drugs only if you can’t handle the depression.” Despite the mounting evidence that depression is a brain disorder, mothers to be are expected to utilize “will power” in order to stabilize their illness. Known risk factors for illness severity such as extensive family history, early onset of symptoms, and documented recurrent bouts of illness are quickly disregarded when pregnancy is added to the equation. However, skeptics have noted the World Health Organization (WHO) finding that clinical depression is poised to be the primary source for the global burden of illness. The treatment requirements of depressed pregnant females need to be addressed.

Many assume that psychiatrists always endorse medications for treatment. My book, The Pregnancy Decision Handbook for Women with Depression, refutes this popular myth. This award winning book simplifies the distinctive steps in the risk versus benefit analysis of pregnancy treatment options. Ultimately, decisions must be individualized with the guidance of one’s mental health provider. Women have various treatment options that are based upon severity of illness. What is the severity of your illness?

Mild symptoms by definition are few in number and do not impede an individual’s ability to function in daily life. Symptoms that are mild can be treated by distraction such as shopping, social interactions, and any activity that keeps the mind preoccupied. On the other hand, severe illness symptoms are numerous and readily impede a person’s daily functioning in work and life. Often, females with severe depression make impulsive and potentially dangerous emotional decisions that can negatively impact their baby.

The stigma associated with psychiatry can impact upon the decision to seek treatment for severe illness. I often wonder if my peers who treat pregnant women for severe heart, seizure, and autoimmune illnesses are questioned about the necessity of their treatments. Perhaps the prevailing myth that pregnancy cures disease only applies to psychiatry and not other specialties.

Someday we will stop making expectant mothers feel guilty and shameful because of their need to treat their medical problem. Severe depression, like other mental illness, is a brain disease. Women should not bear the burden of proving the negative results of a lack of treatment before meaningful discussions of options are held. Severe clinical depression is not the same as sadness. Meanwhile, are we to be in the position of telling patients that if they can’t handle their symptoms they should then come back for another discussion? In the meantime, should they stop all medications and call if they are weak and can’t tolerate their illness?

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