Treating mental health issues during pregnancy

Mental health issues during pregnancy and lactation can be significant and disruptive.  Depression and anxiety are considered the number one complication of pregnancy and the postpartum period with approximately 15% of all pregnant and postpartum women affected by clinically significant mood changes.   Many women seek advice from their health care providers about treatment options.  Readiness to receive treatment differs for everyone; there may  be different comfort levels with different types of treatment.  Traditional treatment options typically include medication and/ or psychotherapy. Other options also need to be considered such as support groups, peer counseling, and home visiting programs.

Options to consider:

Medication

Many women and some medical providers are hesitant to start or continue medication to treat mental health issues during pregnancy; they are concerned about the effect medication may have on the developing fetus. This concern is understandable since women are encouraged to pay careful attention to what they are putting in their bodies even before they get pregnant out of fear that it will harm their baby. In fact, it can feel to a pregnant woman like she is being a “bad mother” if she takes medication to treat her anxiety, depression or other mental health issues. Medication is an effective treatment option for mental health issues. Women are encouraged to weigh the risks and benefits of starting medication versus not starting medication.  You can consider these four questions if you are on the fence about medication:

  • What risks are you taking if you take medication?
    • This question focuses on the known harm or potential harm of taking any medication.  Your doctor or pediatrician can reinforce what is known about the safety rating of any particular medication. An excellent on-line resource for up to date research and recommendations is the webpage moderated by the Massachusetts General Hospital reproductive psychiatry team (www.womensmentalhealth.org).
  • What risks are you taking if you do NOT take medication? 
    • When considering this question, you will want to think about your functioning if your depression or anxiety continues or worsens.  How will this affect your ability to care for yourself or the new baby?
  • What benefit do you receive if you do take medication?
    • Improvement in functioning or recovery typically takes a few weeks once medication has started.  Without medication, recovery can take much longer.  There are certain mental health issues that require medication throughout the pregnancy and lactation if the risk of suicide, psychosis or other self harming behaviors requires it.
  • What benefit do you receive if you do NOT take medication?
    • This is a good question to think about.  Many women report that they would feel guilty if the baby had any birth complications; they would assume that they caused the birth complications if they took medication during pregnancy.  This presents an interesting dilemma where the potential for guilt outweighs the known depression and anxiety.

Often, women will wait until their functioning is significantly impaired before they are agreeable to starting medication during pregnancy or in the postpartum period.  Medication is known to reduce the amount of time it takes for someone to recover from a mental health condition. Some women will try other treatment options before resorting to medication.

Psychotherapy

A significant number of women may be agreeable to trying psychotherapy during pregnancy and the postpartum period as an alternative to medication or in addition to medication.  Psychotherapy focuses on building coping skills to help you manage difficult thoughts and feelings.  It can also help you manage stressful relationships and process past trauma.   Finding a behavioral health provider trained and experienced treating maternal mood disorders can be challenging, especially in more rural areas.  Postpartum Support International has been training the behavioral health community nationally on maternal mental health for 20 plus years.  Their state wide contacts can help find providers in your local community (http://www.postpartum.net/) .

There continues to be stigma around mental health and a fear that someone will take their baby from them if they share how they are thinking and feeling.  A trained psychotherapist is there to help you to feel better.  We know that maternal mental health issues are important and very treatable.  The obstetric provider’s referral to a responsive behavioral health provider can make the difference in a woman following through with getting help. 

Other options

In addition to medication and talk therapy, less traditional forms of help include connecting with community based or on-line support services.    Home based programs have been specially designed to help pregnant and postpartum women living in poverty receive extra support and improve birth outcomes. These nurse, social work and paraprofessional home visitors help reduce isolation and encourage access to care.  Support groups, peer support programs and online support are other avenues for women to get advice and support on managing mental health concerns during pregnancy and the postpartum period.  Not all communities have these services readily available. Postpartum Support International is an important resource in helping women get the help and support they need in local communities.

Picture of Lisa B Kelly, LCSW

Lisa B Kelly, LCSW

Clinical Social Work/Therapist, LCSW, MPH