Depressed, Pregnant, What To Do?

 

Carrey, thirty-two is not so happily pregnant. She is married. She planned this baby, but her mood is low and she is wondering about antidepressants. “Are they safe in pregnancy?” She asks me, hoping that this is a yes or no question. “It is really a nuanced question.” I say, beginning an educational moment that medications cross the placenta and can impact the development and the delivery of the fetus, so we look to the literature to help us out. The literature tells us about studies which describes what happens most of the time, but there can be exceptions and new information that develops over time. “One question is whether there are other options for intervention, while you are pregnant, which pose a lower risk to the fetus,” I say, highlighting that part of the decision about psychotropics during pregnancy is whether or not other modalities of treatment can be tried and could be useful. Experts in the field come to the conclusion that the decision to treat a pregnant woman with medications comes down to a risk/benefit ratio, which means that each individual patient needs to be evaluated to determine if the risk of treatment exceeds the risk of not treating, with psychopharmacology. First and second trimester exposure appears to cause no organ malformation, but third trimester exposure can cause the baby to be born irritable, perhaps to the point of requiring the baby to stay one extra day in the hospital, and thereby increasing the risk for hospital-acquired infections. Some psychiatrists interpret this data to give them a low threshold to treat pregnant women with psychotropics, whereas other psychiatrists take this data to suggest that non-pharmacological interventions should be tried intensively before jumping to medication. There is no agreement, and there are no specific guidelines. This uncertainty in the field causes patients to be confused and, sometimes angry, at physicians who do not share their point of view. With this grey area of treatment, comes a lot of subjectivity about how to proceed which leads to professionals being judgmental with each other, and  patients looking to professionals who lean in the direction they are looking for. Carrey is confused, seeking other opinions. I respect that.