Mental health conditions are common among pregnant and postpartum women, but is it okay to take medication to treat them?

Mental health conditions including anxiety and depression are among the most common disorders affecting women during pregnancy and after birth.

Evidence shows mental health conditions in pregnancy increase the risk of complications for the mother and baby.

However, there is some stigma around taking antidepressants while pregnant or breastfeeding. So how should you decide whether or not to take antidepressants during these periods?

MENTAL HEALTH IN PREGNANCY AND AFTER BIRTH

Untreated anxiety and depression in pregnancy have been linked to an increased risk of stillbirth, premature birth, low birth weight and low APGAR scores (a test done at birth to check the baby’s health in various domains).

In addition, anxiety or depression during pregnancy may lead to increased maternal weight gain, substance use, or smoking. These lifestyle factors can also lead to complications for the baby.

Anxiety and depression during and after pregnancy can affect bonding between mother and baby, and hinder the child’s behavioural and emotional development.

Meanwhile, complications in the pregnancy may worsen mental health symptoms for the mother.

Not coping during pregnancy and especially after giving birth is often stigmatised and puts women at risk of self-harm.

TREATMENT OPTIONS

Depending on the severity of symptoms, treatment options for women during and after pregnancy range from social and emotional support (for example, support groups) to psychological interventions (such as cognitive behavioural therapy) to medical treatments (for example, antidepressants).

Understandably, many women are reluctant to take medications during pregnancy and while breastfeeding due to concerns the drugs may cross over to the baby and cause complications.

Robust evidence about medication use in pregnancy is lacking. This may be due to ethical limitations around trialling medications in pregnant women.
The limited data available – mainly from observational studies on selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), the most commonly prescribed antidepressants during pregnancy – has mixed results.

While some studies have reported no noticeable increase in the risk of congenital malformations, evidence has shown a marginal rise in abnormalities such as heart defects (an extra two cases per 1,000 babies with SSRIs).

COLLABORATIVE DECISIONS

There is a delicate balance to strike between treating your mental health and preventing harm to the baby. To make well-informed decisions, an open discussion between you and specialised mental health care providers on the benefits and risks of starting or continuing antidepressants is essential.

Given poor mental health increases the risk of adverse outcomes for the baby, it may well be that taking antidepressants is the best way to protect the baby.

For women already taking antidepressants, it’s not usually necessary to stop using them during pregnancy. Sudden cessation of antidepressants increases the risk of relapse.

Continuing breastfeeding on antidepressants is likely the best decision because of the low levels of drugs infants are exposed to in breast milk, the advantages of breastfeeding for the baby, and the risks of not taking antidepressants when indicated.

Recently released guidelines on mental health care in the perinatal period (during pregnancy and after birth) warn health professionals against the dangers of failing to prescribe necessary medication.

These guidelines also recommend repeated screening for symptoms of depression and anxiety for all women during the perinatal period. This is crucial to providing women with an early referral to perinatal mental health services if needed.

At present, mental health conditions during pregnancy and after birth often go undetected and untreated.

SUPPORTING PERINATAL MENTAL HEALTH

Mental illness in pregnancy is a significant public health problem. Screening is not always delivered effectively and women may be reluctant to engage due to stigma, time restraints, and lack of childcare or social support.

To address this, strategies need to be put in place to identify solutions that work best for you. This might include assistance with childcare, access to telehealth, visits from a perinatal mental health professional, or written information on medications.

Include your partner or a friend who may be best placed to support you in making complex decisions and choose an LMC that is respectful of individual needs and who provides compassionate care if and when you feel uncertain regarding mental health options.

By Alka Kothari, Associate Professor, Faculty of Medicine, The University of Queensland, Australia.
Published with permission from TheConversation.com

Tips for Staying mentally healthy during pregnancy

Get lots of sleep

Perhaps the best way that you can look after your mind is to get lots and lots of rest. A good night’s sleep is essential for clearing your head and allowing yourself some time to relax.

Eat a balanced diet

Not getting the nutrients you need can negatively affect your mood, perhaps more than you realise. While sustaining a balanced diet is the first step towards maintaining your mental health, ensuring that you are switching up your recipes helps you avoid falling into a boring routine that negatively affects your attitude towards food.

Move your body

Maintaining an exercise routine is also just as beneficial for your internal state as it is for your physical health. Getting out for a walk increases your physical fitness at the same time it does your mental wellness. Staying inside for days on end can negatively affect your mental health so doing daily exercise is a great way to refresh yourself and gain some clarity on what’s going on inside your head.

Try some meditation

Meditation, particularly the kind that involves deep, concentrated breathing, is a fantastic way to clear your mind and focus on feeling some positive energy.

Drink plenty of water

While ensuring that you are well-hydrated is essential for the physical health of you and your bub, it will also do wonders for your head. Drinking plenty of water is a great way to calm yourself, clear your head and boost your mood.

Keep communicating

Ensuring that your routine involves catching up and communicating with the important people in your life is one of the best ways to look after your mind. Talking about what you are feeling is one of the simplest yet most effective ways that you can release some of that build-up of mental pressure. Finding someone to talk to, whether it’s a friend, your family, or a professional, will improve your mental state exponentially and will benefit you more than you realise.

If this story has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 0800 LIFELINE or free text HELP (4357).

Originally published in Issue 18 of BUMP&baby magazine.

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