Depression, Medication and Pregnancy: Separating Fear from Fact

The pros and cons of anti-depressant medication during pregnancy are thoughtfully explored as Dr. Ann and Dr. Estie discuss the quandary that women often find themselves in; what to do if you want to get pregnant, think you might be pregnant and have a diagnosis of depression? 

Please note: This episode explores mental health treatment alongside fertility and pregnancy, topics that may be sensitive for some listeners.

Stay in touch!

This podcast is a conversation, and we’d love to hear from you. If you have questions, topics you’d like us to explore, or are interested in being a guest on a future episode, email us at onandoffthespectrumpodcast@gmail.com

Music

Composer / Writer / Author: ROSSANO GENTILI - SIAE IPI: 161539866

Transcript

SPEAKER_01 0:29

Hi everyone, this is Dr. SD Hess. And I am Dr. Ann Kirsch. And we're here this evening, once again, our podcast on and off the spectrum. This evening, we have a very important topic that we are bringing up. And uh Anne, you and I were talking uh about a case that you had that was simulating enough that we thought we should explore this more, both in terms of research and and and current notices uh about what the bigger implications of your case means for women of the world, really.

SPEAKER_00 1:10

Exactly. And so we wanted to bring this case to you because it caused such conversation between the two of us that we just knew that there were people who would be listening to us who would also be having this kind of a situation or something similar. So a few years ago, I had a young woman client who was an Orthodox Jewish woman. And she was in the process of looking for a husband. And she was lovely, highly functional, very smart, um, and taking antidepressants and specifically an SSRI.

SPEAKER_01 1:54

And which is a serotonin reuptake inhibitor. Right. For those who don't know, basically our bodies are chemistry sets. And so uh there is a neurotransmitter that is part of our brain system that helps us with stabilizing mood, affect the ability to think clearly called serotonin. And for some people, they just don't make enough of it, or it releases prematurely through sweat or urine. And uh SSRIs are serotonin reuptake inhibitors, which goes ahead and holds on at the receptor site of our in our brains of this chemical so that it doesn't release prematurely.

SPEAKER_00 2:40

Right. And having an SSRI that helps you to feel happier, helps your moods to stabilize, helps you to feel not so depressed or not depressed at all, is how everyone wants to feel. We all want to feel like we can go through our life at our very best. And so this young woman was taking in an SSRI, and she was doing great. She was in in college, she was very, very functional, a very lovely, lovely person. And she met a young man and they began to date, and things looked pretty good. They looked like they would be a good match, they were happy with one another, they were dating for a while, as is common in Orthodox Jewish culture. Um they then started to talk about themselves in a deeper fashion. And and my and my client revealed to this young man that she was taking an antidepressant and that, and she told them how much it had changed her life and how remarkable it was, and described how she was before, which was functional but not at her best. Because as uh Estee was explaining, an SSRI brings you up to a normal level in your brain. It doesn't bring you higher or lower, it just gets you to that normal place for your brain. So she explained all of this. She was doing very well. He went home and he told his parents about this new information. And after some discussion, his family and this young man decided that she would not be the right person for him to marry because they needed someone who would be consistently strong for as a wife, as uh in the role of a mother in the family, and they were concerned that she would have to stop taking her SSRI when she was pregnant. Now we're going to talk more about whether or not that's true and under what situations that might be true. But I bring up this case because it was so sad the way it ended, because it didn't need to end that way. This young woman had the okay of her doctor and had spoken with her primary care doctor, spoken with uh future OBGYN, and had been told that no, she could stay on her SSRI, that there was a lot of research, there's a ton of research now about whether or not SSRIs are okay to take. And she was given the okay. But the family that she was going to marry into was not happy about this, and it broke up a relationship that would have probably been a beautiful relationship.

SPEAKER_01 6:05

But I think, and I mean, as tragic as that story is, it happens a lot. A lot. And even if it doesn't cost somebody's future engagement or marriage, there is always a question: what do you do when you find out that uh you're pregnant or would like to become pregnant? And if you have, well, maybe we should talk a little bit about antidepressants because I know that lately there's been a lot of talk on social media and influencers about how antidepressants are the magic pill.

SPEAKER_00 6:43

And uh so, and then and and the strange thing is it goes both ways. People online talk about it being a magic pill, and everyone should be on it because it will make your life wonderful and will make you more beautiful. But there are also people who are talking about how no one should ever take an antidepressant, and there's been a lot of talk about that. And uh, that is not something that we as clinicians are in agreement with. What we do know is that the best advice that a person can get about whether they should start an antidepressant, how long to stay on it, what the negative effects, positive effects are is go to your own doctor. Have a long conversation, make an appointment that's not a physical appointment, make an appointment where you sit in the doctor's office across the desk from him or her and have this conversation.

SPEAKER_01 7:45

But you know, I think there is a variety of depressions. I mean, there is um, you know, I just failed my test, yeah, I'm sad. Right. And it's called um, you know, episod episodal episodic situational depression. So for specific for that one particular part of life. Okay. And it could last for a little bit, but usually time, distractions, it it you you come out of it. All right. Right. So when would we even consider to put somebody on an antidepressant? And by the way, neither Anne or I are MDs. Again, this you go back to your clinical medical team to get directional. That would be a primary care physician, a psychiatrist, for example.

SPEAKER_00 8:39

Right.

SPEAKER_01 8:40

Right. We know that it becomes diagnosable by the level of interference. How long are you depressed? What is the level of functional impasse? What, for example, if it's like um I didn't get out of bed today because I just couldn't, you know, I was feeling too sad and too. Then we're moving away from the idea that this is some kind of situational uh concern, that this really could be a potential chronic issue that might have gotten triggered actually by some kind of situation, but is lasting longer than a couple of weeks and is interfering profoundly with overall function. Then we move into a different realm. We move into the realm of it considering antidepressants. Not that you couldn't use psychotherapy for across the board issues, but certainly we would look for other methods of intervention, uh, breathing techniques, meditation, possibly acupuncture, certainly uh traditional Western, and if that was going in your direction.

SPEAKER_00 9:52

Right. And I just want to make clear that a situational depression happens when some specific thing has happened: a death in the family, a divorce, um, a child's illness, things that are specific to the time and place that they're occurring. And over time, what's what's accepted is that and understood is that it'll get better, you'll feel better, you'll come out of it, and that's where therapy comes in. Um, we both see have seen lots of people not on medication, but who need to work through the sadness and the feelings that they have. And sometimes staying in bed for a day is something that is the best thing to do. Watch an old movie, eat popcorn. If you're able to do that, sometimes that's the best treatment. But having an antidepressant is really dependent on how long your life is being impacted in a negative way by the feelings that you're having. They can be externally based, meaning things are going on in your family, you're of origin, your current family, or it can be something that's going on inside you as a human being that you can't quite figure out, but you know that you can't function well feeling the way that you're feeling.

SPEAKER_01 11:24

One of the more profound symptoms of uh depression is something called ahedonia, is actually the inability to feel. And you are walking through life numb, which becomes now a question of actually danger, right? Because we need our emotional state to kind of tell us where we are in space and time to warn us when necessary.

SPEAKER_00 11:50

Yes.

SPEAKER_01 11:50

So we know. Oh, by the way, no one has ever gotten high on an antidepressant. Exactly. It doesn't work that way. They don't. And so do people get addicted? Not really. No, because it doesn't give the high. And as you were saying, it brings you kind of like to baseline. So you're feeling normal enough, maybe normal enough to give us room now, so that your psychotherapist, for example, can now do the work necessary so that you can go ahead and uh figure out the root cause of the depression that might have gotten triggered by you know a current event of some kind. But all right. Now, though, let's say that either you're anticipating getting pregnant or you make a discovery that you are pregnant and you're on antidepressants and they're working for you, and you are stabilized. And now, you know, the the I think the old thinking was that you get off of all meds.

SPEAKER_00 12:58

That's right.

SPEAKER_01 12:59

Absolutely, that's right, and you have a lot of women who suffered horrifically, horrifically, with a lot of risk factors for their unborn child.

unknown 13:11

Right.

SPEAKER_00 13:12

Okay. But the question is medicine has changed over time, like like it always does. And what we know now is that a healthy mother tends to give birth to a healthy child. And if you're not healthy as a as a woman, if you have physical issues that aren't being attended to, they have to be looked at. But we're speaking specifically of depression. If you have depression, if you've been depressed for a long time and you found that taking an antidepressant, an SSRI, has truly benefited you. And then you find out that you're pregnant or you want to get pregnant. We've both had women who have come to us for therapy, and it's been this issue that's been the presenting issue. Recently, I had a woman who got married later, she was now in her early 40s and did not have children, and she wanted very much to have her own child, but she also had been depressed since childhood. She was a perfect candidate for an SSRI, and she was on an SSRI, and it made a huge difference in the way she could live her life, the fact that she could even think about being married, could even think about having a child. And so now what does she do? What would you do? Ask yourself the question: what would you do if you're in a circumstance where you've heard all the nonsense that goes on online, you've heard stories one way and another. What what do you do when you find out that you're pregnant?

SPEAKER_01 15:05

Well, I'll tell you what I think we would advise. You get to you get yourself educated. Yes. You listen to the concerns. I mean, there have been, you know, older studies which suggested if women stay on um stayed uh on their their antidepressants, that there was a higher risk of baby babies being born with congenital malf malfunctions. And actually, what we've discovered now is that the risk is just as high, in fact, probably higher if a woman does not have her depression treated for uh a rise in similar risk, including preterm birth, uh, miscarriage, um, or pregnancy complications. Overall, though, is and you were saying something so profound, when you have a healthy mama, you have a healthy baby, okay? Right. There is one circumstance which I actually think is a positive thing to discuss. Some parents are concerned there is something called neonatal adaptation syndrome, right? Which happens in about 25 to 30 percent of women who do indeed take SSRIs during the pregnancy, and it usually lasts at the birth of the child between 24 and 48 hours, uh, typically when the babies are still hospitalized with their with their mommies, and it is generally transient, resolving in a couple of days, maximum a couple of weeks. And uh this is uh where you see the child having what looks like slight uh withdrawal um uh experiences, um, but it's a transient state, and again, um without any further complications to our understanding.

SPEAKER_00 16:56

Right. There's no harm done to the child. The child, in in the small amount of cases where this happens, um there is every every reason to believe based on what we've all seen, what the doctors, what the scientists have seen is that in the cases where this happens, um everyone comes out fine. The babies are fine, and the mommies are fine. And the issues that a woman would have about depression and and postnatal depression um don't exist. They don't happen because she's been on her antidepressant. And as we know, being on an antidepressant and being in therapy is the best way that this works. So having a therapist to call, having your obstetrician on board with what you're doing, knowing what to look forward to, what to expect, and knowing that the outcome for something that's so transient is such a small thing that can happen, is nothing to worry about. Well, there is no zero risk.

SPEAKER_01 18:12

That's right. But the the point being is that with the right kind of support and discussion points, I think parents, future parents, can make thoughtful decisions for themselves.

SPEAKER_00 18:25

That's right.

SPEAKER_01 18:26

I don't think we can emphasize enough again that a healthy mom indicates a healthy baby. All right. But in addition, if you are mildly depressed, if you've had a circumstance um say uh passing of a family member that you were close to, and you are uh grappling with you know sadness that you haven't really experienced before, but it's mild. You're able to go to work, you're able to function, you're able to have relationships, then we're not even talking about the category of antidepressants.

SPEAKER_00 19:04

You'll talk to your friends, you'll talk to your family members, you'll talk to therapists if you have one. Um, but this is a normal part of life. What we're talking about are things that change the way you can live your life, from it being a normal part of life to it being something that is so profoundly disturbing that you need help from the medical profession. Right. And so that's where we always suggest, and any good therapist would suggest that you speak to your medical professionals. Right.

SPEAKER_01 19:43

And I think that's what we we you know came away with. You know, I was wondering, and when you're talking about that case, did it ever come up where, you know, that um young man and woman would have discussed potentiality with the young woman's uh physician to see what he or she would have recommended, you know, under the circumstances that she would get pregnant, you know, just to prevent the loss of this kind of relationship.

SPEAKER_00 20:13

I think I think that that would be a brilliant thing to do. Yeah. To sit down with the therapist involved, sit down with the physician involved, the OBGYN, and get the information from the person who is absolutely the one who can give it to you, the science-based answers. Um, but unfortunately, in the case that I was talking about, um it was it was it was not something that the family of this young man was willing to do. He was, they didn't believe in therapy per se. They were willing to go to the rabbi and talk about this, but unfortunately, they didn't invite the young woman and her family into those discussions. And so what happened was they were given advice that led them to understand or believe that it wasn't going to be a good match to make.

SPEAKER_01 21:24

But I think it's a telling story, and I appreciate you being able to share the specifics, because I think these kinds of misguided uh decisions uh with lifelong consequences are you know are made all the time. And again, I think the the biggest takeaway uh banner, you know, if we were going to have our our uh our bumper sticker for the for the evening would be two points. Again, a healthy mommy is a healthy baby. And secondly, and most importantly, Importantly, talk to your physician, talk to your medical expert, and listen to all of the arguments, all the sides, so that you and your partner can make a healthy decision for yours and your baby's future.

SPEAKER_00 22:17

Absolutely correct. You know, it wasn't that long ago, maybe 10 years ago, that people didn't talk about mental health as actually being a health issue. It was something shameful, something that people didn't talk about, that they didn't want anyone to know about. Children, adults, they didn't want anyone to know that they had a therapist. Now I have young young kids that I see and young adults that I see who talk about me as if I'm a family member. All of their friends know about Dr. Ann. They know about this, about the kid being in therapy. And I have had parents call. It hasn't happened a lot, but it has happened where parents that I don't know have called, and how they've gotten my number has been because their child is a friend of the kid that I'm seeing in therapy and has talked about it in such a positive way that now they're thinking maybe their child could benefit from therapy. So we're in a whole new world where we're talking about uh health issues in pregnancy, and we're talking about mental health, and mental health and physical health cannot be separated, they have to go together. And so all of you out there who are listening, think about it that way. Well, this is Dr. Estee Hess. And it's Dr. Ann Kirsch. And we're so happy to be able to share this information with you both on and off the spectrum.

SPEAKER_01 24:04

We welcome you to our future podcasts, and uh, I very much appreciate this very challenging question that has come up for obviously quite a few people. Absolutely. Have a good night. Good night.