While, as a society, we are getting better at talking about mental health in general, there is still a lot of misunderstanding around antidepressants and pregnancy.
But it’s an important conversation to be having, with one in five pregnant women being affected by depression and anxiety.
All too often, those who are pregnant or trying to get pregnant are faced with a double dose of worry: That staying on antidepressants may cause harm to their unborn babies, or that their mental health may worsen if they decide against taking medication.
If mental health conditions are left untreated, they can have detrimental effects on the mother’s and baby’s wellbeing, explains Lesley Gilchrist, registered midwife and co-founder of My Expert Midwife.
‘It is therefore paramount that pregnant women receive treatment, whether that be in the form of antidepressants or therapy, or both,’ she says.
But pregnant women often report feel judged, shamed or confused about their decision around antidepressants – this is something that needs to change.
Here, four women share their experiences.
Amy Gower is 33 and lives in London. She decided to continue with her antidepressants, after thoroughly researching the risks versus benefits.
After giving birth, Amy’s son was in NICU and she was commuting between the maternity ward and his ward, for two days, following a 24 hour labour.
Exhausted, the night before she was going home, a midwife was checking she had all the correct medication, and asked her: ‘Are you still on escitalopram?’
She said yes.
‘Ok,’ said the midwife. ‘Do you know that it can have side effects in pregnancy?’
‘Yes’, she said again, now feeling irritated.
‘I’d done my research and had the baby at this point,’ she tells Metro.co.uk. ‘So, what was the purpose of her question?’
She continues to say that she knows the midwife was only doing her job, but it stuck with her.
‘It shows just how much words and insensitivity around mental health -particularly after giving birth when the hormones are everywhere – can hurt,’ she says.
Amy has been on antidepressants since 2017 and was keen to come off them when she got pregnant, due to the fear of harming her unborn baby. However, she then decided that it would be more beneficial to stay on them.
I was asked by a midwife if I was aware of the potential side effects of the medication – after I’d had my son
‘My GP explained that my health is equally, if not more, important than an unborn child – and that I must prioritise my own mental health, particularly to get through a pregnancy.’
‘She convinced me that my mental health was too important to jeopardise and that the risk factor is so low for the antidepressants to cause any foetus problems.’
She was, however, worried about the side effects, having read these in detail.
‘I didn’t want my child to be born with a defect that I was to blame for,’ she says. ‘I suppose that in itself says a lot about my mental health at the time.’
Amy decided to stay on antidepressants throughout the pregnancy.
‘The support of my GP and husband helped me reach this decision,’ she says.
Her decision was informed, researched, and with the help of her doctor – making from the comment from the midwife even more insulting.
Amy’s son is a now one-year old.
‘A few weeks after his birth my mood was all over the place and eventually, I accepted that I needed to increase my dose,’ she says. ‘I increased my dose to the maximum and I’m still on that.
‘I’d like to come down on my dosage someday but know that this is the best thing for me right now.’
Amy explains that she now accepts that taking medication isn’t a weakness, it’s a support – and she believes that we need to change how we talk about pregnancy and mental health as a society.
‘I’m not proud of my depression and anxiety but I accept that it’s something which therapy and medication has helped me with,’ she says. ‘The combination of the two, after many years of trying just therapy, has worked for me.
‘I hope others who have similar fears and worries to me can see that you can be on medication and be pregnant and have a healthy baby.’
Zoe Pickburn, 31, a journalist based in West Yorkshire. With the support of her GP, she has decided to stay on her medication – despite a previous doctor telling her it would be ‘irresponsible’.
Zoe is 14 weeks pregnant. As soon as she took a positive test, she made an appointment to see her doctor. At that time, she had a whole list of anxieties but the main one was related to her antidepressants.
‘I’m sober (so no booze or cigarettes) and vegan (so no soft cheese, shellfish, etc.), so antidepressants were one of the only potentially harmful things for me really,’ she tells us.
‘The GP told me that because it’s unethical to test meds on pregnant women, there isn’t much evidence either way: they don’t know for sure that it’s totally harmless.
‘But, they do know for sure that stress is harmful in pregnancy.’
Zoe had previously been on a high dose of SSRIs, before she started trying to conceive, but a GP had advised she come off of them. It took longer than expected for Zoe to get pregnant and so, she ended up being off medication for quite a long time.
The impact of not taking her medication took its toll on Zoe and, after struggling for several months, she decided to go back on a low dose – after being reassured by a different doctor that it was OK to do this.
She did, however, receive some conflicting advice at the beginning of her journey, showing that there is still misunderstanding and misinformation out there, even from health professionals.
‘Back when we started trying to conceive, I had an appointment with a different GP, primarily to discuss whether I should stay on my meds or not,’ says Zoe.
‘He told me that I would be irresponsible to even try to get pregnant on SSRIs, which scared me a bit – and is why I was so determined to get off them completely, even though it made me really quite unwell.’
The GP she spoke with more recently advised her that this was incorrect.
Pregnancy is supposed to be such a magical time, and for so many of us, it just isn’t
‘The more I think about it, the more mad I get at that first doctor who did discourage me,’ says Zoe.
‘It wasn’t just advice to come off them if I can, it was the implication that if I don’t come off them then I’m already an irresponsible parent.
Now, having weighed up the risks versus reward – knowing that poor mental health during pregnancy is bad for a baby – Zoe has decided to stay on her medication.
‘Last time I came off antidepressants completely I was really not in a good place (having suicidal ideation, etc),’ she explains.
‘My life is fairly stressful anyway. I have a job, freelance on the side, and go to night school to get my journalism qualification – as well as growing a whole new human from scratch!
‘On balance, the tiny risk of being on them seemed worth it, to vastly reduce the known risk of being off them.’
So far, Zoe feels certain she made the right decision, noting that she thinks she’d really struggle to cope without them just now.
‘I’m an emotional rollercoaster at the best of times, and even more so now,’ she says.
She does have some concerns, though. ‘I do worry a lot about how I would feel if something were to go wrong now and for it to be down to the SSRIs, but honestly… I don’t think I could be a functioning parent without them.’
Zoe thinks it’s important that we normalise the conversation around depression and pregnancy.
‘Mental health – and especially maternal mental health – is still so taboo,’ she says. ‘Pregnancy is supposed to be such a magical time, and for so many of us, it just isn’t.
‘It’s easy to feel very alone, I think, especially in these early days when we’re not telling many people – and so the wider range/breadth of experiences that are shared, the better.
‘There is some expectation, I think, that women give everything up for their children and never complain about it. Saying that I need medication to cope is already giving me a nagging feeling of not being good enough as a parent – before I’ve even had my baby.’
She concludes: ‘Do what’s right for you. You need to be as well as you can be, to parent this baby, and if that includes taking antidepressants then it is what it is.’
What should someone who is deciding whether to stay on antidepressants consider?
This is a very individual and personal decision and one which should always be discussed with the woman’s own doctor or mental health specialist.
Both women and their health care professionals should take into account the stage of her pregnancy, how she is responding to treatment, the severity of her symptoms, her risk of relapse if treatment is stopped and the possible risks of continuing on the medication.
To make a truly informed decision regarding treatment, the potential risks and benefits of treatment versus non-treatment need to be assessed and the B.R.A.I.N. acronym is an excellent tool to help women inform their decision-making process:
B is for benefits. What are the benefits of taking antidepressants for me, my pregnancy and my baby?
R is for risks. What are the possible risks to me, my pregnancy and my baby of having treatment? What could the risks be for me, my pregnancy and my baby of not having this treatment?
A is for alternatives. Are there alternative options or treatments available? What are they?
I is for intuition. What does my intuition and instinct tell me? This one may be harder to use if the depression and/or anxiety is moderate to severe, as it can be harder to trust your own instincts when your emotional wellbeing is affected.
N is for nothing. What would happen if I decided to do nothing? What could happen to me in my pregnancy or to my baby?
Source: Lesley Gilchrist, registered midwife and co-founder of My Expert Midwife.
Lynsey Carratt is 40 and lives in London. She decided to stop taking Citalopram after getting pregnant.
Lynsey had been taking Citalopram since 2017 to treat anxiety and depression.
She and her husband then started trying for a baby in late 2019, a few months after they married. At the time, she decided to reduce her daily dosage from 20mg to 10mg; so a relatively low amount.
However, as she entered 2020, she made the conscious decision to come off the antidepressants altogether, and discussed it with her GP.
‘I felt much stronger, and I wanted to give us the best possible chance of having a baby, she says.’
By March 2020, Lynsey was fully functioning without the tablets, and they’d also reached a milestone in their pregnancy quest.
‘Finally, after six months of unsuccessfully trying, it was time to take the first step into a fertility investigation.’ she says.
She adds that it is advised that women aged over 36 should see their doctor if they haven’t conceived within six months.
Lynsey was booked in for a ‘Fertility MOT’ at the hospital, which would have involved an ultrasound scan and blood tests. However, this appointment was cancelled due to the onset of Coronavirus, and lockdown.
This was a blow and, on top of that, Lynsey found herself with a lot on her plate.
‘As we navigated the lockdown, being stuck indoors together constantly put pressure on our relationship,’ she says.
‘My mother had just finished her radiotherapy to treat breast cancer and was yet to go into remission. And my dad was in the latter stages of dementia – and was particularly struggling with the lockdown.’
This all led to a return of her anxiety and depression, with days full of tears, low moods, and some days not wanting to get out of bed, or talk to people.
‘I tried to counteract this by throwing myself into volunteering in the local community, and took up running,’ she says. ‘I didn’t want to restart the Citalopram as we were still trying for a baby.
‘And often, when you restart taking the antidepressants, the side effects can make you feel worse before you feel better. I didn’t want to put myself through those again, especially during a time of uncertainty.’
I was told if I was depressed, I shouldn’t have a baby
After trying for ten months, Lynsey was 39 and still no nearer to conceiving. She paid for a private ‘Fertility MOT’, which confirmed that her egg count was declining.
However, she could conceive naturally, so they carried on trying.
Unfortunately, in November 2020, her father became seriously ill with a blood clot on his lung – and he caught Covid while in hospital.
‘We didn’t think he was going to make it,’ Lynsey says. ‘He spent a month in the hospital, it was a very difficult time, and I struggled.’
So, she decided to restart my Citalopram; it wasn’t an easy decision.
By March 2021 – a year later – Lynsey and her husband underwent their delayed fertility treatments on the NHS.
However, in May 2021, Lynsey took a pregnancy test – and it was positive.
She was still taking a daily dosage of 20mg Citalopram at this point and so on receiving the news, she contacted her GP to seek advice.
‘I was advised to stop taking my Citalopram and allow my pregnancy hormones to take over, which I have done,’ she says.
‘I am now almost eight months pregnant.
‘I have read so much information about antidepressants and pregnancy, and there are many issues to consider.
‘For example, medical research suggests that (although not definitively) that taking SSRIs (the group of tablets Citalopram belong too) can increase the risk of miscarriage and premature birth.’
Lynsey feels that she has made the right decision for her.
She does say that some aspects of the pregnancy have been challenging, however, as it was deemed as high-risk pregnancy, because she is40.
‘I was anxious,’ she says. ‘And pregnancy tiredness has also had a negative effect on my mental health. However, I have tried not to beat myself up about it. If I felt tired and needed to rest, I have rested.’
She is now eight months pregnant.
‘I feel like taking antidepressants is a very personal decision,’ she says, ‘and no one should be judged for making a decision that they think is right for them.
‘You do feel judged for taking antidepressants, as I still believe there is a stigma around them.’
‘I was trolled on an article I wrote about trying for a baby and living with depression,’ she continues. ‘They wrote if I was depressed, I shouldn’t have a baby.
‘However, many people who live with depression are not depressed constantly and do recover.’
‘I think it’s important to speak openly about it because many pregnant women will find themselves in this position and not know where to turn.’
Jenni Regan, is CEO of charity London Arts and Health.
She stayed on medication throughout her pregnancy and thinks we need to get the message that ‘looking after mum first’ is the most important thing.
Jenni has lived with mental health problems since her teens, with a diagnosis of depression and anxiety.
When she got pregnant, after undergoing IVF treatment, she was working for mental health charity, Mind, and so was very aware of the issues.
Almost immediately, Jenni referred herself to the local perinatal team.
It was there that she was then given a formal diagnosis of bipolar disorder and prescribed medication, including antidepressants.
However, because she had experienced problems with infertility, when she got pregnant, she says that she felt ‘determined’ to do all she could to have a healthy pregnancy.
‘My first thoughts were that I shouldn’t be taking any medication, during pregnancy,’ she says. ‘I felt really guilty that I may be harming my baby.’
She later realised that having a healthy pregnancy involved looking after her mental health
‘I was really lucky that my psychiatrist kept giving me the message that keeping me well throughout pregnancy was the most important thing.
‘The risk of me becoming very unwell in the postnatal period was far higher than the tiny risk to the baby.’
Jenni acknowledges that she was lucky to be given a midwife who specialised in mental health, however, her IVF clinic did challenge the medication that she was on, as she had lots of contact with them in early pregnancy.
‘I know from being on parenting groups that most mothers are persuaded to come off anti depressants during pregnancy and during breast feeding.’
Jenni’s GP wanted to carry out a medication review early in pregnancy, but I requested to stay under the care of the specialists.
I have bipolar disorder and I dread to think what the outcome had been if I had been unmedicated
‘Because of the other medication I was on was anti-psychotic, both me and baby had to be monitored really carefully after the birth (my daughter for withdrawal symptoms).’
She says that this made her feel ‘really awful and guilty’.
However, they were both OK. ‘I was also monitored really closely at home the first couple of weeks after birth,’ she explains, ‘with health workers looking for symptoms of post-natal depression or worse post-partum psychosis.’
Jenni now has an eight year old daughter but says that she did feel judged for taking medication for her mental health throughout her pregnancy.
‘For me it wasn’t from medical professionals, because my care was under specialists and was very good.
‘There is still such a stigma around antidepressants, I am always hearing from people who are trying to come off them.
‘I have a long term thyroid problem, my husband has epilepsy – and we wouldn’t dream of stopping these medications.
‘In my case, my mental health problem is long and enduring and quite simply I take medication to keep me well.’
Postpartum illness can be devastating, says Jenni.
‘Working at Mind (where I ran the script advice service for soaps and dramas with mental health stories), I became involved in an EastEnders storyline around post-partum psychosis,’ she tells us.
‘I met lots of women who had developed this after giving birth. Until then, I had no idea that, as a woman with bipolar, I actually had a one in four chance of developing this illness. I had thought that depression was my only risk.
‘I dread to think what the outcome had been if I had been unmedicated.’
T’here is so much focus on keeping babies happy, however if mums are depressed or not coping this is a huge risk to the baby. We need to get the message across of looking after mum first.’
She advises seeking specialist information: ‘A specialist will ensure you are on the safest medication and on the right dose (my dosage went up as I grew!).
‘If you can get a referral to a specialist perinatal service then do but it is a bit of a postcode lottery.’
What are the risks of taking antidepressants while pregnant?
The NICE guidelines highlight that there is no confirmed definite association between the use of SSRIs in pregnancy and the incidence of malformations in the unborn child.
NICE also points out that although some studies have shown a connection between the use of SSRIs in pregnancy and an increased risk of miscarriage, preterm delivery and low birth weight, the data from these studies was conflicting.
As these outcomes are often associated with maternal depression, it may be that the latter is a confounding factor here.
When exposed to SSRIs in the weeks leading up to their birth, approximately one in three babies may show mild withdrawal symptoms, such as jitteriness, fast breathing, agitation and poor feeding.
This transient neonatal withdrawal syndrome usually disappears within the first couple of weeks without the need for treatment.
Babies that have been exposed to SSRIs in the womb after week 20 of pregnancy may have a slightly increased risk of being born with Persistent Pulmonary Hypertension of the Newborn (PPHN) which is a rare but potentially serious problem that causes breathing difficulties in the newborn.
If a mother is not treated with antidepressants during her pregnancy, the chance of her baby having PPHN is about 2 in 1000. This increases to about 3 in 1000 for those babies whose mother is on antidepressants.
It is paramount to keep in mind that although there are potential risks to treating depression with medication, there are also real risks to not treating depression.
Although we’ve already established that the risks from taking antidepressants in pregnancy are rare, there is no medicine that is completely free of risk.
Women should discuss any doubts or concerns with their own health care professional, who should be aware of their medical, emotional and social history.
If there are concerns about the safety of their current antidepressant, switching to a different one may be possible.
In most cases, it is thought that the benefits of treating depression/anxiety with antidepressants in pregnancy outweigh the risks for both mother and baby.
Source: Lesley Gilchrist, registered midwife and co-founder of My Expert Midwife.
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