Six Things You Should Know About Antidepressants and Pregnancy

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antidepressants pregnancyIn light of the recent uproar over the article on antidepressants and pregnancy that was published this week on the New York Times‘ Well Blog, I thought I would pause today on the unknowns that likely burden every single mom who suffers with a perinatal mood or anxiety disorder like PPD.  There is so much mixed-up and contradicting information out there: co-sleep/don’t co-sleep, breast-is-best/healthy mom-is-best, have a birth plan/let go of the birth plan; cloth diaper/disposable diaper; medicine for depression and anxiety is safe/medicine is not safe.  As if being a mama wasn’t confusing already, all of this conflicting info is enough to make a mama’s head take a double-spin.  And its exhausting!

Those of us who specialize in perinatal mental health wish more than anything that there were more “knowns” for you- that there was one right answer for everyone so that we could take the burden away from you for having to figure it all out.  And we know that when you are tired and anxious and overwhelmed and unsure there is nothing more difficult than having to make a decision when the information is complicated and so much unknown exists in the midst of it all.  Truthfully, it’s not okay that we don’t know more and we need to keep on doing the research necessary to continue to build toward more clarity.

So, what I want to say to you is this: If you are frustrated, we get it.  If you are confused, it makes sense.  If you are angry, you get to be angry.  And if you have questions, ask them.  When you reach out for help from a trained professional you have a right to know their expertise, their commitment to best practice and professional development, and their loyalty toward helping YOU decide what the best course of action is for your particular situation.  Not every mom with postpartum or antenatal depression or anxiety will end up including medicine in her treatment plan, but many will.  And those of us out there rooting for you and your babies understand the trust that you put in us to help you decide what is the safest and most appropriate way to help your family thrive.

So, to summarize what I consider to be some of the most important parts of the beautifully written response to the New York Times story on antidepressants and pregnancy from PSI, here are six important facts:

  1. It is not possible or appropriate to make one blanket statement regarding the use of SSRI medication during pregnancy (or breastfeeding).  These decisions need to be made on a case-by-case basis and must take into account each mom’s unique symptoms and family picture.
  2. While there has been some research that suggests that SSRIs may not be safe to take during pregnancy, there is more research to suggest that they are.  And, when we look closely at this research, the statements made to suggest that SSRIs are dangerous to a fetus are selective and do not account for the whole picture.  Another way of saying this is that many of these studies you sometimes see covered by the media are not “clinically sound.”
  3. Untreated and under-treated perinatal mood and anxiety disorders can have significant negative effects on a developing baby’s social, emotional, and cognitive development.  This, by the way, is rarely if ever debated.
  4. Sometimes lifestyle changes like increased sleep and nutrition or non-pharmaceutical treatments like acupuncture and light therapy help a mom recover from her symptoms, but sometimes they do not and a more involved treatment like psychotherapy or the use of an SSRI is required for a mom to be well.
  5. Taking an SSRI medication during pregnancy under the guidance of an appropriately trained clinician is not irresponsible.
  6. There is most definitely some “gray area” when it comes to the use of SSRI medicine during pregnancy and breast-feeding.  And many of us are uncomfortable with the “grays” and want instead for there to be more a more black-and-white, clear answer to these things.  While this gray area can be confusing, however, it does not need to be as scary as the New York Times suggests.  Instead, we can try and think of the gray as a place for options….

So, moms:  On behalf of all of the appropriately trained perinatal mental health specialists out there, we know that these decisions are hard for you and that the choice of whether or not to take medicine while you are pregnant or lactating is rarely simple.  We believe that you want what is best for your baby (and so do we!) and we are confident that the choices that you make that lead you to wellness will undoubtedly benefit your kiddos in the long run.  We will continue to research and understand the role of pharmaceutical medicine in the treatment of perinatal mood and anxiety disorders and will advise you on best practice and sound clinical knowledge.  We will not mislead you.  We will let you know what we don’t know, but we will also let you in on what we do and we will do this with educated knowledge and research-based understanding.  And, we know that this does not feel easy, although we wish that it were.  But you have our promise to continue to learn and push and stand by your side as you do what is required to be your best self.  For you and for your baby.

~ Kate Kripke, LCSW

 Photo credit: © Valua Vitaly – Fotolia.com

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CALL FOR SUBMISSIONS: Submit Your Story for New Postpartum Anthology

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postpartum depression storiesApproximately 1 in 7 women suffer from postpartum depression after having a baby. Many more may experience depression during pregnancy, postpartum anxiety, OCD, and more. Postpartum depression is in fact the most common pregnancy-related complication, more widespread than gestational diabetes, preterm labor, or pre-eclampsia. Yet confusion and misinformation about postpartum depression and anxiety are still widespread. Myths surrounding mothers’ mental health challenges can have devastating effects on women’s well-being as well as their identities as mothers, too often leading to shame and inadequate treatment. Although postpartum and antenatal depression and anxiety are temporary when treated, untreated mood disorders can lead to long-term consequences for both a mother and her child. A mother can feel very alone, ashamed, and hopeless. And keep silent.

Mothering Through the Darkness: Stories of Postpartum Struggles will be a unique anthology with the goal of breaking that silence. With this collection of essays, the HerStories Project will try to dispel these myths and focus on the diversity of women’s experiences through the voices of mothers themselves. Mothering Through the Darkness will be the third book published by HerStories, which has already published The HerStories Project: Women Explore the Joy, Pain & Power of Female Friendship and My Other Ex: Women’s True Stories of Losing & Leaving Friends (to be released on September 15th).

The HerStories Project is thrilled to be partnering with and supporting Postpartum Progress with Mothering Through the Darkness. Ten percent of the profits from the sales of the book will go toward the nonprofit organization’s mission of supporting maternal mental health.

For this anthology they now have opened submissions and are seeking unpublished, first-person essays from mothers about their experiences with postpartum depression, anxiety, or other mental health struggles during or after pregnancy. They’re looking for well-crafted, true accounts that explore and examine aspects of this experience. Submissions must feature a strong and compelling narrative. They’re looking for well-written prose, rich detail, and a strong, distinctive voice.

Essays submitted for the book and the HerStories Writing Contest (learn more about the contest below) will be judged by the editors of the HerStories Project, as well as several talented writers listed below whose lives as mothers or as clinicians have been affected by postpartum depression and anxiety. Essays will be judged on their emotional power, originality, and quality of their prose.

Guidelines

Previously unpublished and between 1,500 and 3,000 words. Please also submit a short bio of 50-100 words, including whether you’ve appeared in other publications.

Deadline

December 1, 2014

The Writing Contest

Your submission to Mothering Through the Darkness can be, if you choose, simultaneously entered into the first HerStories Project Writing Contest. The HerStories Project will award $500 to one submission for Best Essay and $100 to two runners-up. All three essays will be published in the book, and each winner will receive a paperback copy.

To cover the costs of sponsoring the contest, they are asking for a $10 reading fee with your submission. If this fee presents a financial hardship in any way that would otherwise prevent you from submitting an essay, they will waive this fee and this will not affect the status of your entry. Again, you do not need to enter the Writing Contest to submit to the Mothering Through the Darkness book.

Writing Contest Judges

Katrina Alcorn is the author of Maxed Out: American Moms on the Brink. She is a writer and a design consultant. She holds a master’s degree in journalism and documentary filmmaking from UC Berkeley and blogs at WorkingMomsBreak.com.

Lisa Belkin is the Senior National Correspondent for Yahoo News. Previously she has held staff positions at the New York Times and The Huffington Post. She is the author of three books, including Life’s Work: Confessions of An Unbalanced Mom, and the editor of two anthologies.

Julia Fierro is the founder of The Sackett Street Writers’ Workshop. A graduate of the Iowa Writers’ Workshop, she recently published her first novel, Cutting Teeth, an Oprah Pick of the Week.

Kate Hopper is the author of Ready for Air: A Journey through Premature Motherhood and Use Your Words: A Writing Guide for Mothers. Kate holds an MFA in creative writing from the University of Minnesota and has been the recipient of a Fulbright Scholarship, a Minnesota State Arts Board Grant, and a Sustainable Arts Grant. She teaches classes and holds retreats for mother writers.

Lindsey Mead is a corporate headhunter with an MBA from Harvard who also writes for her popular blog, A Design So Vast. Her work has been featured in numerous anthologies

Jessica Zucker, PhD is a psychologist specializing in women’s reproductive and maternal mental health. A consultant to PBS’ This Emotional Life and the Every Mother Counts campaign with Christy Turlington, she has been a contributor to NPR and is currently writing her first book for Routledge on maternal attachment

How To Submit

Click here to submit your essay for consideration. For more information, visit the HerStories Project website.

 

Photo credit: © tashatuvango – Fotolia.com

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Off to Preschool: Postpartum Depression Milestones

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I tearfully sent off my nearly DSC01078four-year old PPD baby to preschool yesterday.  She beamed with excitement and pride as she marched off to “big girl” school with her older sister, a first grader.  I spent my day alternating between sorrow and happiness.  My sweet baby girl is no longer a baby.  My postpartum depression and postpartum anxiety manifested itself in a hyper connection with her.  I worry that I have damaged her by being so sick the entire first half of her first year of  life.

I felt so helpless as I saw her uncertain face and her tiny hand waving at her dad and I as we dropped her off. I wanted so badly to take her in my arms and just keep her small.  This childhood transition rocked me to my core.  It exposed all of those old feelings of inadequacy, guilt and shame that ruled my psyche with an iron fist during my darkest days.  I decided instead to write a long letter to my daughter’s teacher.  I wanted this new teacher to understand how sometimes my early experiences of being my baby girl’s mom cloud my perception.  My sweet girl loved her first day, and she told me all about it for a half hour.  Her joy and excitement were contagious.  Her favorite part of her day was music class.  She skipped into school this morning with the confidence of someone twice her age.  I know that she knows how much I love her.  I hope that she always remembers that.  I will keep reminding myself to give myself grace during these milestones and transitions.  I am a good enough mom, and I am exactly the mom my sweet girl needs.

I offer this to my fellow Warrior Moms.  Give yourself grace during these childhood transitions.  Know that you are exactly the mom that your baby needs.  No one else can take your place.  Do not forget to bring Kleenex and sunglasses so that your baby will see your lovely smile behind the tears.

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New York Times’ Biased Reporting On Antidepressants And Pregnancy Hurts Moms

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On September 1st, the New York Times published a misleading and irresponsible article on antidepressants and pregnancy: Possible Risks of Antidepressants to Newborns. It was published in print on September 2 as well with the headline “Pills May Put Babies At Risk,” though if you read the article there’s no “may” about it, but instead lots of research showing children of moms who take SSRIs are probably in very big trouble. Below in its entirety is a response to the article put together by Postpartum Support International. I’m sharing it in full at their request.

We write on behalf of Postpartum Support International (PSI), the leading organization dedicated to helping women suffering from perinatal mood disorders, and to educating families, friends, and healthcare providers so that pregnant and postpartum women can get the support they need to recover.

As a group, we are deeply concerned by Roni Caryn Rabin’s inaccurate and dangerously biased piece in the New York Times’ Well blog on September 01, 2014:  http://nyti.ms/1no0Boy.  Her article is likely to foster unnecessary fear among women who struggle with mood disorders who plan to become pregnant, are pregnant, or are in the postpartum period. The implication that women idly choose to start or to remain on antidepressants, such as Selective Serotonin Reuptake Inhibitors (SSRIs), or any other medication during pregnancy is insulting and demeaning. Women who, under a healthcare provider’s care, choose to remain on medication do so to counter moderate to severe depression or anxiety symptoms that would otherwise render them functionally impaired.

Rather than refuting the Rabin piece line by line, we will simply address the key inaccuracies. Please refer to the PSI website at http://www.postpartum.net for further information and for resources and referral options for those suffering from perinatal and postpartum mood disorders in the U.S. and other countries.

The author has chosen to cherry pick studies to support her misguided, inaccurate hypothesis, and ignored studies that failed to find increased risks associated with SSRI use in pregnancy. Rabin failed to quote any reproductive psychiatrists, who specialize in this field and work on a daily basis with women suffering from various mood disorders before, during, and after pregnancy. Instead, she chooses to quote a non-physician, Dr. Mintzes, who lacks the psychopharmacologic training and experience necessary to make such global claims. Statements made by Dr. Mintzes are inaccurate and amount to fear mongering.

In terms of the assertion that fetal exposure to SSRIs increases the risk of birth defects, including but not limited to cardiac defects, this is an antiquated and now disproven theory. There are many highly reputable studies that have failed to find any associated risk. Every pregnancy has a 3-5% risk of resulting in major malformation, and study after study has failed to find any increased risk of such major malformations after exposure to any SSRI.

Regarding Rabin’s assertion that SSRIs result in cardiac problems in infants, studies have found that there is no relationship. One study, published in the American Journal of Psychiatry in 2008 followed over a thousand women. The findings were that there was no increased risk of heart defects associated with Paxil. A recent large scale study published in the New England Journal of Medicine in June of this year concluded that the results of this large, population-based cohort study suggested “no substantial increase in the risk of cardiac malformations attributable to antidepressant [including Paxil] used during the first trimester.” (Funded by the Agency for Healthcare Research and Quality and the National Institutes of Health – Huybrechts et al. NEJM June 2014)

Furthermore, the FDA warning that was initially posted in 2005 regarding risk of cardiac defects associated with Paxil exposure in utero has not been changed despite the FDA recanting the warning in other press releases.

Ms. Rabin also quotes a Norwegian study by Skurtveit and suggests it is a definitive finding regarding language acquisition deficits in three year olds as a result of long term SSRI use in pregnancy. However, upon close reading of this paper, it is apparent that the findings are anything but certain. Instead, only 386 of 51,748 women surveyed (0.7%) used SSRIs during pregnancy, and of these, only 161 reported long-term use. This is a very small number of women and the results were marginal at best.  Forming any conclusions regarding SSRIs during pregnancy is dangerous and inappropriate.

Another risk referred to in the article is Poor Neonatal Adaptation Syndrome. A small minority of babies experience self-limited symptoms of PNAS following in-utero exposure to SSRIs. To equate those rare cases to the withdrawal of babies from addictive substances taken by drug-abusing mothers is misguided and dangerously misleading and reveals a bias in the author.

The PNAS and Persistent Pulmonary Hypertension of the Newborn (PPHN) study from 2006 quoted in the piece as definitive has been followed subsequently by many other studies that have clarified the risk to be quite small and not significant enough to warrant stopping necessary medication.

There are further inaccuracies reported in Rabin’s piece. The risk of prematurity from exposure to SSRIs in utero is minimal at best. Studies found that mothers taking SSRIs might deliver one week early, which is still considered full term.  Women are routinely under-treated for depression and anxiety during pregnancy as a result of unfounded fears, such as the ones propagated by Rabin’s article. Anxiety and depression can cause an early labor.

In terms of the risk of neurodevelopmental delays and autism as a result of SSRI exposure, there have been many studies that fail to show such associations. The research consistently finds that any potential increased risk is based primarily on the underlying psychiatric illness being treated, not from the medications directly.

While multiple ‘risks’ of exposure to SSRIs were highlighted in Rabin’s article, the well-established and repeatedly documented true risks associated with fetal exposure to untreated depression and anxiety were systematically glossed over. Depression during pregnancy increases the risk of prematurity 2-3 fold. Depression and anxiety during pregnancy also profoundly increase the risk of postpartum depression, which may have profound negative effects on both the baby’s and any siblings’ development (Pilowsky et al 2008).

In contrast to this poorly researched, biased article that fails to inform accurately, the New York Times effectively documented the potentially devastating consequences for mother, baby, and family from under-treated peripartum and postpartum illnesses in the series of articles released in June 2014 by Pam Belluck.

As an organization comprised of clinicians, researchers, families, and advocates who strive to help women, babies and families, the Postpartum Support International community is profoundly disappointed in the New York Times’ biased and inaccurate reporting. Women suffering from perinatal mood and anxiety disorders must be supported, and treated, not shamed. No clinician prescribes any medication in pregnancy without an appreciation that the risks of the untreated illness are far greater than any risk associated with medication being prescribed. Women rarely choose to take medication during pregnancy if they can avoid doing so; however, pregnancy is hard on its own, and pregnancy for women suffering from perinatal mood and anxiety disorders can be painful beyond words.

There is no excuse for such reporting that clearly seeks to dissuade women from getting the treatment they require. There are horrible stories in the news regularly that document the risks of untreated perinatal illness for mom and her children. Why these inexplicably sad outcomes cannot be seen as a reason for treatment is truly beyond comprehension.

Yes, risks exist from exposure to SSRIs in pregnancy. However, these risks must be put in context and compared fairly with the potential devastating effects of untreated maternal illness. Such a risk versus benefit analysis occurs daily among women, their partners, and clinicians. Rather than condemning the choices made, it is about time for society to support these women and show compassion for the painful ordeal they are experiencing by virtue of suffering from a perinatal mood and anxiety disorder.

Ann D. S. Smith, CNM, PSI President

Carly Snyder, MD, PSI Research Chair

Catherine Birndorf, MD, PSI President’s Advisory Council

Adrienne Einarson, RN, Reproductive Psychiatry Group Founder

Editor’s note: The original version of this letter as it was submitted to us and published stated that Dr. Urato is not a not a physician. This is incorrect. The letter meant to state that Dr. Mintzes is not a physician, and has now been corrected to reflect that. 

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