Psychiatric Medications in Pregnancy

By
Shannon M. Clark, MD
|
February 4, 2022
Psychiatric Medications in Pregnancy

Mental health, psychiatric medications, and pregnancy

Though resources and information are increasing, it is still difficult to find evidence-based information on the management of mental health disorders in pregnancy, especially when the pregnant individual needs medications. Some individuals are on medications before pregnancy, and others will be started on medications during pregnancy. Either way, having an obstetrical care provider who is knowledgeable about management of mental health disorders in pregnancy, as well as the medications needed to treat the individual, is crucial.


I sat down with a reproductive psychiatrist, Dr. Kristin Lasseter, for an in-depth conversation on this topic.

We discuss the following:

  • Impact of maternal psychiatric illness
  • Consequences of lack of treatment or under-treatment on pregnancy outcomes
  • General treatment concepts
  • Specific meds for treatment of depression, bipolar disorder, anxiety, schizophrenia, and ADHD
  • Recommendations from MFM and psychiatry
  • Resources: MCH Center of Women's Health, Mother To Baby, Postpartum Support International
Psychiatric medications in pregnancy

Jump to these topics within the conversation:

  • 8:13 When to have the conversation with a healthcare provider about pregnancy and psychiatric medications
  • 12:22 The consequences of untreated mental health disorders including depression, bipolar disorder, and schizophrenia
  • 17:17 Depression medications and pregnancy
  • 22:20 Postpartum depression risk
  • 25:00 Tricyclic antidepressants
  • 31:45 Lithium and pregnancy
  • 41:45 Anxiety disorders and medications
  • 46:00 PTSD and treating underlying disorders that lead up to anxiety
  • 53:00 Treating ADHD in pregnancy

Stopping psychiatric medications for the sake of the pregnancy is not the answer

As OBGYN, I have heard other providers tell patients to stop taking psychiatric medications cold-turkey as soon as the patient becomes pregnant. They say this because they are concerned about the medications’ effects on the fetus. However, just because a person is pregnant does not mean that the pregnant individual can handle being off medications nor do mental health disorders go away with pregnancy.

With a pregnancy, there are two people to think of—the pregnant person and the fetus.

As Dr. Kristin Lasseter says in our conversation, “Even if you’re thinking about the fetus, it’s important to remember that the illness itself is actually more risky for the fetus than the medication itself.”

Resources

If a person becomes pregnant and is on psychiatric medications, she recommends they use these specific websites to find the best information possible:

Your OBGYN or psychiatrist can call the postpartum support international (PSI) line and get a second opinion about staying on medication during pregnancy. This line offers specific information from those who are specialized in this subject.

Learn more from Dr. Lasseter!

You can learn more from Dr. Lasseter on Instagram at @the.reproductive.psychiatrist. If you are local to Austin, TX, you can also check out her clinic, RPC Austin.

Shannon M. Clark, MD

Shannon M. Clark, MD

Shannon M. Clark, MD, MMS is a double board certified ObGyn and Maternal-Fetal Medicine Specialist, and founder of Babies After 35. In her roles as a clinician, educator and researcher at UTMB-Galveston, she focuses on the care of people with maternal and/or fetal complications of pregnancy. Dr. Clark has taken a special interest in pregnancy after the age of 35, which according to age alone, is considered a high-risk pregnancy.

Follow Shannon on TikTok @tiktokbabydoc, Facebook @babiesafter35, and Instagram @babiesafter35.

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