Mental illness is common in the United States. In fact, according to the National Alliance on Mental Illness, approximately 1 in 5 adults experiences mental illnesses, such as anxiety, depression, schizophrenia, and bipolar disorder, each year. Whether you have experienced psychiatric illness all of your life, or you develop psychiatric illness as part of your pregnancy or postpartum experience, you do not have to suffer. There are safe ways to cope with many psychiatric illnesses and still have a healthy pregnancy, birth, and breastfeeding relationship with your baby.
What drugs are safe?
If you are already taking medication to treat a psychiatric disorder, you might wonder if it is possible for you to continue to take that medication during your pregnancy and while breastfeeding, as well as what the effects of going off of the medication might be. The best thing to do is to consult with your doctor or midwife and your psychiatrist. Often medical providers are cautious about drugs during pregnancy, which is mostly because there is not very much research that demonstrates drug safety or lack thereof in pregnant people. You might need to advocate strongly for yourself or even seek out different care providers who are more experienced treating pregnant women with mental illness. It is okay to be persistent until you are satisfied with your care.
In 2015, the Food and Drug Administration in the United States, which used to classify medications and their safety during pregnancy on a graded scale (A, B, C, D, X), updated their guidelines to require drug manufacturers to include specific labeling to address concerns of people who want to have a baby. And more and more is discovered every day about what drugs are safe or not during pregnancy and breastfeeding. For instance, we know now that taking one of several antidepressants is relatively low risk (you can read more about the specifics in this The Pulse blog post). But some medications like valproate, which is commonly used in the treatment of bipolar disorder, carry large risks for the fetus’s physical and cognitive development, and should be avoided if possible.
Researchers also know that treating mental illness during pregnancy and breastfeeding is generally better for both mom and baby than leaving the illness untreated. In making decisions about what medications to take during pregnancy, it is important to weigh the risk of taking the medication versus the risk of leaving the disease untreated. If you are taking medication for a psychiatric illness, but you have had periods of wellness in the past that you have successfully gone off the medication, it might be possible for you to go off it during pregnancy, but that is something to only try with the support of your care providers.
Other Therapy Options
Drug therapies, while effective, are not the only option for treating psychiatric illness during pregnancy and breastfeeding. In a meta-analysis that assessed the effectiveness of non-pharmacological therapies on treating depression and anxiety pre- and postpartum, researchers from The Netherlands found that cognitive behavioral therapy, interpersonal psychotherapy, and acupuncture were all effective to varying degrees in treating depression.  In cases of severe psychiatric illness, electroconvulsive therapy may also be effective.
Many other types of psychotherapy exist and may be helpful for treating psychiatric disorders during pregnancy and breastfeeding. Individual therapies include dialectical behavioral therapy, psychodynamic psychotherapy, eye movement desensitization and reprocessing, and solution-focused brief psychotherapy. Couples and family therapy may also be helpful tools, as are community or group therapy.
Developing a personalized plan
Regardless of the severity of your psychiatric illness, it is a good idea to start thinking about how the emotional and physical challenges of having a baby will affect your mental and physical health before conception. Other considerations that your care providers can help you think through include:
- Planning for parenthood
- Balancing hormones
- Individual risk of relapse
- Optimizing physical health
- Maximizing sleep
- Understanding genetic risk factors
- Accessing other support services
Some evidence shows that having support from your partner and family can help reduce severity of perinatal mental illness. Consult with them and with your care providers to make a plan for how to best care for yourself and your baby.