Mental Health Monday–Pregnancy

From time to time, we have pregnant women on the inpatient unit for treatment. It’s always a delicate situation because we not only have the woman’s life to think about, but also her unborn child (or children in the case of twins).

Research-based information is limited because it’s not really kosher to do experiments on pregnant women or children, so making recommendations for medications can be complicated.

For pregnant women who have mild to moderate symptoms of depression and anxiety, the first line of treatment is psychotherapy.

However, if the mom-to-be has severe symptoms of mania (grandiosity, pressured speech, increased risk-taking and pleasure-seeking behavior, lack of sleep, distractibility), depression (to the point where she’s suicidal or not eating or not sleeping, etc), or psychosis (with symptoms of hallucinations, delusions, and disorganized thinking), it’s important to get her treatment IMMEDIATELY!

Generally, treatment for moderate to severe depression and anxiety includes therapy PLUS medications, namely SSRIs like Prozac and Zoloft, and Benadryl for sleep (because sleep disturbance is common). For mania or psychosis, antipsychotic medications such as Haldol or Zyprexa are used to treat symptoms.

If mom-to-be isn’t eating or drinking, if she’s catatonic (not moving, talking, or communicating), or isn’t responding to medication treatment, ECT (Electroconvulsive Therapy) can be used. ECT is actually safer than medications, however, because of a lot of stigma, is usually used if other treatments fail.

We do have some information about certain medications that can cause birth defects and developmental issues in unborn children. Lithium can cause heart defects if used in the first trimester, Depakote and cause neural defects, Paxil can cause pulmonary hypertension.

SO, it’s UBER important to discuss the pros and cons of medications with a pregnant woman.

BOTTOM LINE: Studies have shown that STABILIZING MOM-TO-BE’S MOOD IS THE MOST IMPORTANT FACTOR IN HAVING A SUCCESSFUL OUTCOME. If mom-to-be isn’t doing well, it’s less likely that her child will do well. In that sense, the potential benefit of medication outweighs the potential risks.

Remember, these posts are for writing purposes ONLY and are NOT to be construed as medical advice or treatment.

Check out Lydia’s Medical Monday and Sarah Fine’s The Strangest Situation.


7 comments on “Mental Health Monday–Pregnancy

  1. Sheri Larsen says:

    I can only imagine the difficulty in caring for a pregnant woman in any of these conditions. It must be tough, not to mention gut-wrenching.

  2. amie borst says:

    this is a part of mental health that i’d never considered before. thanks for the information!

  3. This reminds me of the fiasco that Tom Cruise started when he said that Brooke Shields (who had post-partum depression) was just suffering from a lack of good vitamins. For the record…I think that Tom Cruise is a tool.

  4. Linda Gray says:

    First, I agree with Michael about Tom Cruise 🙂
    What a dilemma to be faced with as a mental health care professional! You deal with some major serious stuff, Laura. Thanks for talking about this and giving us insight into the big issues. Two questions: what is included in “pressured speech?”, and, when you say the outcome for the child is better if the mom is doing well emotionally during her pregnancy, do you mean physical outcome? Thanks–great post!

  5. Karen Lange says:

    Good advice. Thanks for sharing your wisdom!

  6. Vicki Tremper says:

    Lots of plot ideas now pinging around my brain. Thanks for that! I think that every woman is different, and every woman’s needs are different. No one else gets to judge those needs.

  7. Very interesting info. Great post!

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