Psychiatric medication in pregnancy: difficult decisions

“Nine months is a very long time if you are depressed or anxious.”

To take medication or not to take medication; for some women with mood disorders, this can be the most difficult decision they will make during their pregnancy.

“Moms & Meds: Navigating Pregnancy and Psychiatric Medication” is a newly-released documentary film that explores the options women face when they want to have children, but take psychotropic medication for mental illness. The film follows multiple women as they attempt to navigate the conflicting attitudes surrounding this issue.

Each expectant mother’s tale is different but they all have a common theme, namely, the difficulty of making the correct choice for them when it comes to treating their psychiatric disorder during their pregnancy. One participant in the documentary describes it as “an out-of-body experience”.

The documentary clearly illustrates the difficulties women with mood disorders encounter when faced with this difficult decision. Conflicting advice means there is often no clearly defined path. Many women are inadequately informed as to what their best options are if this turns out to be the case. Women describe their efforts in seeking medication that wold not cause harm to their baby, but being invariably steered away from medication and told to consult with a psychiatrist. Yet the psychiatrist’s view can often contrast with the views of a family physician or obstetrician.


Within the documentary, Dr Stephen Contag, a Maternal and Foetal medicine expert at Sinai Hospital in Baltimore, Maryland, explains that likelihood of encountering a mood disorder when pregnant is “significant”. These can range from anxiety disorder, to mild or severe depression, bipolar disorder, or psychosis.

According to Dr Contag, there is far from a clear consensus in the medical community on definitive advice for expectant mothers unsure as to whether to start, stop, or continue taking medication.

Psychologist Elizabeth Fitelston, of the Department of Psychiatry at Columbia University in New York City, says that this is a rapidly growing field, with much more evidence emerging on the effects of stress in pregnancy on both mother and baby in the short and long-term, as well as the effects of medication taking during pregnancy.

Fetelson adds that she believes it’s not risk/benefit – rather it is “risk/risk”; “Where there’s illness, there’s risk… there’s not a one-size-fits-all algorithm for decision-making, you have to look at the individual person.”

Minimising medication exposure is key, as well as maximising non-pharmacological options that may help, she says, adding that the risks of medication and the risks of untreated illness are both significant. “The worst of both worlds.”

There is a tendency to dismiss mental illness in pregnancy, as it is not visible; “mood disorders in pregnancy is not simply hormonal changes in pregnancy that can be written off,” explains Dr Contag. “These are real conditions… these are by definition high-risk pregnancies.”

Watch the trailer below:

Read more about the documentary here.


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