Speaking Up About Depression in Pregnancy

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S T O C K Y O U R M E D I C I N E C A B I N E T F O R I N S T A N T C A L M

Imagine this: You open your bathroom cupboard and spot your pill bottles and bandages neatly nestled in baskets, The Home Edit – style. No one wants to get sick, but stocking up on and organizing the essentials will leave you covered if your family comes down with a cold or a stomach bug . When you have time, sweep for these basic supplies and pick up anything missing the next time you’re at the store: thermometer; OTC meds such as fever reducers, pain relievers, decongestants, antidiarrheal, antibiotic ointment, and antihistamines; throat lozenges; tissues; bandages; gauze; and tweezers.

Never run out of bandages, thanks to the Welly Excursion Kit. It’s stuffed with all the goods you need to clean up cuts and scrapes. $40; getwelly.com

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F R E E Y O U R S E L F F R O M Y O U R D E V I C E — Y O U M I G H T E V E N R E D U C E A N X I E T Y

Your phone, the frenemy: It keeps you connected, lets you work from anywhere, and helps you take a gajillion cute snapshots of your kids. But studies show that compulsively checking your phone can wreak havoc on your posture, productivity, attention span, and relationships. To turn down the compulsion dial, disable push notifications, says Larry Rosen, Ph.D., a research psychologist and author of The Distracted Mind. “Those alerts—a new friend request! a social media post!—create a false sense of urgency that can fuel anxiety,” he says. In each app’s settings, swipe to disable those pop-ups and dings. The updates and new posts will still be there—when you decide to give them your attention.

Make fruit fun again.

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S H A K E U P Y O U R A P P R O A C H T O P R O D U C E : I T ’ S D E L I C I O U S A N D G O O D F O R Y O U

For every additional serving of produce you eat each day, you may reduce your risk of heart disease by 4 percent, found a study in the British Medical Journal. But if you’re bored out of your gourd by apples or baby carrots, switch up your prep game. “I recently discovered a newfound love for smoothies, which are an amazing way to add tons of fruits and veggies,” says Parents advisor Dalina Soto, R.D., a nutritionist in Philadelphia. “And I’m obsessed with everything bagel seasoning—I always add it to roasted or sautéed veggies.” Stock up on frozen produce so you always have fruits and vegetables on hand, and don’t overlook the deliciousness of a fruity dessert. “My family loves berries with whipped cream,” Soto notes.

Rescue produce that’s deemed too ugly for stores and try some out-of-yourcomfort-zone fruits and veg with a delivery service like Misfits Market. Prices vary; misfitsmarket.com

Women of ten feel pres su re not to ta ke a d rug for depres sion or a n xiety—a nd yet doctors say no one shou ld have to choose between her ow n hea lth a nd her baby ’s.

by V I R G I N I A S O L E - S M I T H / illustrations by B I J O U K A R M A N

W H E N E M I LY, a mom of three in Atlanta, became pregnant with her first daughter, she says her doctors acted as though “it was a given” that she would immediately stop taking the combination of Zoloft and Xanax she had used for years to manage her chronic depression and anxiety.

“When I asked whether I could keep taking them, they treated me like a heroin junkie or something,” recalls Emily, now 28, who asked to use only her first name. “I did stop, but I was submitted to a drug test at every prenatal appointment even though I’d never used recreational drugs in my life. The message was, ‘Be quiet, you’re fine, think of the baby.’ ”

Emily didn’t feel fine. She spent her pregnancy in a deep depressive state and in her final trimester began wrestling with suicidal thoughts. At the sixweek checkup after giving birth to her daughter, Emily saw a different doctor, who recognized her symptoms as signs of severe postpartum depression. The doctor suggested Emily begin taking medication again, which she did.

But during her second pregnancy and when she became pregnant for a third time, in 2018, Emily decided to pause taking her prescribed medicine again.

“I didn’t want the very accusatory questions at every appointment, so I just shut up,” she says. “I thought, ‘This is what pregnancy is like. Being this sad is the norm, and I just have to get through it, even though my anxiety is so high, it feels as if I’m trying to crawl out of my own skin.’ ”

Five months into Emily’s third pregnancy, her dad died unexpectedly, an event she says solidified her need for help and her resolve to ask for it. Emily met with her doctor, who wrote a new prescription for Lexapro, a selective serotonin reuptake inhibitor (SSRI) used to treat anxiety and depression, which she had been taking with great success prior to getting pregnant. “It was such a relief to finally be heard—and to feel better.”

A Shift for Doctors

“For too long, the attitude has been that medicating psychiatric illness during pregnancy is optional and even selfish,” says Parents advisor Alexandra Sacks, M.D., a reproductive psychiatrist and author of What No One Tells You: A Guide to Your Emotions From Pregnancy to Motherhood. “We need to reframe this. Being proactive about your menta l health is responsible, not selfish.”

Psychiatric illnesses complicate an estimated 500,000 pregnancies each year, making them one of the most common health concerns facing moms-to-be. Nevertheless, prenatal health-care providers are often reluctant to write prescriptions for antidepressants, mood stabilizers,

and other mental health medications because they frequently don’t have enough data about how the medications can affect a developing fetus. Most FDA-approved drugs (not only antidepressants) for adults are, by extension, approved for those who are pregnant even though there is very little pregnancy-specific data available. For example, 90 percent of drugs approved since 2010 have no human data on pregnancy.

In many instances, doctors must rely on small case studies involving only a handful of patients or testing on animals. When guiding women in choosing medication during pregnancy, doctors often have to compare similar drugs, with data available for only one. Lexapro, for example, hasn’t been studied for risk of birth defects, but no risk is associated with Celexa, a similar antidepressant, which has not been associated with birth defects in human studies, though some research shows that taking it during the third trimester may slightly increase a baby’s risk for lung complications or cause mild withdrawal symptoms in the first few days of life.

The lack of safety data is a problem for drugs that treat any medical condition that persists into pregnancy, especially when uncertainties about safety lead to reluctance to treat medical conditions that may harm women and their babies. However, this is particularly true for untreated depression, which is associated with worse pregnancy outcomes, such as giving birth prematurely or the baby being too small at birth. Mental health conditions often worsen during pregnancy and in the postpartum months because of hormone f luctuations. In fact, as many as one in five women suffer from mood or anxiety disorders during pregnancy, regardless of whether they had them before. Research has a lso found that anxiety, depression, loneliness, and post-traumatic stress in pregnant and postpartum women have been significantly higher during the pandemic, underscoring the need for studies that will give doctors and women the information they need to make the informed choices about their mental health treatment in pregnancy.

A Legacy of Omission

“Pregnant women have largely been excluded from pharmaceutical research, even for medications they would benefit from and are likely to end up using anyway,” says Anne Drapkin Lyerly, M.D., an ob-g yn and professor in the department of social medicine for the Center of Bioethics at The University of North Carolina at Chapel Hill. This is because clinical trial regulations passed in the 1970s prohibited women with “reproductive potential” from participating in early-phase clinical trials in order to avoid the possibility of birth defects—effectively stopping all drug research on women between the ages of 18 and 45. It wasn’t until the early 1990s that researchers began to question that logic. “Female bodies are not just sma ller ma le bodies, especia lly when they ’re pregnant,” Dr. Lyerly explains. “Given the physiological differences, they process drugs differently too. So if you’re going to prescribe medications for women, you should test them in women, rather than extrapolate from the data you’ve collected from men.” In 1993, Congress passed legislation requiring drug researchers funded by the federal government to include women

“My obstetrician was saying, ‘You should talk to your psychiatrist about this,’ and my psychiatrist was saying, ‘Talk to your obstetrician.’ ”

(as well as people of color) in clinical trials, unless they could prove that the medication would have no applications for women’s health (such as a drug to treat prostate cancer).

“But pregnant women were still largely left out of the equation. For one thing, they were considered a vulnerable population along with children, prisoners, and people with intellectual disabilities. This had a chilling effect on research because there was fear that it was unethical to include pregnant women in clinical trials,” Dr. Lyerly says. This has left “pregnant women with the terrible choice of using a medication that may be dangerous or ineffective, or not using it and exposing themselves and their fetus to the risks of their disease.”

Dr. Lyerly disagrees with the notion that “ethics” is what keeps pregnant women out of drug trials: “In fact, ethics demands that we do this research because without it, we don’t know whether drugs are safe or even dosed correctly,” she explains, emphasizing that “pregnant women deserve care that is based on evidence, and access to medications and treatments that will optimize their health as well as the health of their baby.”

Caroline, a mom of two in Clinton, South Carolina, who had a psychotic break and was diagnosed as bipolar a year before becoming pregnant with her now 10-year-old, remembers the conf licting direction she received while pregnant. “My obstetrician was saying, ‘You should talk to your psychiatrist about this,’ and my psychiatrist was saying, ‘Talk to your obstetrician.’ They kept kicking it back and forth, and neither one would say what I should do.” Ultimately, Caroline (a pseudonym) decided to stay on both the antidepressant Prozac and the antipsychotic medication Abilify for her first two trimesters. She then weaned off during her third trimester and for the year that she breastfed because she was concerned that the drugs could pass through breast milk, though there is little data available about this. “My mom stayed with us, and then we hired baby nurses, because a lack of sleep can trigger my episodes,” Caroline says. “ We got through it, but I was very aware that whole year of how dangerous