Some expectant moms take break from antidepressants for fear of side effects
Marisa Gabel, of Fargo, has been on Zoloft since she suffered a major depressive episode 10 years ago.
With the added help of her spirituality and counseling, the 31-year-old mother of two has done well on the medication.
But when Gabel became pregnant with her first child four years ago, she had to decide whether to stop taking it.
"From a clinical perspective, I witness countless women struggling with this very quandary - to be or not to be on medication during pregnancy and/or while breast-feeding," Dr. Jessica Zucker says in a Q-and-A for The Huffington Post.
The Los Angeles psychologist who specializes in maternal mental health has written on the topic for Every Mother Counts, former model Christy Turlington Burns' nonprofit organization founded in 2010.
"While there is no definitive answer, the most central consideration is taking the mother's symptoms seriously and proceeding with sensitivity and care regarding the mental and physical health of mother and baby," she says.
The good news is the risks appear to be very small, says Dr. Stephen Linn, an OB-GYN with Fargo's Essentia Health, but small and zero are not the same thing, so women have to make a judgment call - with the help of their psychiatrist or physician - whether they can manage their depression or anxiety symptoms without the help of medication.
"When you talk about drugs and pregnancy, as well as breast-feeding, there's a handful that are 100 percent absolutely safe, there's a handful that are 100 percent absolutely dangerous, and then there's the other 99 percent of drugs that are somewhere in between," he says.
Dr. Laura Musteti-Oprea, a psychiatrist with Fargo's Sanford Health, lists miscarriage, preterm labor, low birth weight, and developmental and congenital anomalies among the possible side effects associated with SSRIs, the most commonly prescribed category of antidepressants.
"Generally, patients prefer to be off medication, at least for the first 12 weeks of pregnancy," she says.
Much of the decision depends on the severity of the illness.
"Like every spectrum of life, you have the extremes, and most people are somewhere in the middle of two extremes," Linn says.
Obviously, he says, those with severe mental illness who may be a danger to themselves or others should remain on medication.
For others, the answer may not be as clear.
"I think philosophically, whether you're pregnant or not, you shouldn't take any medicine unless you really need to. The question is, how do you define the word 'need'?" he says.
In Linn's experience, the divide is about 50/50 between women who stay on and women who go off medication, with a slight leaning toward going off.
"I would say the majority do go off. It's not like a 90 percent majority, but I think a small majority do go off, and most of those do well without the medications," he says.
For Kelly Barbot, of Fargo, the answer was easy: no meds.
"I read different articles that depression and anxiety meds could cause birth defects; even though there was a very slim chance, my husband and I didn't want to risk it," says the 28-year-old mother who just had her baby boy on Wednesday.
Some opt to reduce their dosage rather than stop taking their medication completely.
"Generally, the ones who are stable for at least six to 12 months can consider tapering their medication if they feel comfortable with that," Musteti-Oprea says.
However, when you look at the research, it's all or none, Linn says.
"They don't stratify it based on dosage. There's no 'proof' that a lower dose is less risky, but theoretically, common sense would say yeah, that might be the case," he says.
Ideally, the discussion should start before conception.
"The 'perfect' patient would come in before they get pregnant and say, 'Hey, I'm on this medicine, what do you think about it? I'm thinking about getting pregnant soon,' and then we can kind of talk about the pros and cons and make an educated choice up front and then go with it," Linn says.
Gabel talked about her decision with her doctor and psychiatrist, and together they decided she should go without medication right before she got pregnant and during pregnancy.
"I wasn't anti-medication, and I think it's every person's or family's choice of what they do, but for me, I didn't want to be on medication during the pregnancies," she says.
She suffered from postpartum psychosis after her first child was born, so with her second, she restarted her medication three or four weeks before her due date.
"With Annika, I knew what I went through with my first, so I was very prepared," Gabel says.
She says she would tell women trying to conceive to get as much information as they can about their options before they make a decision.
"I do know women that have been on antidepressants during pregnancy, and their children have been healthy," she adds.
Women who choose to go med-free during pregnancy can focus on other ways to manage their symptoms.
Barbot relied on the right combination of exercise and rest.
"Exercise was key; I forced myself to go on days I felt really down or buzzed up on anxiety. Whenever I was done, I felt like all the pieces of the puzzle were there and I could think clearly," she says.
OB-GYNs like Linn encourage enlisting the help of a psychologist or counselor for "talk therapy" during - and often after, since women with pre-existing depression are more likely to experience postpartum depression - labor and birth.
"There are studies that show that cognitive-behavioral therapy works really well for this group of patients," Musteti-Oprea says.
She encourages women to seek emotional support from family and friends, especially since they're the ones who are likely to be among the first to notice any mood or behavioral changes.
Gabel relied on her family, friends and faith to help her through her two pregnancies without antidepressants.
"I reached out for support and any resources I could get my hands on," she says.
She tried to take care of herself, stay in touch with her feelings and communicate what she needed to her husband.
"Speaking up and asking for help reveals strength of character and courage - two core ingredients that we should all aspire to model for our children," L.A. psychologist Zucker says.
Readers can reach Forum reporter Meredith Holt at (701) 219-9728