Depression & Anxiety Help

[Belia]

Hi-

Do any of you have any experience working with pg women who suffer from depression and/or anxiety? Did they stay on their meds or go off while pg? What was your experience either way? What do you do or recommend when you start to work with a new mom and they have depression/anxiety issues or history?

You guys can probably guess why I'm asking..... I'm struggled with this my entire adult life. See a therapist weekly and a psychiatrist every 3 months at least. It takes periodic tweaking, but I'm very stable with help. I get the sense that meds such as these are probably frowned upon around here at the MDC, but they've been a life saver for me. These issues are a big reason why I've waited so long to even try to get pg at age 35 after being in a great marriage for 9 years.

My psych is great- very open and supportive of whatever I want to do. I have my first appt at only 5 weeks with the midwife next week, so we'll see what she says. For now I'm just holding steady, but concerned! Of course!

How do you professionals handle mamas like me? (Paging Doctor Jen!)

P.S. I'm on Lexapro 30 and Cymbalta 60.

[DoomaYula]

I'm a birth doula, and I also experience depression and anxiety.

My personal feeling is that it's a risk/benefit thing. The benefit of being sane and even-keeled outweighs the risks posed by Zoloft or Prozac (the meds I've taken), for all of my pregnancies. I've been pregnant in three different states, and so I've seen different docs/mws throughout, and everyone has agreed with that sentiment.

[doctorjen]

I've had experience with a number of women with anxiety or depression during pregnancy. Some women I've care for have actually had improvement of symptoms during pregnancy, while some have had no change, and some have even worsened. Some studies seem to suggest that women are at higher risk of depression during pregnancy than even after (postpartum depression.)
Anyway, usually treatment decisions are very individualized. The SSRIs (Lexapro included) have some data in pregnancy, and generally seem to be pretty safe. Cymbalta is newer and won't have as much data available yet. Usually, I work with a client's psyciatrist if they have one as well as the client and we try to figure out if the potential risks of the medication (which the ones you are taking don't have any well known major risks yet) are worth the improvement in symptoms. Some women will choose to go off meds and see what happens, with the option to restart if symptoms worsen - some will want to continue throughout pregnancy - and some will actually need more or different meds during pregnancy.
I think it is important to treat mental health issues during pregnancy as seriously as physical issues. Untreated depression is linked to premature birth and low birthweight, actually. Hopefully, your psych will be willing to help with medication decisions and your midwife will be comfortable managing the rest.