Maternity leave has been blissful for Jess Young.
It’s a feeling the veterinarian radiologist from Bridgeville missed out on following her first two pregnancies.
The difference: remaining on the regimen of anti-anxiety medications prescribed years ago during her residency at the University of Pennsylvania.
“With my first pregnancies, I had been on Lexapro but decided to go off of it even though my provider said it was safe,” Young said. “I was hesitant, and I thought, ‘Eh, I feel good, I don’t really need it.’ ”
Turns out she did.
“My pregnancies were smooth sailing, but as soon as I left the hospital, it was horrible. It hit me like a rock,” she said. “The hormones started crashing, and I just sat on the couch crying. I couldn’t shake it, and I couldn’t enjoy my baby. It made me so sad.”
For years, many pregnant women with depression and anxiety have stopped taking antidepressants out of fear the medications could harm their babies. But maternal mental health specialists say growing evidence shows untreated psychiatric conditions during and after pregnancy can pose greater risks — including preterm birth, impaired bonding, psychiatric emergencies and even death — prompting doctors to encourage more women to remain on carefully monitored medications.
Nearly 25% of women enter pregnancy with depression, but less than half remain on medication for fear of dangers to the baby, according to the National Institutes of Health.
Research suggests potentially greater risks to mom and baby for going untreated.
Dangers to patients include higher likelihood of less routine prenatal care, gestational diabetes and hypertension, said Dr. Ewurama Sackey, medical director of women’s behavioral health at Allegheny Health Network. Higher stress levels in a mother can cause preterm labor and low birth weight for infants, she added.
The American College of Obstetricians and Gynecologists recommends selective serotonin reuptake inhibitors, or SSRIs, for pregnancy. SSRIs are a class of drugs typically used to treat depression, anxiety and other psychological conditions.
According to data in the New England Journal of Medicine, SSRI use during pregnancy has been proven to pose little or no risk to the baby for the most serious adverse outcomes.
“SSRIs do not cause an increased risk in miscarriage,” Sackey said. “Nothing has been conclusive to show that the baby develops autism, depression or ADHD.”
A possible side effect called Discontinuation Syndrome, or a type of withdrawal, develops in a small percentage of infants. The symptoms, which include irritability and jitteriness, typically resolve themselves after a few days and do not require hospitalization.
Aside from keeping physical stressors and risks at bay, health experts said, SSRIs can be critical in keeping women from plummeting emotionally after giving birth.
Women who go untreated for depression and anxiety are more likely to have issues bonding with their baby, Sackey said. That can lead to long-term detriment, including impacts on the baby’s IQ and development, according to Harvard University’s National Forum on Early Childhood.
Women experiencing depression also may be more likely to self- medicate or harm themselves.
“Psychological conditions are a leading cause of death in pregnant and postpartum women,” said Dr. Meredith Spada, medical director of the Perinatal TiPS program at UPMC Western Behavioral Health. “If left untreated, there can be really serious potential consequences.”
Perinatal TiPS provides real-time consultations to medical providers — including primary care physicians, OB-GYNs and psychiatrists, as well as physician assistants, nurse practitioners and nurse midwives — caring for pregnant and postpartum patients. That helps address a growing need driven by the prevalence of mental health issues and a nationwide shortage of perinatal psychiatrists. The program was piloted by UPMC to expand providers’ access to expert support.
“Patients don’t call the line directly. If a provider is concerned, they call, and we help walk them through things and, then with permission, reach out to the patient to offer care coordination,” Spada said. “The model is designed to help providers feel more comfortable caring for patients with psychiatric and substance-use disorders and to help connect patients to resources.”
A Perinatal TiPS team serves every county across the state. The service is free for patients and providers. UPMC Perinatal TiPS covers the 27 counties in Western Pennsylvania. The program is a partnership between UPMC Western Behavioral Health, UPMC Magee-Womens Hospital and UPMC Children’s Hospital of Pittsburgh.
Patients do not have to be UPMC providers or have UPMC insurance for their provider to utilize the line.
Mental health conditions account for about 23% of pregnancy-related deaths, according to the Maternal Mental Health Leadership Alliance.
Research presented at the annual conference of the Society for Maternal-Fetal Medicine showed that pregnant women who stopped taking antidepressants are nearly twice as likely to have a mental health emergency as those who continue on course. Of the 1,400 women in the study, those who discontinued medication had 500 more emergency department visits for behavioral health issues than women who remained on the drugs.
“If you are on certain medications prior to pregnancy for depression and anxiety, it is recommended — save a few — to stay on them,” Sackey said. “We want to help treat the disorder but also help prevent new or worsening perinatal symptoms.
“We’re not just treating mom. We’re protecting the family.”
For Young, the sudden onset of panic and fear was crippling. She spent weeks crying on the couch, not able to shake the dread.
“I was so focused on being afraid and I couldn’t explain it,” she said. “I never felt anything like that. I had a finite amount of time to bond with baby, and I spent a good portion of it just sad.”
This time, Young established a plan with her physicians that was believed to be the safest and most beneficial, which was to stay on medication throughout her pregnancy.
Her path didn’t include prescriptions only. She sought therapy, received a good amount of rest and was purposeful in her daily activities.
“Having that system, in addition to the SSRIs, I haven’t had any of the same feelings. It’s been a complete 180 from last time,” she said. “It has by far been the most relaxing and enjoyable experience.”
UPMC’s Spada said medications in pregnancy are assessed using a risk-risk framework — the possible risk of a medication versus the known potential serious detrimental consequences of going untreated.
Drug therapy should be individualized, she said, and based on prior treatment response.
“Is there a medication that’s going to keep mom well?” she asked. “That would be the discussion I would have. Antidepressants are a tool in our toolkit, just like therapy, meditation, exercise and utilizing one’s support system. These are all things I would recommend in conjunction with medicine.”
It’s an ongoing battle to combat years of social stigma associated with mental health issues, Spada said. Treatments are effective, she said, and the safety data is overall reassuring.
“If left untreated, mental health conditions can have severe consequences,” she said.
The third time was the charm for Young.
“I realized that any benefits would outweigh the low risk of SSRIs during my pregnancy,” she said. “I made the same mistake twice. I wasn’t going to let it happen again.”