In light of the recent uproar over the article on antidepressants and pregnancy that was published this week on the New York Times‘ Well Blog, I thought I would pause today on the unknowns that likely burden every single mom who suffers with a perinatal mood or anxiety disorder like PPD. There is so much mixed-up and contradicting information out there: co-sleep/don’t co-sleep; breast-is-best/healthy mom-is-best; have a birth plan/let go of the birth plan; cloth diaper/disposable diaper; medicine for depression and anxiety is safe/medicine is not safe. As if being a mama wasn’t confusing already, all of this conflicting info is enough to make a mama’s head take a double-spin. And its exhausting!

Those of us who specialize in perinatal mental health wish more than anything that there were more “knowns” for you—that there was one right answer for everyone so that we could take the burden away from you for having to figure it all out. And we know that when you are tired and anxious and overwhelmed and unsure there is nothing more difficult than having to make a decision when the information is complicated and so much unknown exists in the midst of it all. Truthfully, it’s not okay that we don’t know more, and we need to keep on doing the research necessary to continue to build toward more clarity.

So, what I want to say to you is this: If you are frustrated, we get it. If you are confused, it makes sense. If you are angry, you get to be angry. And if you have questions, ask them. 

When you reach out for help from a trained professional, you have a right to know their expertise, their commitment to best practice and professional development, and their loyalty toward helping YOU decide what the best course of action is for your particular situation. Not every mom with postpartum or antenatal depression or anxiety will end up including medicine in her treatment plan, but many will. And those of us out there rooting for you and your babies understand the trust that you put in us to help you decide what is the safest and most appropriate way to help your family thrive.

So, to summarize what I consider to be some of the most important parts of the beautifully written response to the New York Times story on antidepressants and pregnancy from PSI, here are six important facts:

1. It is not possible or appropriate to make one blanket statement regarding the use of SSRI medication during pregnancy (or breastfeeding). These decisions need to be made on a case-by-case basis and must take into account each mom’s unique symptoms and family picture.

2. While there has been some research that suggests that SSRIs may not be safe to take during pregnancy, there is more research to suggest that they are. And, when we look closely at this research, the statements made to suggest that SSRIs are dangerous to a fetus are selective and do not account for the whole picture. Another way of saying this is that many of these studies you sometimes see covered by the media are not “clinically sound.”

3. Untreated and under-treated perinatal mood and anxiety disorders can have significant negative effects on a developing baby’s social, emotional, and cognitive development. This, by the way, is rarely if ever debated.

4. Sometimes lifestyle changes like increased sleep and nutrition or non-pharmaceutical treatments like acupuncture and light therapy help a mom recover from her symptoms, but sometimes they do not and a more involved treatment like psychotherapy or the use of an SSRI is required for a mom to be well.

5. Taking an SSRI medication during pregnancy under the guidance of an appropriately trained clinician is not irresponsible.

6. There is most definitely some “gray area” when it comes to the use of SSRI medicine during pregnancy and breast-feeding. And many of us are uncomfortable with the “grays” and want instead for there to be more a more black-and-white, clear answer to these things. While this gray area can be confusing, however, it does not need to be as scary as the New York Times suggests.  Instead, we can try and think of the gray as a place for options.

So, moms: On behalf of all of the appropriately trained perinatal mental health specialists out there, we know that these decisions are hard for you and that the choice of whether or not to take medicine while you are pregnant or lactating is rarely simple. We believe that you want what is best for your baby (and so do we!), and we are confident that the choices that you make that lead you to wellness will undoubtedly benefit your kiddos in the long run.  

We will continue to research and understand the role of pharmaceutical medicine in the treatment of perinatal mood and anxiety disorders and will advise you on best practice and sound clinical knowledge. We will not mislead you. We will let you know what we don’t know, but we will also let you in on what we do and we will do this with educated knowledge and research-based understanding. 

And, we know that this does not feel easy, although we wish that it were. But you have our promise to continue to learn and push and stand by your side as you do what is required to be your best self. For you and for your baby.

~ Kate Kripke, LCSW