Depression in pregnancy

I would like to thank Drs. Hatters Friedman and Hall for their excellent article, “Antidepressant use during pregnancy: How to avoid clinical and legal pitfalls” (Current Psychiatry, February 2013, p. 10-17; http://bit.ly/1EIIYvD). Their emphasis on the risks of untreated depression was much appreciated and resonated deeply with me because of my own experiences.

During the second year of my residency, I treated a 31-year-old woman who experienced depressive symptoms starting in her first trimester of pregnancy. She was suffering from major depressive disorder, single episode, mild type, and was referred to me for psychotherapy. As the therapy and her pregnancy progressed, her depression worsened and I faced the difficult decision of starting a pregnant woman on psychotropics.

Despite her worsening symptoms, I was hesitant to offer her medication because she was pregnant. My discussion with my psychotherapy supervisor was the first in a series of events that made me aware of the stigma regarding prescribing psychotropics to pregnant women. I was amazed when he expressed his views of “not exposing pregnant women to medications” without a reasonable discussion of benefits. While discussing the risks, my patient replied bitterly: “You doctors won’t even say Tylenol is safe…everybody only thinks about the baby. What about me? I stopped being a person the day I became pregnant.”

After a careful risk-benefit discussion, and with guidance from my psychopharmacology supervisor, we started my patient on sertraline. More than 6 years later, I still recall my patient’s description of her attempt to fill her prescription. She said the pharmacist refused to fill the prescription and told her that a pregnant woman should not be taking that medication, implying she was being a “bad mother.” She said to me, “I did not have the strength to walk across the road to the other pharmacy. This incident again confirmed that I don’t exist; I am just a body for the baby.” I was horrified. Are we not taught to discuss the risks and the benefits of a treatment, and then help patients make the best decision for themselves? I am amazed at how often we let our personal views bias the way we look at objective evidence and how little we think of what a patient wants or needs.

After a few weeks, my patient started sertraline and responded well. She continued to attend therapy regularly. For months after her symptoms remitted, she described how disconnected she had felt from herself and how she later grieved for the time lost. Although she never blamed me, I always felt guilty for adding a few weeks to her suffering by not starting her on medication earlier.

This experience had a lasting personal impact. I am committed to ensuring that my residents and I are up-to-date about prescribing psychotropics for pregnant patients. However, the need for these well balanced and well written articles is ongoing, because I continue to see patients whose psychosis or depression worsens dramatically because their psychiatrist abruptly stopped maintenance medications during pregnancy.

Rashi Aggarwal, MDAssistant ProfessorUMDNJ-New Jersey Medical SchoolNewark, NJ

I would like to thank Drs. Hatters Friedman and Hall for their excellent article, “Antidepressant use during pregnancy: How to avoid clinical and legal pitfalls” (Current Psychiatry, February 2013, p. 10-17; http://bit.ly/1EIIYvD). Their emphasis on the risks of untreated depression was much appreciated and resonated deeply with me because of my own experiences.

During the second year of my residency, I treated a 31-year-old woman who experienced depressive symptoms starting in her first trimester of pregnancy. She was suffering from major depressive disorder, single episode, mild type, and was referred to me for psychotherapy. As the therapy and her pregnancy progressed, her depression worsened and I faced the difficult decision of starting a pregnant woman on psychotropics.

Despite her worsening symptoms, I was hesitant to offer her medication because she was pregnant. My discussion with my psychotherapy supervisor was the first in a series of events that made me aware of the stigma regarding prescribing psychotropics to pregnant women. I was amazed when he expressed his views of “not exposing pregnant women to medications” without a reasonable discussion of benefits. While discussing the risks, my patient replied bitterly: “You doctors won’t even say Tylenol is safe…everybody only thinks about the baby. What about me? I stopped being a person the day I became pregnant.”

After a careful risk-benefit discussion, and with guidance from my psychopharmacology supervisor, we started my patient on sertraline. More than 6 years later, I still recall my patient’s description of her attempt to fill her prescription. She said the pharmacist refused to fill the prescription and told her that a pregnant woman should not be taking that medication, implying she was being a “bad mother.” She said to me, “I did not have the strength to walk across the road to the other pharmacy. This incident again confirmed that I don’t exist; I am just a body for the baby.” I was horrified. Are we not taught to discuss the risks and the benefits of a treatment, and then help patients make the best decision for themselves? I am amazed at how often we let our personal views bias the way we look at objective evidence and how little we think of what a patient wants or needs.

After a few weeks, my patient started sertraline and responded well. She continued to attend therapy regularly. For months after her symptoms remitted, she described how disconnected she had felt from herself and how she later grieved for the time lost. Although she never blamed me, I always felt guilty for adding a few weeks to her suffering by not starting her on medication earlier.

This experience had a lasting personal impact. I am committed to ensuring that my residents and I are up-to-date about prescribing psychotropics for pregnant patients. However, the need for these well balanced and well written articles is ongoing, because I continue to see patients whose psychosis or depression worsens dramatically because their psychiatrist abruptly stopped maintenance medications during pregnancy.

Rashi Aggarwal, MDAssistant ProfessorUMDNJ-New Jersey Medical SchoolNewark, NJ

I would like to thank Drs. Hatters Friedman and Hall for their excellent article, “Antidepressant use during pregnancy: How to avoid clinical and legal pitfalls” (Current Psychiatry, February 2013, p. 10-17; http://bit.ly/1EIIYvD). Their emphasis on the risks of untreated depression was much appreciated and resonated deeply with me because of my own experiences.

During the second year of my residency, I treated a 31-year-old woman who experienced depressive symptoms starting in her first trimester of pregnancy. She was suffering from major depressive disorder, single episode, mild type, and was referred to me for psychotherapy. As the therapy and her pregnancy progressed, her depression worsened and I faced the difficult decision of starting a pregnant woman on psychotropics.

Despite her worsening symptoms, I was hesitant to offer her medication because she was pregnant. My discussion with my psychotherapy supervisor was the first in a series of events that made me aware of the stigma regarding prescribing psychotropics to pregnant women. I was amazed when he expressed his views of “not exposing pregnant women to medications” without a reasonable discussion of benefits. While discussing the risks, my patient replied bitterly: “You doctors won’t even say Tylenol is safe…everybody only thinks about the baby. What about me? I stopped being a person the day I became pregnant.”

After a careful risk-benefit discussion, and with guidance from my psychopharmacology supervisor, we started my patient on sertraline. More than 6 years later, I still recall my patient’s description of her attempt to fill her prescription. She said the pharmacist refused to fill the prescription and told her that a pregnant woman should not be taking that medication, implying she was being a “bad mother.” She said to me, “I did not have the strength to walk across the road to the other pharmacy. This incident again confirmed that I don’t exist; I am just a body for the baby.” I was horrified. Are we not taught to discuss the risks and the benefits of a treatment, and then help patients make the best decision for themselves? I am amazed at how often we let our personal views bias the way we look at objective evidence and how little we think of what a patient wants or needs.

After a few weeks, my patient started sertraline and responded well. She continued to attend therapy regularly. For months after her symptoms remitted, she described how disconnected she had felt from herself and how she later grieved for the time lost. Although she never blamed me, I always felt guilty for adding a few weeks to her suffering by not starting her on medication earlier.

This experience had a lasting personal impact. I am committed to ensuring that my residents and I are up-to-date about prescribing psychotropics for pregnant patients. However, the need for these well balanced and well written articles is ongoing, because I continue to see patients whose psychosis or depression worsens dramatically because their psychiatrist abruptly stopped maintenance medications during pregnancy.

Rashi Aggarwal, MDAssistant ProfessorUMDNJ-New Jersey Medical SchoolNewark, NJ