Since many antidepressants, in limited testing, show a low risk to fetuses, doctors often let pregnant people choose what they want to do. There isn’t a wealth of information on the subject because almost no one wants to test drugs on pregnant or nursing parents. You cannot Google your way to the right answer. This means that these decisions cannot be made based just on facts. They have to be made largely on priorities. The thing is, there is no way to be risk-averse while pregnant. Being pregnant is itself a life condition that is inherently risky.
On June 30, 2015, the FDA did away with the risk classifications A, B, C, D, and X for drugs in pregnancy. These assessed the risk of injury that pharmaceuticals taken during pregnancy could have on fetuses, ranging from A: “No risk in controlled human studies” to X: “Contraindicated in pregnancy.” The agency implemented the Pregnancy and Lactation Labeling Rule (PLLR) adding specific pregnancy and lactation subsections to include information (when available) on the effects of medicines on pregnancies and nursing babies. The site notes that half of the 6 million people who get pregnant in the U.S. each year take medications of some sort. According to the CDC, one in nine people experience depression before, during, or after pregnancy, and the National Institute of Mental Health puts the number for postpartum depression at 15 percent of births. There are likely many unreported cases. Stress in pregnant women can cause negative outcomes for the fetus, including premature births and low birth-weights. None of the options for depressed pregnant people are totally ideal.
“It’s not one size fits all here,” says Katherine Economy, an obstetrician-gynecologist with a focus on maternal fetal medicine at Brigham and Women’s Hospital in Boston. “It’s always a very personalized discussion. Each woman is different, their exposure to SSRIs are different.” She’s referring to selective serotonin reuptake inhibitors, a category of drugs usually prescribed for depression and anxiety and considered fairly safe for pregnant women to take. Wellbutrin, the drug I take is an atypical antidepressant, a norepinephrine-dopamine reuptake inhibitor (NDRI). “For some women [antidepressants] are life changing, and they can’t do their activities and everyday living without them,” Economy says. “If they have high blood pressure, you leave them on their hypertension medicine during their pregnancy. I think women who have mood disorders, if they are significant enough, they absolutely should stay on their medication.”
Not every physician feels the same way. Both of the psychiatrists I saw during my pregnancy had differing opinions on what drugs I should or even could take safely. When I called my psychiatrist to tell him that I was pregnant, the nurses called back with the message: “Go off everything immediately.” I was shocked that such a nuanced question would be handled in such a flippant, commanding manner. I demanded he call me back himself. When we spoke, I told him that without me, there would be no baby, and I needed to be medicated to function under the stressful transitions pregnancy brings. A few months prior, I had undergone a major depressive episode and my dose was increased. I told the doctor that I would go back to the lower dose, but I would not go off the medication entirely. He agreed. Months later, he told me I couldn’t take my medication while nursing. I knew that if I had to choose between being medicated or nursing, I was going to choose to be medicated. How could I care for a newborn while not taking care of my own mental health? Luckily, another psychiatrist kept me on my antidepressant while breastfeeding, but drew the line at anti-anxiety medication.