Women's Reproductive Mental Health Clinic

If you have a history of mood and/or anxiety disorders, it’s important to plan in advance for pregnancy — even if you’re not currently having symptoms or taking medications — due to increased risk of relapse during and after pregnancy. When you come in for a pre-pregnancy consultation, you can expect a thorough evaluation and evidence-based recommendations regarding the risks of using psychiatric medications during pregnancy versus the risks of untreated psychiatric disorders for both yourself and your baby during pregnancy. We will work with you to develop a personalized treatment plan to help you transition to motherhood the safest way possible.

Perinatal depression is one of the most common complications during and after pregnancy. Researchers believe that untreated maternal depression increases risks of medical complications for the mother during pregnancy (e.g., preeclampsia, c-section, preterm birth) and has a lasting effect on the baby’s cognitive and behavioral development. Infants born to mothers with untreated perinatal depression are at higher risk for ADHD, anxiety and depression during childhood and adolescence.

Depression and anxiety are sometimes overlooked in expectant mothers because changes in sleep, appetite and energy overlap with common physical complaints of pregnancy. However, for women with a history of mood and anxiety disorders — and especially for women who’ve discontinued psychiatric medications prior to pregnancy — the risk of relapse and recurrence is significant. After thorough consideration of the risks and benefits for both mother and fetus, our team will develop an individualized treatment plan, which may include psychotherapy, medications or other treatments.

Symptoms of depression during pregnancy:

• Feeling sad, depressed and/or crying a lot
• Diminished interest in becoming a mother
• Feeling worthless or guilty, especially about not being a good mother
• Strong anxiety, tension and/or fear, either about your future child or other things
• Sleep problems (not being able to sleep despite feeling very tired or sleeping more than usual but not feeling rested)
• Thoughts of wanting to be dead or wanting to kill yourself
• Having low energy
• Loss of or increase in appetite or weight
• Trouble focusing, remembering things or making decisions
• Feeling restless or irritable
• Having headaches, chest pains, heart palpitations, numbness, or hyperventilation

Postpartum psychiatric illness has been associated with ongoing risks for recurrent illness in the future and has serious negative effects on both the infant and mother.

Postpartum depression occurs in 13-20% of births. It usually emerges during the first 1-4 months after childbirth, but may occur at any point up to 12 months after delivery. Depression after childbirth is a serious illness and can have a significant and lasting impact on the patient, infant and family.

Symptoms of postpartum depression:

• Feeling sad, depressed and/or crying a lot
• Intense anxiety, rumination, obsessions
• Loss of interest in usual activities
• Feelings of guilt, worthlessness or incompetence
• Fatigue, irritability, sleep disturbance
• Change in appetite
• Poor concentration
• Feeling inadequate to cope with a new infant
• Excessive worry about baby’s health
• Suicidal thoughts

When a mother is diagnosed with postpartum depression, our team will develop a thorough treatment plan using an evidence-based approach that considers the risks and benefits for both the mother and her baby. Any treatment plan will also carefully consider the safety and impact of psychiatric medications for mothers who are still breastfeeding their infants.

Postpartum anxiety disorders, such as panic disorder, obsessive compulsive disorder, and generalized anxiety disorder, are common and often coincide with depression. Most anxiety symptoms respond to individual therapy, including cognitive behavioral therapy (CBT) and interpersonal therapy. However, in more severe cases, medication may be needed to completely resolve symptoms.

Symptoms of postpartum anxiety:

• Intrusive or persistent thoughts of danger or inadequacy
• Excessive worry about child's well-being or ability to parent
• Restlessness
• Muscle tension
• Fatigue

Experiencing miscarriage at any point in pregnancy is a serious traumatic event. Many women struggle with physical and emotional pain, profound grief, and feeling isolated or overwhelmed. Research shows that in the six months following a pregnancy loss, women frequently experience symptoms of anxiety and depression in the context of grief. In cases where bereavement develops into a more serious psychiatric condition (which frequently occurs in patients with a prior history of depression or anxiety), a combination of supportive psychotherapy and medication can be an effective treatment.

Infertility affects an estimated 10-15% of couples of reproductive age. Several studies have indicated that patients undergoing in vitro fertilization (IVF) experience high levels of stress, depression and anxiety. In particular, women with a history of depression and anxiety are at higher risk of relapse due to increased stress brought about by the process of fertility treatment.

In addition, researchers believe that higher levels of depression and anxiety are associated with lower pregnancy rates among patients undergoing IVF. Treatment for depression and anxiety becomes important during fertility treatment, as studies show depression may negatively affect conception rates. Both medication and cognitive behavioral therapy can be helpful in alleviating these symptoms and improving chances of successful conception. Our team works with couples to develop a thorough treatment plan that considers the risks and benefits of initiating medications during the fertility treatment and, if needed, continuing medication throughout pregnancy.