When a woman is being treated with psychiatric medication (taken because she has bipolar disorder, obsessive-compulsive disorder, depression, or anxiety) and wishes to have a child, how should she proceed? Continue the current therapy or stop it?
And if one of these conditions appears for the first time during pregnancy, what should she do?
This decision should not be made alone, but together with the gynecologist and the psychiatrist, who must carefully assess each case and explain clearly and thoroughly what risks and benefits are involved in either situation. Only an informed woman is able to choose, without being swayed by common misconceptions that either demonize medication or, on the contrary, see it as a cure-all for every situation.
In general, it is useful for the woman to be clear on these two points:
1 – numerous studies now show that an unmanaged psychiatric condition negatively affects the child, both with regard to birth and to psycho-emotional development in the following years. For example, it is often linked to maternal complications (eclampsia, toxemia of pregnancy) as well as to a higher number of preterm births, cesarean sections, and low birth weight; in the postpartum period, on the other hand, it is the mother-child bond that can suffer the most damage, with all the consequences this can bring (see «Some Effects of Maternal Depression on the Baby's Development»).
While for some women with psychiatric conditions pregnancy can act as a protective, balancing, mood-stabilizing factor, to the point of allowing them to stop their medication, in the postpartum period, as many case studies point out, the likelihood that symptoms will return, even in severe form, is very high if therapy is not resumed.
2 – as for medication, the teratogenic risk has decreased considerably today, though of course not for every drug, which is why it must necessarily be the psychiatrist who, based on the woman's specific condition, provides a «personalized» prescription able to minimize risks and maximize benefits.
See «The Importance of Psychotherapy in Pregnancy» (forthcoming).