Questions & Answers on Psychiatric Medications
Tadao Ogura, M.D.
Can I Take Psychiatric Medications During Pregnancy?
This question will be discussed on two levels. The first is based on an “official” version and the other is “unofficial.”
Officially, the FDA classified all medications based on their potential risks on the fetus by Pregnancy Risk Category. This Category is based mainly on animal studies and in small part on actual complications reported by doctors and patients. Unfortunately, these reports cannot be scrutinized for their validity.
Risk Category A medications are the safest. They are defined as medications for which there are controlled scientific studies on pregnant animals and clinical reports on pregnant women that have failed to demonstrate any risk to the fetus in the first trimester and no evidence of risk in later trimesters.
A medication classified as Risk Category B or C has either 1) studies on animals that have revealed adverse effects on the fetus but there are no controlled studies on women or 2) no studies on animals or women are available at all. Most psychiatric medications are classified as Category B or C for pregnancy.
Most psychiatric medications are classified as Risk Category B or C because it would be unethical to design and conduct controlled studies on the safety of psychiatric medications for pregnant women and their unborn babies. Thus, psychiatric medications are generally suggested as being justifiable "only if the potential benefits justify the risk to the fetus and/or to the mother."
It has been conventional wisdom that a pregnant woman should not take any drug or medication unless "absolutely necessary" and it is generally recommended that they avoid alcohol, cigarettes and over-the-counter medications. But if a pregnant woman is suffering from a serious "medical condition" such as a heart condition or pneumonia, they still must consider taking medications, even if the medications might pose risk to the fetus, or even to themselves.
In these cases, they must decide which would be the lesser of two evils, because many untreated medical conditions may endanger the lives of the unborn fetuses as well as the mothers. Thus, the ultimate decision must be the mothers', along with their doctors and their husbands, weighing the risks and benefits.
One problem in the past, however, has been that the mothers and their obstetricians only considered the physical risks to the mothers and their fetuses. More recently, some doctors are beginning to realize that the mental and emotional states of a pregnant woman have a profound influence on her fetus.
If a woman is severely depressed, her depression may cause negative impact on her unborn child and may bring about various defects, abnormalities, and dispositions for future psychiatric conditions. This negative impact of the mothers' "mental" and "emotional" states may be just as damaging as any obvious "physical" complication.
Therefore, if you have been diagnosed with a psychiatric condition, whether mild or severe, and you are pregnant, discuss the situation with both your psychiatrist and your obstetrician. In order to make the right choice regarding whether or not to take ANY medication, you must be as well informed as possible, so you should definitely talk to your doctors.
As I have already noted above, most psychiatric medications are classified as Category B or C. But you should also know that, contrary to popular belief, most psychiatric medications have been found fairly safe for pregnancy.
This is based on the findings from thousands of pregnancies while voluntarily or inadvertently on psychiatric medications. Most common medications such as Prozac, Zoloft, Paxil and Wellbutrin have been around for a few decades now, and, as a result, data have been building up to thousands of cases of pregnant women who happened to be, or chose to stay, on their psychiatric medications during their pregnancies.
Again, since the FDA regulates psychiatric medications, all these cases are required to be reported. The accumulated reports on these cases have created a vast database for analysis, which is the main source of information available today. However, it is impossible to determine whether a reported complication to a fetus was truly due to psychiatric medications or the other substances (including food).
“The Power of Mother Nature”
The unofficial version is based on my personal observations and experience with many pregnant women. I have seen about a dozen cases of women who managed to stay off all their psychiatric medications by “the Power of Mother Nature” during their pregnancies and nursing period. It seems that pregnant mothers posse a special power to ensure the safety of their fetuses. Here is a case to illustrate this point.
Betty was a 27 year-old woman who had a history of eight hospitalizations for her Bipolar I Disorder with Psychosis and Panic Disorder. She was on Lithium, Depakote, Haldol, and Clonazepam. She became stable enough to date with a man and, subsequently, married him. One day, she was told by a doctor that she was pregnant and went into a panic. She beeped me for an emergency and said, “If I stop my meds now, I will go off (become psychotic), again. If I don’t, I may lose my baby. What should I do?”
I asked Betty how serious she was about having the baby. She said that she would do anything to carry the baby. I said to her, “First you must tune yourself into a mother mode. Try to get connected with your baby inside and start to feel and act like a mother. When you feel connected with your baby inside, stop all your meds.”
Betty had to be seen on and off during her pregnancy but she managed to stay off all her medications. She delivered a healthy baby girl and nursed her with her breast milk for about four months. However, two weeks after she changed to the bottle-feeding, she went into a manic state. Since she and her husband were prepared for that in advance, she went back on medications and did not have to be hospitalized, again.
This case illustrates how a woman can change her body (including the brain) from “just a woman mode” to “a mother mode.” Many of my patients were able to stop their psychiatric medications by changing their “mode” into that of “a mother.”
However, I also found out that not all women could do this. As I discussed in this booklet, “we are not created equal” at all and, rather, are different every which way. I saw many women who were simply not created to become mothers and, therefore, they were not able to change their “mode.” These women had to remain on medications during their pregnancies.It is my observation that about 60% to 70% of women can change themselves into the “mother mode.”