What Should I Know About My Mental Health During Pregnancy?

Mental health during pregnancy plays a critical role in postpartum well-being, yet many people aren’t sure what’s safe or where to start. If you’ve ever wondered how to get help or how to support someone you love, you’re not alone.

It’s important that pregnant people have access to safe, effective mental health care. That’s why reproductive psychiatrists and OB-GYNs often work together to provide the best support. In this episode, Dr. Ruta and Allie are joined by reproductive psychiatrist Dr. Marlene Freeman, MD, and OB-GYN Dr. Jessica Vernon, MD, PMH-C, to talk through what to look for, how to ask for help, and how to decide what treatment is right for you.

Whether you’re planning for pregnancy, navigating new symptoms, supporting someone you love, caring for a patient, or looking for evidence-based guidance on medication safety, Drs. Nonacs, Freeman, and Vernon walk you through your next steps.

Resources:

• Learn about pregnancy and breastfeeding medication safety from MotherToBaby. Listen to their podcast to hear more about everything from sushi to the RSV vaccine.
• Read more on psychiatric medications safety in pregnancy from the MGH Center for Women’s Mental Health.
• For more information on research about psychiatric medication use during pregnancy visit the National Pregnancy Registry for Psychiatric Medications website.

Disclaimer: This podcast is not intended to be a substitute for professional medical care. The views, thoughts, and opinions shared today are the speakers’ own. **Trigger Warning** Depression, anxiety, and suicidal ideation

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So Glad You Asked with Dr. Ruta Nonacs is brought to you by the MGH Center for Women's Mental Health and the J. Willard and Alice S. Marriott Foundation. 

Transcript

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Listener 1 00:00:00

I've always been an anxious person. However, it's been about twelve years since I've been taking paroxetine, twelve and a half milligrams daily, and Wellbutrin, three hundred milligrams daily. And now that I'm considering pregnancy, I'm worried about the effects on the baby. I read some stuff related to cardiovascular disease and babies exposed to these types of medicines. I was initially thinking about slowly getting off my meds, but it seems now it may do more harm than good during pregnancy and maternity itself.

Dr. Ruta 00:00:29

Welcome to So Glad You Asked, the show where real moms bring us their toughest questions. I'm Dr. Ruta Nonacs, a perinatal psychiatrist at Mass General Hospital with over 30 years of experience supporting the mental health of moms and helping them navigate the emotional highs and lows and the often unexpected challenges that come with planning a family, pregnancy, and motherhood.

Allie Hales 00:00:51

And I'm Allie Hales, a mom of four. I know what it's like to scour the internet wide awake at 2:00 am with a million questions, wondering if what I was experiencing was normal. That's why we created this show. It isn't just for real moms. It's by real moms. Every episode is a conversation led by you. Your questions, your experiences, your mental health front and center. 

We know that one of the biggest risk factors for postpartum depression and anxiety is experiencing depression or anxiety during pregnancy. And yet, the symptoms don't always feel obvious. They can build gradually, linger for weeks or months, and become your new normal before you even realize something isn't right. That can make it especially hard to know when and how to reach out. How long is too long to feel that way? At what point should you bring it up? And to whom? Do you start with your OB? Should you be seeing a psychiatrist? And what if what you're reading online doesn't quite match what you're experiencing or what your provider is telling you? On today's episode, we're talking through what depression and anxiety symptoms can look like during pregnancy, how to recognize when something may need more attention, and how to take that first step in asking for help. We'll also cover what the research shows about effective treatment, how to have these conversations with your OB, and how different providers can work together to support you. We're so glad to be joined today by Dr. Marlene Freeman and Dr. Jessica Vernon.

Allie Hales 00:02:22

Dr. Marlene Freeman is a professor of psychiatry at Harvard Medical School and the Abra Prentice Foundation Chair in Women's Mental Health at Massachusetts General Hospital. She also serves as the associate director of the Center for Women's Mental Health at Massachusetts General Hospital and the medical director of the MGH Clinical Trials Network and Institute. Her research and clinical expertise focuses on mood disorders and women's mental health, with additional expertise in nutrition, integrative medicine, and mental health.

Allie Hales 00:02:54

Dr. Jessica Vernon is a board-certified OBGYN who has supported thousands of people throughout their reproductive journeys. She is the associate medical director at Oula Health, a midwifery-led women's health startup based in New York City, and serves on the board of Postpartum Support International. As a mom of two, she brings her lived experience to her work. She is especially passionate about holistic, person-centered care and has developed multiple programs to expand access to perinatal mental health care. Her first book, Then Comes Baby: An Honest Conversation About Birth, Postpartum, and the Complex Transition to Parenthood, is available now and you can also find her online at drjessicavernon.com and on social media @dr.jessicavernon. We're so glad you're both here.

Dr. Ruta 00:03:44

Thank you so much.

Dr. Jessica Vernon 00:03:46

Thanks so much for having us.

Dr. Ruta 00:03:47

It's so great to have uh Jessica here as an OBGYN. I feel like, you know, we have all these experts, but we really need the voice of people who are on the front lines of perinatal mood and anxiety disorders, which is really obstetric providers. And um, I'm just wondering, so, you know, I've been in this field for many, many years now. Too many.

Dr. Ruta 00:04:14

We've seen incredible advances in terms of awareness of perinatal mood and anxiety disorders, and uh professional organizations like ACOG, American College of Obstetricians and Gynecologists, and people like you have really played an important role. We have routine screenings which are recommended that started back in 2015. But women are still falling through the cracks. We're still seeing women who don't get treatment, who don't get diagnosed, and, I wanted to open this question to you first, Jessica, as an OBGYN. What can we do better? How can we collaborate better with mental health providers?

Dr. Jessica Vernon 00:05:02

Yeah, I think a lot of it is educating our OBGYN trainees, midwifery trainees, all the people in these specialties because from when I was training, we didn't talk about this at all. We really were only looking for people postpartum who might have suicidal ideation. That was basically the extent of what we were told to look for. And training has improved over the years, but there still are a lot of practitioners that aren't comfortable having this conversation. They don't know where to start, they don't know what to do if someone does have symptoms. And so just increasing awareness and access to education for providers is a big thing. And also empowering patients even if their provider doesn't ask to feel equipped to ask those questions of their provider and get the help they need. And if their providers aren't helpful, then going other places to get those resources they need.

Dr. Marlene Freeman 00:05:51

Well, I would just echo the same sentiment. You know, we want to make sure, as one of my mentors once said, that whenever a woman asks for help and knocks on a door, that every door is the right door. And so that means that we have a really collaborative approach that healthcare providers across disciplines are all tuned in to mental health and what women may need for support and referrals for treatment. You know, really, we want to make sure that you know, our OB colleagues, mental health care colleagues, primary care specialists, and really as much of the public as possible is really educated about maternal mental health. And then, you know, even if they're not in a position necessarily to provide treatment, they know how to make sure that women can find it. 

Dr. Marlene Freeman 00:06:47

So I think that that's really important. And what I'd really want to underscore is that, you know, that in psychiatric training, there's really a lack of education around pregnancy and postpartum. Many psychiatrists are really uncomfortable helping women when they're pregnant or postpartum. And so we really in our field need more education around the OB setting, just like we want our OB colleagues to feel more supported in terms of women's mental health.

Dr. Marlene Freeman 00:07:18

And I think we can really appreciate in perinatal psychiatry how many barriers individuals must overcome by the time they reach us. However, women are often seeing their obstetrical care providers, you know, longer term. It may be the healthcare provider that they're most comfortable with. And so we want to make sure that our OB colleagues are really supported in terms of, um, advocating for their patients, recognizing when women have mood or anxiety disorders, and, you know, how to get them help.

Allie Hales 00:07:51

And Marlene, you touched on, you know, recognizing when that's happening. I felt like when I was pregnant, there were so many changes. There's so much, you know, there's so many clickbait titles online that you can be terrified by. I remember even, you know, my mom talking about when she was pregnant, there was some medication that was turning babies' teeth gray and then there's all these things that are kind of in your mind that you're thinking of pregnant, like I don't want to take the wrong medication or I don't want to eat the wrong food or I don't all these things. And so I feel like most women are pretty stressed about making the right choice or avoiding the wrong choice.

Allie Hales 00:08:31

And so how do you tell if your stress or anxiety or the things that you're experiencing are just a normal part of pregnancy or something more that needs to be further addressed?

Dr. Marlene Freeman 00:08:44

You raise great points. There are really like an infinite number of things to potentially be concerned about and learned about, learn about during pregnancy. And so, you know, we don't want to pathologize normal concerns and worries, but we also don't want to be dismissive of what may be excessive worry and distress. So, you know, I think that that one of the things we want to watch for is an individual's ability to function and take care of herself. So if concern and worry are interfering with, you know, everyday, life functioning. You know, ability to care for oneself, be able to experience some joy and pleasure. You know, we want to make sure that we're tuned into that. Um, I really think also that social media and being online has made it more difficult for individuals to separate from some of these worries and concerns. So, um, you know, one of the things we want to be asking people is, you know, whether they're able to function and we want to make sure that we're asking it in the appropriate context.

Dr. Marlene Freeman 00:10:01

So functioning in terms of being pregnant, you know, especially if someone is experiencing morning sickness or fatigue, we want to put what normal functioning is for them in context. So it may not be functioning as if, you know, they were feeling at their best before pregnancy, but we want to make sure that people are doing, you know, their basics in terms of self-care, maintaining their relationships.

Dr. Marlene Freeman 00:10:28

We want to make sure that people are not spending all their time worrying or that the concern isn't interfering with, say, self-care like eating and sleeping and engaging with loved ones. And in terms of the postpartum also, you know, we know that um many women are anxious. There are many things to be anxious about bringing a newborn baby home from the hospital. But we want to make sure that anxiety isn't eclipsing other factors in life.

Dr. Marlene Freeman 00:11:02

So one thing that we may watch for during pregnancy and postpartum is, is the woman able to be excited about the pregnancy or excited about the baby at least some of the time. So we want to be realistic. You know, it's not always fun to be pregnant or not always fun to have a newborn baby. It's like these are really very difficult challenging situations, but we want to make sure that there is some um bonding or connection or excitement at least some of the time. And when it's not there, that's really a red flag for us. And we want to make sure that individuals can really engage with their support systems. So friends, family, loved ones, we really worry when people are isolating themselves.

Dr. Jessica Vernon 00:11:49

Yeah, I think my first pregnancy, I was so anxious, I was completely disembodied, I wasn't connected to the baby at all. I was constantly worried that something could happen to them. And I spent two years postpartum with anxiety, depression, OCD before I kind of hit rock bottom. COVID happened and we were in a pandemic in New York and it took that point for me to kind of get on an antidepressant and realize what was happening to me because no one had flagged it and I didn't know.

Dr. Jessica Vernon 00:12:21

I just thought I was a high-functioning new mom who was trying to do it all and that was normal and I was just struggling more than other people at it. So I didn't even know until I hit my bottom. And as soon as I got on medication, I got the perspective and I was able to distance myself from it. And then I was able to work on the other things involving self-care, setting boundaries, seeing a therapist, taking time for myself, all of these things that I kept with me through my recovery and then through my second pregnancy. And it was just night and day.

And I talk to people about this all the time that I wish I could have had that experience with my first because I spent so much time in my head in this anxiety that I missed the early part of her life.

Allie Hales 00:13:05

That's such a great point and I read one of Jessica's blog posts about this very topic and I just Jessica I wanted to ask you guys a follow-up, you know, how can expecting parents, especially those, you know, with medical knowledge or past trauma, how can you practically balance the awareness of risks while also staying, you know, emotionally present during pregnancy?

Dr. Jessica Vernon 00:13:30

Yeah, I think it's really hard and um we just have to focus on kind of trying to stay embodied and not getting lost in the spiral of thoughts that go on. I agree with Marlene, social media has made it really hard. I also have a lot of people coming in now who have been on ChatGPT or Claude and going on these conversations and really asking them like, "How long a day are you spending on these things?" And when people answer honestly that they're spending hours a day or they can't fall asleep because they're doing these things, like that's something that's a red flag for me that I'm that I'm looking out for.

Dr. Jessica Vernon 00:14:07

But also kind of just validating and acknowledging that we know pregnancy is very anxiety provoking. It's often honestly like the first time in your life where you feel completely out of control and that's scary for people and they don't know how to accept that and embrace it and so they try to control everything by googling it and doing everything as perfectly as possible. So just acknowledging that but also helping them build in flexibility, and be prepared in case things go off course.

Dr. Jessica Vernon 00:14:36

And also talking to my patients that come in and I know they have risk factors, they have histories that are going to set them up for more anxiety during pregnancy, I really try to talk to them about that early on and make sure they have good support in place, whether that's a therapist, a doula, other people in their um close circle that they can talk to about these things and go to if they feel overwhelmed.

Dr. Ruta 00:14:58

I think a lot of patients are worried about overburdening their doctors and it feels like sometimes you go into your doctor's office and you want to get to one, two, and three, and mental health is often four, five, and six. What are the things that you want to hear about? What should patients be bringing to you with regard to their mental health?

Dr. Jessica Vernon 00:15:24

I want to hear about all of it. It's just kind of, I have a very holistic approach, so I want to hear about everything, but I think the big thing is for the providers to kind of set up a space where it feels comfortable, non-judgmental, and you're actually asking, how are you feeling? That's a huge question because people will often be like physically, what's going on, you know, making sure we're hitting those milestones in the pregnancy, everything's going done, but always pausing and saying, how are you feeling? What's going on on the other side of this when you're at home? How's everything with your family? You know, what's keeping you up at night? And just making a space for that.

Dr. Jessica Vernon 00:16:03

I think people really open up. I always have tissues in my office. People start crying all the time because once they have that space where they can really talk about it, they just open up and talk about it. So I would say, you know, patients shouldn't be afraid to bring up anything, but if you feel like you have a provider where that's not possible, then we need to find other avenues for you to have those conversations.

Dr. Ruta 00:16:27

I think that's a great point. Everyone would love to have an OB like Jessica who asks them about how they feel, but what happens when you have an OB who doesn't get it or is dismissive when you're talking about mental health issues? What should they do? Where should they go next?

Dr. Jessica Vernon 00:16:47

So, I would say the first thing is you can bring another support person in, whether it's your partner or a doula or somebody else who can really advocate for you in the visits. That can be helpful sometimes. You can also go to Postpartum Support International. They have a lot of free resources and can help you get the support and care you need, whether it's virtually for some of their free support groups or a therapist in your area or psychiatrist or psychiatric nurse practitioner in your area. You can also go look for another provider. I know for some people it's really hard and not every space you live in might have a lot of nearby providers, but you are free to advocate for yourself and find another provider who might listen to you more.

Allie Hales 00:17:30

I ended up switching providers during one of my pregnancies and it was so overwhelming and scary, but I was so glad I did it. And I think, you know, at least for me, there I wanted to be a good patient, you know, like I wanted my OB to leave my appointment and be like, “Wow, Allie just asked such great questions. She was so efficient. Like there are no issues, like I love having her as a patient.” Like that's kind of what my goal was in these appointments. And then when it really wasn't going well, it was scary for me to feel like, you know, worry about what my OB would think of me leaving or, you know, all of those different things. Obviously, I was more emotional and everything because I was pregnant, but it definitely was a concern and something that was hard. But I agree it was definitely a great change for me and it was such a relief to then be with a provider who I could ask these questions of, and feel like it was a safe space to communicate openly and that made a huge difference.

Allie Hales 00:18:33

I know that there are a lot of questions that come up in between appointments and I think one of the biggest ones is, you know, what medication can you take? Like if I have a headache, can I take Tylenol? If I have indigestion, can I take, you know. So where should someone go to find accurate information about medication use in pregnancy?

Dr. Jessica Vernon 00:18:52

Yeah, yeah. And it's hard because a lot of things don't have great data, you know, we can't do prospective double-blinded controlled trials in pregnant people. But Mother to Baby is my favorite go-to for patients. It has really good data sheets, um that are easy to read. It has all of the information for pregnancy and breastfeeding, and it's telling you the amount of information that's available out there. So that's a good one. And if there's anything like a supplement or a product you're using, because a lot of people who are anxious want to ask about all their products as well, they have toxicologists available nine to five. You can call them and they have supplementary databases of information where they can look up for you and let you know. Because I don't know about, you know, I don't know about all the data for everything that's in somebody's skin cream or some, you know, other products they're using. And so that can be really helpful for some people. 

And then of course for psychiatric medications, I also always give them information from MGH Center for Women’s Mental Health from the website because it's really wonderful and has the most up-to-date data. So that can be reassuring for someone who's really making that decision, do I want to stay on my medication, do I want to stop, do I want to go to a different medication? I think that information for those who are really looking for that is very helpful.

Dr. Ruta 00:20:10

I think in general they're just these are really difficult discussions. I think, you know, many women have chronic medical and psychiatric illnesses that they're dealing with. And, you know, we'd love to have women come in to discuss their plans for pregnancy before they're even pregnant so we can formulate a plan, we can streamline their medication regimen, and really get them on a protocol that works for them. So it takes time. It's not like with a headache or a cold, you can look on an online site. You weren't prepared for that necessarily, but you really want to pull in providers in advance.

Dr. Marlene Freeman 00:20:55

I would really emphasize that many of our patients, many individuals, have either chronic or recurrent disorders including psychiatric disorders. And so it's important, I really, it's really important I think for women to understand that mood and anxiety disorders are common.

So many of our patients feel all alone in making these decisions about whether or not to take medications or what treatments to pursue when they're pregnant, but it's so important to underscore that they're not alone, that there are many women in the same situation, but they just don't openly talk about it because unfortunately there's a lot of stigma.

Dr. Marlene Freeman 00:21:39

But it's also really important that from the time that women are of reproductive age or before reproductive age, that the medications that they're on are the most reasonable medications for pregnancy, either planned or unplanned, because even in the case of a planned pregnancy, so many of our patients are at risk of relapse if they stop medications that are working for them.

Dr. Marlene Freeman 00:22:04

And so we want to make sure that they understand the risks and benefits of any medication whether or not they're planning pregnancy. And really, you know, so many patients start medications, of course, when they're not well. And then the goal is for them to be their best, you know, be in remission from whatever disorder that they're suffering from, and really live their lives to the fullest. So for many women, that's going to mean starting families.

And so we really want to make sure that even if someone's not planning pregnancy at the time they start a medication, that the medication that they start would be reasonable if they suddenly find out they're pregnant or if they're planning pregnancy.

Dr. Jessica Vernon 00:22:46

Yeah, I think one of the things the reproductive psychiatrists I've worked with have helped me on is counseling around not just the risk of the medication and the benefit of the medication, but the risk of severe anxiety, depression, or uncontrolled bipolar, these sort of things, which a lot of people don't look at from that lens. Where like you want to know about the risks and how this could affect your baby, but how can severe anxiety or depression affect your baby? And so that's an important conversation that we need to be having more of as well.

Dr. Marlene Freeman 00:23:13

Absolutely. You know, we we have such a rich area in the fields of psychiatry, psychology, all mental health research that the impact of a mom being unwell in terms of depression, anxiety, which are the best studied, you know, those impact almost every aspect of child development and and maternal-baby bonding, and really can have lifelong consequences for the baby, really transgenerational effects. So that's really an excellent point that you're making.

Dr. Ruta 00:23:46

Such an incredibly important point. And Jessica, you had mentioned earlier that you can't do a randomized controlled trial about safety of medications. And so many of the studies we have are based on medication exposure but also exposure to illness and all the things that go on with illness and and I was wondering if Marlene could tell us a little bit about the research she's been involved in with the the National Pregnancy Registry which is helping us to learn more about medications.

Dr. Marlene Freeman 00:24:18

So, in our National Pregnancy Registry for Psychiatric Medications, all the patients who participate have a psychiatric disorder and are on some psychiatric medications. So in our registry, patients enter the study during pregnancy and then they're followed throughout pregnancy and into the postpartum. There are two phone interviews during pregnancy and one postpartum, so it's all remote, really with the aim of making it as low burden as possible for individuals to participate and share their information. And we've had so many patients say that it feels meaningful to participate in this because while they've struggled so much with the decision to take medication or not, they feel less alone in participating in this study, and they also feel like they're helping other women who are in the same situation.

Allie Hales 00:25:13

So next we're going to get into your questions and talk through how this plays out in real decisions. Okay, so our first question. I have always been an anxious person. For 12 years, I have been taking paroxetine and Wellbutrin daily. Now that I am considering pregnancy, I'm worried about the effects on the baby. I've heard that there is a risk of heart disease. I was initially thinking about slowly getting off my meds, but I'm also worried about how I will do without my meds.

Dr. Marlene Freeman 00:25:40

When we're thinking about the risks and benefits of the use of medications during pregnancy, we really want to tailor our risk-benefit analyses to the patient. So a really patient-centered approach and really collaborative decisions with the patient. So a lot of that will depend on the patient's history. So someone who's had moderate to severe anxiety or depression it's important that they're well during pregnancy. And so we get a really careful history, what medications they've been on, what's worked best for them.

Dr. Marlene Freeman 00:26:16

And for some antidepressants, there's a lot of information to integrate, which is no small task, even for psychiatrists. But we would say that, you know, in terms of antidepressants, they're some of the most commonly used medications in pregnancy. And so they are extremely reasonable for use during pregnancy for many women. So some medications are well-known and older, some are newer, and so it really makes sense that if an individual's going to take a medication during pregnancy, it's important that it's a medication that works for that woman.

Dr. Marlene Freeman 00:26:55

So we don't want to have both the combination of exposure to a medication and exposure to the untreated illness. So that doesn't do anybody any favors. That's not good for the mom, that's not good for the baby. So we want to make sure that if a mom is treated with medication during a pregnancy that she's treated to wellness. Because if someone is unwell during pregnancy, that really increases the risk of severe postpartum illness. So we want to make sure that the aim is wellness before delivery.

Dr. Marlene Freeman 00:27:28

Also, we want to make sure that women are not only treated with medication, but also are receiving other treatments like psychotherapy. We want to make sure that exercise, nutrition, and all those other things are emphasized as well. And so the medication is just one aspect of care, but for so many women that we see, it's essential for their care because in terms of achieving remission for so many women, medication is a reasonable and an important part of the treatment plan.

Dr. Jessica Vernon 00:28:03

Just to add from the OB perspective, and this is why I think it's so important that patients have access to someone like Marlene or a specialist, because often, like we mentioned earlier, their psychiatric provider might not have this information and so they might tell them to go off of their medication or that it's unsafe. And I'm also telling patients that they might encounter other people during their pregnancy if it's like a maternal fetal medicine specialist or even the pediatrician or someone at the hospital who might tell them, we need to do extra ultrasounds or we need to have the pediatrician present at birth because of this medication. And sometimes that information is outdated as well.

So I will tell them, you know, this is what we know based on current data, but don't be surprised if somebody recommends this or that based on one study that was there or data that used to be relevant but is no longer relevant. Just so they're aware if those things come up and that doesn't peak more anxiety for them.

Dr. Marlene Freeman 00:28:56

Those are excellent points. And if I could just add, it's terrifying for pregnant women to receive different information from different healthcare providers and sources. And so, even if someone's made a really thoughtful, educated decision about their medication use during pregnancy or while they're breastfeeding, if they hear from someone else that that there may be something, you know, frightening about it, it really derails, you know, their whole decision-making process and makes someone really doubt themselves. And women often feel so guilty and terrible. Sometimes people are overtly told that they did something wrong by taking their medication.

Dr. Marlene Freeman 00:29:36

And it's just heartbreaking, you know, if someone's in a situation where they need to be on medication to stay well, and they're made to feel that they did something wrong. So, that really, I think, puts the onus on us as healthcare providers to make sure as well as we can that healthcare providers across disciplines are well-educated about psychiatric disorders during pregnancy and postpartum, and the risks and benefits of treatments.

Allie Hales 00:30:05

No, I appreciate all that. And it is such a balancing act to try and figure out, you know, what the best route forward is. And I was just wondering, Jessica, if you could speak to this a little bit on the OB side and what you see clinically too. You know, I think a lot of people, even those, you know, who might not be on medication or those without prior loss or whatever the circumstance, feel anxious early in pregnancy because there's so much you just don't know yet. And we spoke to that a little bit before, but we did get a lot of questions, you know, on how do you manage that constant uncertainty, those constant feelings of anxiety, and, you know, fight that urge to look up everything online or monitor every symptom or think about every worst-case scenario. How do you manage those things moving forward?

Dr. Jessica Vernon 00:30:49

Yeah, it's a really hard balance. I do want to let people know it typically gets better after the first trimester once you get past that high miscarriage rate, once you see the early results from your screenings that things are looking good. For a lot of people that early anxiety does improve. But it's always good to have community and other people around you that are supporting you, validating you.

Dr. Jessica Vernon 00:31:15

But also, you know, trying to build in that flexibility like I was talking about before that like there's some things out of our control and that's okay and we just have to take it as it comes and try not to get on those places like social media or there's a lot of groups on different apps where if I get on there I can just feel the palpable anxiety and tension that people are just going down these crazy threads of thoughts. So trying to stay away from those places. Really if you have specific questions, ask your provider. They should be available whether it is on the phone or via an email or a message through the electronic medical record. Like that's what they're there for.

Dr. Jessica Vernon 00:31:53

So they can give you the right information and definitely patients, I try to meet them where they are because if you've had a prior loss, if you've had a long history of infertility, you've had other poor pregnancy outcomes before, you're going to want more early ultrasounds and more testing early on and and that's okay. I want people to be able to get that when they need that. But also be able to sit with them and have those conversations about what is really underlying these fears and how can we work to help support them so that they can get better sleep at night and not spend all their time googling.

Allie Hales 00:32:25

Thank you. And then we'll just do one more question before we end.

Dr. Ruta 00:32:29

I had a miscarriage. I'm taking Lexapro. I feel so guilty. I read that antidepressants can cause miscarriage. Should I stop the Lexapro?

Dr. Marlene Freeman 00:32:38

I'd be happy to address that. So, there have there were early studies, um, that suggested an association with being on an antidepressant and higher rates of miscarriage. And miscarriage itself is hard to study because it's actually so common. And individuals who are on a medication may be monitoring more closely or reporting more often if they have a miscarriage. So, the studies that demonstrated that there might be association did not show a cause effect.

So they didn't show that antidepressants caused an increased risk of miscarriage. So studies that were done subsequently looked at women with depression on antidepressants and women with depression not on antidepressants and did not show a difference in the miscarriage rate. So that tells us something that having a diagnosis of depression may be associated with higher rates of miscarriage. So that doesn't mean we want individuals with depression to blame themselves in any way for a miscarriage.

Dr. Marlene Freeman 00:33:49

But what it does suggest to us is that there's something about having depression and the stress response associated with having depression that may increase the risk of miscarriage, which makes us come back to where we usually come back to, that optimizing someone's wellness and supporting them is the most important thing in terms of good pregnancy outcomes. So the other thing I just want to emphasize about miscarriage is that we usually have no idea why some individual has a miscarriage, and when something bad happens during pregnancy, there's usually a desire to feel more control over that and to come up with a reason like why did this happen? What caused this? What did I do?

Dr. Marlene Freeman 00:34:33

And the bottom line is there's usually no reason that we can point to that something bad happens like a miscarriage or a poor pregnancy outcome. There's just as Jessica was talking about, so much uncertainty and so many things out of the individual's control. So to date, we do not have any evidence that being on an antidepressant itself increases the risk of miscarriage.

Allie Hales 00:35:00

No, I think that's really helpful to hear because I think a lot of times you worry about a medication and maybe you see something online like going back to finding things online that seems, you know, safer or more natural or, you know, but you're right, it's not necessarily studied or we don't, you know, know where it's being resourced from and so I appreciate both of you and sharing the resources that you have for women to be able to go to and look up, you know, everything from shampoo to medication.

Allie Hales 00:35:30

It’s really amazing to have those resources because I remember googling, you know, a lot of things when I was pregnant and being able to have those resources is just so important and I think really helpful especially in that first trimester knowing that sense of control and whether it's healthy or not to be googling. I know everyone does, so I appreciate you directing that in a healthier, more reliable place. But, we just so appreciate both of you being willing to come on and like you mentioned before, I think Jessica at the beginning, we don't often talk about depression and anxiety in pregnancy, at least I don't remember hearing much about it.

Allie Hales 00:36:09

I think most of the time we hear about it postpartum. So I really appreciate both of you and the work that you're doing in bringing light to this because I think it is really important and I think it gets missed a lot of the time. So, thank you both so much for being willing to come on and talk about this.

Dr. Ruta 00:36:25

Thank you so much. Pregnancy is often framed as a time of joy and anticipation, but for many people, it's also a time of emotional vulnerability. When depression or anxiety become part of that experience, it can be confusing, distressing, and often very isolating. While depression and anxiety are relatively common during pregnancy, they are treatable. And you don't have to navigate this experience alone. Help is available, and there are safe and effective ways to manage these symptoms. Your pregnancy shouldn't be something that you simply endure.

You deserve to feel supported and well. Reaching out is the first step toward feeling like your best self and will allow you to build the kind of support that can carry you through pregnancy and into the postpartum period. Thanks for tuning in. As a reminder, please note that this podcast is not intended to be a substitute for professional medical care. The views, thoughts, and opinions shared today are the speaker's own.

Dr. Ruta 00:37:33

Your feedback and questions drive this show, so feel free to send us an email at podcast@womensmentalhealth.org or leave a voicemail at 617-643-9232.

Allie Hales 00:37:47

You can find additional resources at our resource hub at sogladyouasked.org. This show is executive produced by Dr. Lee Cohen, produced by Mike Brown and Peri Barest, and edited by Mike Brown. This is So Glad You Asked with Dr. Ruta Nonacs and Allie Hales, brought to you by the MGH Center for Women's Mental Health and the J. Willard and Alice S. Marriott Foundation. Listen and subscribe wherever you get your podcasts.