Depression Treatment & Pregnant Women: Meds or Therapy?

In a New York Times article (April 26,2016) entitled “Treating Pregnant Women for Depression May Benefit Baby, Too,” writer Nicholas Bakalar discusses a study showing the health risks for babies whose depressed mothers weren’t medicated, and the physical benefits for the babies of depressed women who took anti-depressants during their pregnancies.

However, in the discussion of depression treatment for pregnant women, the article doesn’t mention the possibility of first using talk therapy before stepping up to anti-depressant medication.

In my experience (and that of many other therapists), talk therapy may be treatment enough for many people suffering from depression, so it seems a bit rash to jump to medication without trying talk therapy first.

Talk therapy doesn’t have any physical side effects, and countless studies show that when medication is needed, patients do better with a combination of talk therapy plus medication, rather than medication alone.

As a therapist with over 20 years of experience, I’ve referred patients for medication when needed, but for many patients, getting enough psychotherapy is effective treatment.

Insurance companies are quick to pressure therapists to refer for medication because it’s a less-expensive form of treatment, but that’s a level of intervention that is not always warranted.

Just as bariatric surgery isn’t necessary for every patient who needs to lose weight, anti-depressants aren’t necessary for every patient who is depressed. The patients who need the surgery or medication should get them, but for a patient whose life isn’t in danger from obesity or depression, a lower level of care with fewer potential complications makes sense, with continued assessment to see how the patient responds to that treatment.

Many a pregnant woman who is depressed can be helped by examining what her mother was like when the now-pregnant woman was growing up—especially from birth to age five—and understanding what she may have “absorbed” psychologically from her mom.

Messages that may contribute to the need for depression treatment in pregnant women and new mothers

Here is a very short list of some ideas that mothers can subtly or overtly communicate to their daughters which have implications for how the daughter looks at her own pregnancy and impending motherhood:

• When you have a child, your life is over.
• Motherhood is a burden, a vale of tears.
• I had a great body before I became a mother, and I’ll never get it back.
• When you become a mother, your marriage will suffer.
• I hope you have a child exactly like you (not said in gratitude for the daughter’s enrichment of the mother’s life).
• I never wanted to be a mother.
• I could have been a _________, but I got pregnant.

Positive messages for pregnancy and motherhood

Contrast that list with this one, expressing ideas that mothers can communicate to their daughters. Think about the difference between the pregnant women whose mothers conveyed the ideas listed above, versus the pregnant women whose mothers conveyed these ideas:

• I’m so happy to be your mother.
• I didn’t fully understand love till I became a mother.
• I’ve grown so much and learned so much from being your mother.
• Every day is Mother’s Day because of you.
• Being a mother is the most fulfilling “job” I could ever have.

As you may imagine these messages that women get from their mothers about the joys or tribulations, the fun or the crushing responsibility of motherhood set the pattern for much of how women experience pregnancy and motherhood.

Exploring these messages before, during, and after pregnancy can be the difference between a joyful pregnancy and experience of motherhood and a depressed, suffering one. This exploration helps the woman to enjoy motherhood and convey that enjoyment to her child, which helps the child feel loved and appreciated.

This improves life for mother, child, and perhaps future generations.

Treating depression in pregnant women using anti-depressants has been linked to physically healthier babies, which is a great outcome.

And psychotherapy, with or without medication, goes far beyond, by including the fruitful, potentially life-changing work of improving the psychological health and enjoyment of life for mother and child.

If you tend toward depression, working with a good therapist can help you understand the underlying issues and take a proactive approach to managing your mood and enjoying your life. For a pregnant woman, this becomes even more important.

If you’d like to learn more, reach out to me here. I look forward to speaking with you.