Medication and Other Treatment Approaches

The women that we spoke to expressed mixed feelings and experiences about using medications as part of their perinatal mental health (PMH) treatment approach. They shared issues specific to medications but also spoke about broader PMH treatment approaches, services and providers, including things like:

• Deciding whether to take medications or not
• Medications and breastfeeding – balancing risks and benefits
• Critical importance of finding a health care provider
• Getting the right medication and giving it time to work
• Medications as part of a broader treatment plan
• Emergency and inpatient care experiences
• Weaning off medications and long-term mental health management

Deciding Whether to Take Medications or Not

Fear and hesitation about taking medication had an impact on decision-making for pregnant or post-partum women. Some women expressed fears about harming their babies if they kept taking medications for existing conditions or for new mental health issues. Susan said worries about medication harm made her decide to not take medication for her depression and “so I suffered throughout it for the rest of my pregnancy”.

 

Medications and Breastfeeding – Balancing Risks and Benefits

Concerns about the safety of the medications for their babies while breastfeeding made many women seek information from various sources about the risks and benefits.

Other women sought out professional guidance from psychiatrists, midwives or other sources. Candace was reassured after checking on her own and then with her doctor: “When I was at the doctor’s office, I had … they asked, you know, ‘Are you nursing?’ I said, ‘Yes.’ And we did a search to find out what was the best antidepressant to take while nursing”.

Amanda2 had persistent doubts, despite reassurance. She tried various strategies to feed her babies while on medications, such as opting for bottle or formula feeding or timing medications as far away from feeding times as possible.

 

Critical Importance of Finding a Supportive Health Care Provider

We spoke to many women who stressed the importance of having a trusted, knowledgeable health care provider, such as a family doctor or psychiatrist, who listened and used holistic approaches. Those who were able to access specialized perinatal mental health care providers reported the most positive experiences. However, getting access to specialized care was a problem for women who really needed immediate care.

Leah spoke of “wait list is miles long – I did not think I had any chance [of] getting in”. Julie spoke of long waits to get psychiatric care: “I was on the waitlist or there was nothing that had moved along with this. I had followed up with my ob-gyn office asking where I was on the queue. I was told the referral was made. I just have to wait. And then a month later – that’s went I went to Emerg pleading for someone to help”.

Women felt that being assessed and provided with an accurate diagnosis was essential to getting the right care. Erin1 participated in a “research study where they took DNA from me to see which kind of medications I would respond to. And I was put on a better medication to help me”.

 

Getting the Right Medication and Giving it Time to Work

Staying in close contact with their health care provider was also very important as starting the right medication could make an immediate difference to some women, but for others, medications needed to be adjusted or changed. They made some people, such as Susan, feel worse for a while – “I went on the antidepressants and I almost felt worse – anxiety was just through the roof”. However, over time women felt better as their symptoms quieted and their medications reached maximum effectiveness.

Candace spoke about how taking medication eventually reduced her symptoms “I didn’t feel as nervous all the time. – I didn’t have as many physical symptoms, symptoms of anxiety. And so, along with that – I could then spend the time focusing on the thought part. So because the physical symptoms were quieted down and more manageable, I was able to start focusing more on how to retrain my mind”.

 

Medications as Part of a Broader Treatment Plan

Medication alone was typically not enough to get better, for the women we spoke with. Medication reduced their symptoms and made it easier to engage in therapy to develop coping skills. Cognitive Behaviour Therapy (CBT), along with psychological and emotional supports, combined with medication was particularly helpful for women’s recovery. Kalli knew medication alone was not the solution. “I know that I also needed the support of a psychotherapist that can help me with strategies and avenues in conjunction with being on the medication to help me out and to cope.” Candace worked with a counsellor who taught her how to manage her symptoms and said “CBT has probably been the biggest contributor to my success”.

Some women spoke about the importance of support such as in-home nursing care as vital to their recovery. Susan said “when I was in the thick of the PPD (Post Partum Depression), she was coming every week and I looked forward to her visits every week and that program was definitely another lifesaver for me. Having that person come in and … – they not only provide support for, you know, how your baby’s developing and everything like that, but they support you in your emotions”.

 

Emergency Care and Inpatient Experiences

Several women experienced acute postpartum psychosis, an immediate psychiatric emergency that required urgent psychiatric care and hospital admission. The women who experienced this type of crisis were admitted to general psychiatric units or spent time in emergency departments which was very difficult for them.  Amanda2 said experiencing post-partum psychosis and being admitted to inpatient psychiatric care “was an incredibly awful and traumatic experience”. However, these women also said the admissions facilitated their recovery, allowing them access to expert care and more tailored treatments.

For readers, if you are experiencing an emergency such as this, you or a caregiver/partner can call 911 for emergency services or contact your healthcare provider immediately. You can also talk to your healthcare provider about strategies before and during pregnancy if you have a pre-existing mental health problem to help prevent problems in the post-partum period.

However, Andrea spoke about receiving electroconvulsive therapy, in combination with medication, and “something switched in my brain. I, all of a sudden, felt like myself again”.

 

Weaning off Medications and Long-Term Mental Health Management

Most of the women we spoke to eventually tapered off their medications when they were ready, supported by strong social and care networks, stable environments and improved coping skills. Others needed to continue with their medications to prevent relapse. Adjusting medications without medical supervision, lead to relapse or increased symptoms for some women. Genna told us that “I started weaning myself off the medication without her [doctor’s] consultation and the symptoms of psychosis started to come back”.