When Jessica found out she was pregnant, she reached out to us for guidance. She had been taking 50 mg of sertraline daily for her anxiety, but her doctor suggested she might need to stop or lower her dose now that she was five weeks along. Jessica had been on this medication for three years and felt stable, so she was understandably concerned about this recommendation. During a live chat, she asked, “Do I have to stop my medication, or could I just switch to a lower dose?”
I explained that it’s crucial to evaluate the risks and benefits of continuing mental health medication during pregnancy. Sertraline is well-researched and generally doesn’t increase the risk of birth defects. However, it can lead to neonatal adaptation syndrome or withdrawal symptoms in 10-30% of newborns, and there’s a slight risk of persistent pulmonary hypertension. Conversely, untreated anxiety can lead to complications such as preterm labor. For many women, staying on sertraline is safer than discontinuing it, but each situation is unique, and Jessica needed to feel comfortable with her choice.
When discussing dosage, I informed Jessica that many expectant mothers think they should decrease their medication after getting a positive test, but the opposite may be necessary. Pregnancy triggers numerous changes in the body, like weight gain and increased blood volume, which can dilute medication effectiveness. As a result, some women might actually need to increase their doses to maintain symptom control.
To delve deeper into this topic, I spoke with Dr. Emily Carter, a psychiatric nurse practitioner specializing in perinatal mental health. She explained that pregnancy alters drug absorption, distribution, and metabolism. For example, slower gastric emptying can delay medication absorption, and increased blood volume can dilute the concentration of drugs in the bloodstream. Furthermore, heightened kidney function means drugs are often cleared more rapidly, leading to lower levels of medication in the body.
I asked Dr. Carter how often she observes women needing to raise their medication doses. She noted that it varies based on the medication type and the specific mental health condition. Typically, providers adjust doses in small increments until the patient achieves relief. Notably, there isn’t a standard blood plasma concentration for most antidepressants, although some mood stabilizers do require monitoring.
What about after childbirth? Dr. Carter explained that the postpartum period can be challenging due to hormonal fluctuations and lack of sleep. Therefore, it’s crucial to approach any dosage changes carefully and collaboratively between the patient and their healthcare provider.
I also asked if other medications besides sertraline might require dosage adjustments during pregnancy. Dr. Carter confirmed that many treatments for mood and anxiety disorders may need to be increased and emphasized the importance of communication between patients and their providers.
When discussing medication with healthcare providers, Dr. Carter advised making an appointment with a specialist in perinatal mood disorders. It’s also beneficial to check out resources like this one on planning for fertility treatment to inform your discussions.
In summary, Jessica decided to continue her current dose for a few weeks while monitoring her anxiety levels, with plans to consult her psychiatrist about possibly adjusting her dose later.
If you’re curious about mental health medications during pregnancy or simply want to learn more about keeping your baby dry during rainy walks, check out one of our other blog posts. Also, if you’re looking into at-home insemination, this kit is a great resource.