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In a recent discussion with Dr. Nathan Fox on the Healthful Woman Podcast, Dr. Shari Lusskin, an expert in reproductive psychiatry, shared important insights into the often-overlooked topic of mental health in pregnancy. While more collaboration is happening between OB-GYNs and psychiatrists in recent years, the need to better understand mental health and medication during pregnancy is still present.

The Stigma of Mental Health Disorders

Mental illness during pregnancy has long suffered from stigma and misunderstanding. Dr. Lusskin was part of one of the first groups of OB-GYNs to focus on mental health in pregnancy, along with Dr. Lockwood Charlie and Dr. Andrei Rebarber. To break down this stigma, Dr. Lusskin believes that doctors should “change the terminology from mental illness to neurobiological disorder…[mental health] has nothing to do with your moral fiber, or your inherent resilience, or character, or your strength as a person.” Unfortunately, anyone can suffer from mental health disorders, like depression, so women need to understand how they can safely manage their mental health while pregnant.

Findings on Medication Management During Pregnancy

Previously, many women were advised to discontinue psychiatric medications during pregnancy, but not all patients can tolerate this. Therefore, OB-GYNs should focus on how to safely adjust and manage medications during pregnancy, which can be complicated. During pregnancy, women go through constant hormone fluctuations that affect brain function. Determining the right medication involves identifying the condition, selecting treatment, and understanding reproductive safety data. Lusskin works with the Reproductive Toxicology Center, a group that looks at the potential harmful effects of medications in pregnancy.

Prozac and other serotonergic antidepressants like paroxetine and sertraline (Paxil and Zoloft) have been studied in thousands of cases in which women had successful pregnancies while on these medications. However, Depakote, used to treat epilepsy and bipolar disorder, should be avoided. There is a higher risk, with about 10% of pregnancies affected negatively. This risk may be considered relatively low, especially by patients who have only had success in seizure treatments with this medication. Dr. Fox emphasizes that “the background risks of problems with the pregnancy [birth defects] are much greater than any potential risk from medication.”

Weighing the Risks and Benefits

Each patient should undergo a risk-benefit analysis that is personal to them and their mental health needs. While there are some risks to medicating during pregnancy, they are fairly low, and the risk of untreated depression itself should be considered. Depression can have severe consequences, affecting nutrition, decision-making, and prenatal care adherence. Additionally, it makes the bonding process after birth more difficult, and this can create a cycle of negativity in the mother, father, and baby. Dr. Lusskin emphasizes that, “Happy mommies make for happy babies.” Emotional well-being supports healthier pregnancies regardless of other challenges. It’s important that you tell a provider about any mental health struggles you are facing so they can discuss options to ensure a safe pregnancy and good mental health.

Learn More on

To learn more about how mental health impacts women during pregnancy, and how mental health needs can be safely managed for mother and baby, check out the full episode of the Healthful Woman podcast.

Carnegie Imaging for Women blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!