Depression and the Pregnant Woman

A few months ago I read a very interesting book. It was called Love Works Like This, by Lauren Slater. Slater is a woman who did not want children, who takes several medications for her depression, and who has been institutionalized because of her mental illness. The book is about her struggle to incorporate “mother” into her identity and to prepare for the life changes of a baby in the face of her illness.

It was an unsettling read. Slater is unconventional in her failure to be charmed by any of the sweetness of motherhood or pregnancy. She steadfastly requires that others – her spouse and a nanny – assume primary caregiving responsibilities for the baby. She decides she’ll “be the dad.”

And yet I cherish the book for giving voice to the taboo feelings toward motherhood that so many women think at one time or another. There are those thoughts that we have and then think “Does that make me a bad mother?” Slater, a psychologist, doesn’t worry about those moral labels. She’s more preoccupied with the question “Can I survive this.”

The first part of her book is about her struggle to go off her medication when she finds out she is pregnant. Because there is little research into the effects of antidepressants on fetal development and newborn complications, mothers have little guidance on how best to balance their mental health needs with their baby’s safety.

Last week a study that looked at WHO data concluded that infants born to women on SSRIs showed withdrawal symptoms and therefore “SSRIs, especially paroxetine, should be cautiously managed in the treatment of pregnant women with a psychiatric disorder.” An article summarizing the study and placing in context for prenatal care appeared in last week’s New York Times.