For Pregnant Women with Mental Illnesses, Medication Can Be a Minefield

When she first started thinking about getting pregnant, then 37-year-old Dina Fiasconaro had many questions. The problem? She had no clue whom to approach with them: "My gynecologist? An OB? My psychiatrist? A therapist?" she wonders in her new documentary, Moms and Meds. "I felt alone and confused, passed back and forth between doctors."

Struggling with severe anxiety for most of her life, the Baltimore-based filmmaker had been stuck on a whirligig of various psych meds for a decade. "When I started to think about getting pregnant, I realized there wasn't a lot of information out there [about which meds expecting women can take]," she told me in an interview last year. So she decided to make a movie about her quest for answers.

Moms and Meds, which is now in distribution, took three years to complete—far longer than she'd hoped. "It [started to feel] like, 'I have to get this off my plate,'" she said in a recent phone interview. Aside from the usual creative hiccups and funding woes (Fiasconaro ended up financing most of the film herself), part of the reason the indie project took so long is because of the stickiness of the subject matter.

In addition to sharing Fiasconaro's story, Moms and Meds follows a handful of pregnant women she tracked down via casting sites and word of mouth. These women—primarily fellow East Coasters, due to geographical and financial restrictions—are afflicted with mental illnesses like anxiety, depression, and bipolar disorder. Like Fiasconaro, they've found themselves flummoxed by doctors' mixed messages and contradictory advice regarding how to have a healthy pregnancy while simultaneously holding onto their mental health.

When she got pregnant within the first month of trying, Fiasconaro was at once thrilled and terrified. "There is a history of mental illness on both sides of the family," she said. "I struggled with whether I really wanted to bring a child into the world whom I knew [would probably] have an issue." She decided she'd feel more comfortable going med-free during pregnancy because staying on the drugs would only "exacerbate [her] anxiety tenfold." She was able to wean herself off of Klonopin and Neurontin, and turned to other strategies for tackling her anxiety.

Fiasconaro ultimately gave birth to a healthy daughter, and she hasn't taken any medications since. She's adamantly zero-judgment about pregnant women who choose to take psych meds, though: She knows all too well how murky a minefield it is. As Dr. Stephen Contag, a maternal and fetal medicine specialist at Baltimore's Sinai Hospital, says in the film, "We have mixed information about the use of these medications during pregnancy. We consider what risks they provide to the mother and pregnancy and what benefits they provide to the mother and pregnancy."

All that "mixed information" can present a frightening conundrum for the thousands upon thousands of women who take psychiatric medication and wish to conceive. (According to research published in the Journal of the American Medical Association, about 30 percent of all women take some kind of psychotropic medication during pregnancy.) There's also the fact that, in some states, taking just one Valium during pregnancy can send you to jail for "endangering" your child, even if the infant is born healthy.

Alabama's controversial "chemical endangerment law" caused Casey Shehi to lose custody of her son and face up to 10 years in prison because she took half a Valium on two particular stressful instances during her pregnancy. (The case was eventually dismissed, but not without excesses of time, expense, and heartache on Shehi's part.) In Texas, a woman named Alma Baker was slapped with felony charges of "delivering marijuana to a minor" for occasionally smoking pot during pregnancy to help relieve her morning sickness. Cases like these set an alarming precedent. As a mom-to-be, you'd do anything to preserve the welfare of your baby.

But when is it safe (and legal) to take meds? And when—if ever—is it safe to set aside your own mental health?The film offers no easy answers because there are none. It's a tricky and personal thing, one that each woman interviewed in Moms and Meds was forced to reckon with on her own.

Kelly, the film's main character, had no prior history of mental illness, but became suicidally depressed within the first four to five months of her first pregnancy. "It was almost like I was a completely different person," she remembers in the film. "[I thought], 'If I run my car into this wall…then people won't have to worry about me anymore.' It didn't make me upset to think about it, and that scared me." Kelly recalls being alarmed enough to check herself into the hospital twice, but she says doctors there discouraged her from trying medication. During the course of the Moms and Meds shoot, Kelly got pregnant again and her symptoms recurred, but she persevered without ever opting for meds.

Another woman, Christine, decided to start taking meds toward the end of her first trimester after she found herself riddled with panic attacks about her ability to a be a mother: "Can I do this? Can women with anxiety be a mother?" she wondered.

Victoria, a New Jersey dancer whose aunt ended up adopting her son after birth, had a history of depression, anxiety, and eating disorders. She wanted to start on meds during her pregnancy but ended up being forced to wait. (It didn't help matters that she lost her boyfriend, her job, and her health insurance within the first few months of her pregnancy.) And Angela, a mom in Maryland with bipolar disorder, was on multiple medications when she got pregnant but opted to wean off everything but Lamictal.

Fortunately, things turned out well for all the women in Moms and Meds and their babies. But according to the organization Postpartum Progress (PP), mentally ill moms-to-be shouldn't automatically assume they need to chuck their prescriptions. Ceasing your psych medication is linked to a higher risk of relapse, and, as PP's website notes, "Many medicines required for the treatment of mental illness including depression, anxiety, OCD, and bipolar are known to be safe enough for pregnant moms when weighed against the known risk to both mom and baby of untreated or undertreated symptoms."

That said, certain meds are safer bets. According to the Mayo Clinic, some SSRIs can be used during pregnancy (think Prozac and Zoloft), as can Tricyclics like Pamelor, and some SNRIs (Cymbalta and Effexor XR). As Dr. Contag noted, it all comes down to assessing the risks vs. the benefits—ideally with an experienced, compassionate OB who specializes in high-risk pregnancies. (Reproductive psychiatrists can also be helpful.)

Sadly, these kinds of doctors can be hard to find, as Fiasconaro knows all too well. "The doctors work in silos," she says. She felt that many of her doctors, including her therapist, dismissed her concerns or simply weren't trained to address her medication-related questions. It's a problem some of the film's other subjects experienced as well. "Nobody is talking to one another… The doctors want to the right thing, but I think their hands are tied bureaucratically and by the health insurance companies," Fiasconaro explained.

Another issue is that many health professionals seem more adept at pinpointing signs of mental disquiet after the baby comes—not before. When asked why she thinks postpartum depression has gotten more attention than prenatal psychiatric conditions, Fiasconaro surmised that the usual postpartum narrative tends to center on new moms without a prior mental health history. "I don't mean to diminish their experiences whatsoever. But maybe it's easier to [process the idea] of 'Oh, I got this thing temporarily, but I'm not really mentally ill.'"

Whatever the case, she hopes Moms and Meds will help elevate the discussion around pregnant women's mental health, both before and after birth.

To stay up to date on when Moms and Meds might be screening in your area, stay tuned on its Facebook page.