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13Nov2012
Female Suffering From Extreme Anxiety and Depression

Question:

I am a twenty eight year old female who is suffering from extreme anxiety and depression. I’m always jittery and I just never feel content. My therapist recommended that I see a psychiatrist for some anti-anxiety and antidepressant medication. However, I’m afraid that this will affect my decision to build my family in the next couple of years.  Is medication harmful during pregnancy? Will I be able to have a healthy child while on meds? Is there any possibility of abnormal fetal development due to effects of meds?
Thanks for your time.

Answer:

Dear Jolene,

Let’s begin with understanding that there are three aspects to your anxiety and depression.  The first is the biological, which is the genetic predisposition we inherited from our parents (50% from mom and 50% from dad).  Now keep in mind, if your parents and family history is negative for anxiety and depression, then this may not be playing a hugh role in understanding your symptoms.  However, if you have a strong family history of anxiety and depression, then it would be more appropiate to think that biology is playing a bigger role in your symptom presentation.

Second, is your psychological make up.  What this suggests is that your personality and the multiple facets it’s composed of plays a part of how you view and interact with the world around you.  We’ve had millions of experiences growing up and have formed very intricate belief systems that guide us through our day-to-day lives. I like to think of these belief systems as a software equivalent on a computer.  As we all know, software systems run on rules (beliefs) and inevitably contain errors.  The only way to fix the error is to look at a presenting problem (set of symptoms) and begin exploring the possible causes.  Once we have identified the suspected cause, we go and closely examine and change that part of the software (beliefs).  You can think of this as updating your software.

Lastly, it is important to understand the Social aspects of one’s life and it’s role in our day-to-day lives.  We all have varying family structures, it is becoming more rare in western civilization to see a nuclear (father, mother, children) families and more and more often we are seeing single parents raising their children.  Clearly, this has impact on the child’s beliefs systems which then later the adult utilizies to navigate through life.  Maybe, someone has a serious medical illness in the family; maybe someone’s parents died; or maybe there are financial stressors; or maybe someone is just overwhelmed by her or his chldren and the stress being a parent carries; you can see there are millions of permutations that give each one of us a unique idenity and a social frame in which to function.

Going back to understanding your depression and anxiety; you have to examine the amount of contributions from each of these 3 areas; how much biological load is involved (genetic predispositon); how much of the symptoms are understood by the your particular psychology?  Lastly, what social aspects are involved in your life that could be amplifing your symptoms?

This is what we refer to as the Bio-Psycho-Social model of any presenting problem.  I think it is critical in addressing all of these attributes when dealing with a medical problem in order to get the best treatment of the illness.  Also, keep in mind that some problems are more biologically determined while others are more psychologically driven.  Thus, medication managment may be more appropriate in some situations and therapy in others.  Usually, a combination is best.

About your question to pregnancy and the use of medications.  The FDA has established 5 categories to indicate the potential of a systemically absorbed drug for causing birth defects. The key differentiation among the categories rests upon the degree (reliability) of documentation and the risk vs benefit ratio. Pregnancy Category X is particularly notable in that if any data exists that may implicate a drug as a teratogen and the risk vs benefit ratio does not support use of the drug, the drug is contraindicated during pregnancy. These categories are summarized below:

FDA Pregnancy Categories
Pregnancy Category Definition
A Controlled studies show no risk. Adequate, well-controlled studies in pregnant women have failed to demonstrate risk to the fetus.
B No evidence of risk in humans. Either animal findings show risk, but human findings do not; or if no adequate human studies have been done, animal findings are negative.
C Risk cannot be ruled out. Human studies are lacking, and animal studies are either positive for fetal risk or lacking. However, potential benefits may justify the potential risks.
D Positive evidence of risk. Investigational or postmarketing data show risk to the fetus. Nevertheless, potential benefits may outweigh the potential risks. If needed in a life-threatening situation or a serious disease, the drug may be acceptable if safer drugs cannot be used or are ineffective.
X Contraindicated in pregnancy. Studies in animals or human, or investigational or post-marketing reports have shown fetal risk which clearly outweighs any possible benefit to the patients.

I would suggest talking to your physican about any concerns that you have in reference to risks during pregnancy so that he or she may specifially address your needs.

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