10 Strategies to Help You Decide if Mental Health Medication Is Right for You
If you are experiencing a crisis, call the National Suicide Prevention Hotline by dialing 988 or 800.273.8255. You don’t have to be feeling suicidal in order to call them - they can support you through any mental health crisis. We also have a list of other crisis resources.
If you’re dealing with postpartum anxiety, depression, or other mental health challenges, you are in good company.
Becoming a new parent or adding a new baby to your family can be such an intense experience. And it’s even more intense if you’re experiencing any mental health challenges.
More and more people are coping with these struggles, especially since COVID-19. One study found that more than 1 in 3 pregnant or postpartum parents suffered from significant depression after the pandemic began. That’s a big increase from about 1 in 5 before the pandemic started. And as you might expect, the numbers are even worse among people of color experiencing economic oppression and racism.
Experiencing these challenges for the first time during your pregnancy or postpartum experience can feel very disorienting.
There is a pervasive cultural expectation telling us that pregnancy and new parenthood should be some of the best, most special times of our lives. But many people just don’t experience them that way, and can end up feeling so much guilt.
“Am I doing this wrong?”
“Do I really love my baby if I’m having such a hard time with this?”
“Why am I struggling so much when everyone else is doing fine?”
These questions can accompany feelings of bewilderment, frustration, inadequacy, or being frozen. These feelings can be experienced by any new parent. But if you’re having these kinds of feelings and finding it difficult to function on a daily basis, you might be experiencing some form of perinatal mood disorder.
If you’re feeling this way, remember that it is not your fault. You have done nothing wrong, and you deserve support to get through this.
If you already have support in place for your mental health including a therapist, psychologist, psychiatrist, etc., this would be an excellent time to check in with your team. Let them know what’s going on for you - it may be time to adjust your treatment plan to manage these new or more intense symptoms.
If you don’t currently have a mental health team, please do what you can to access support. It may feel too overwhelming to make phone calls, research providers covered by your insurance, or investigate other options for support. If that’s true for you, it’s perfectly understandable! Talk to a a trusted confidant and ask for their help in these specific ways. If you need a starting place, Postpartum Support International’s helpline (800.944.4773) can be a good first step.
As you move forward in addressing your mental health symptoms, you may find yourself considering (or being asked to consider) taking anti-depression and/or anti-anxiety medication for the first time.
This is a really personal decision. And for many of us, it feels like our self-worth is somehow wrapped up in the answer.
Even if you strongly support those who take medication to help their mental well-being, it can still feel surprising or upsetting somehow to be in a position to consider this yourself. That’s ok - it doesn’t mean you are secretly judgmental of others. More likely it means you are overly judgmental toward yourself as many of us are.
While you consider this decision, remember that you deserve to be ok.
There is no reason to deprive yourself of support just because you think you should be able to handle every challenge on your own. We all need help from our community sometimes, and you deserve to have the best pregnancy/postpartum experience possible.
As Michelle Obama wrote:
”Sadly, too often, the stigma around mental health prevents people who need help from seeking it. But that simply doesn't make any sense… We would never tell someone with a broken leg that they should stop wallowing and get it together. We don't consider taking medication for an ear infection something to be ashamed of. We shouldn't treat mental health conditions any differently. Instead, we should make it clear that getting help isn't a sign of weakness - it's a sign of strength.”
If you are considering whether to move forward with mental health medication and you feel hesitant, here are 10 strategies to help you make this decision:
1. Imagine what it will be like when you feel more like yourself again.
As you try to find the resources that will help you feel better, this exploration and decision-making process can take days, weeks, or months. Giving yourself some motivation to stay focused on while the going is hard can be a great way to show yourself some love.
Take two minutes to jot down what it will be like when you feel better. Do you picture yourself acting differently with the people around you? Finding it easier to connect with your little one(s)? Can you see a smile on your face? Are you returning to hobbies you love? Sleeping better or feeling more peaceful during the day? Whatever comes to mind, write it down. You can come back to this simple list whenever you need to be reminded of what’s waiting for you on the other side.
TIP: If you find yourself struggling to picture anything good, or if something like “I don’t think I will ever not feel like this” crossed your mind while you read the last couple paragraphs, try something for me. Say to yourself, “That’s the depression/anxiety talking.” You might need to repeat it a couple times to hear any tiny kernel of truth in that statement, but I promise it IS true. Sometimes it helps to have a reminder that the real you is still in there, underneath all the sh*t that your brain might be telling you in the moment.
2. Address safety concerns when considering medication.
Many parents are worried about how medications might affect their baby. This is a completely valid concern if you are pregnant or bodyfeeding. There are certain medications that are not considered safe for babies and it’s important to be able to make an informed choice here.
One thing to keep in mind safety-wise is that most medications do enter babies’ systems (either in utero or through milk), but that often the type and amount of medication that reaches the baby is not harmful.
The Infant Risk Center is one of the world’s leading research centers focused on the safety of medications during pregnancy and lactation. They offer a hotline (806.352.2519, 9am-6pm Eastern Time, Monday through Friday) where you can call and discuss your individual situation, including any possible medications and dosages you’re considering.
This resource is invaluable because all too often prescribers will instruct people to stop nursing their baby in order to begin a new medication, even though that medication actually IS safe to take while bodyfeeding. Clinicians many times don’t have the most current research on this topic (or are trying to avoid any possible liability by giving a blanket “no nursing” recommendation). With this in mind, it’s a great idea to call Infant Risk if you want to double-check a medication that has been recommended to you.
If you are considering a medication that truly would require you to stop nursing your baby, please remember that weaning can intensify mental health challenges. If you need to wean, I highly recommend working with a lactation professional. They can help you make a plan for weaning as gently as possible to hopefully prevent any further mood disturbances, as well as minimizing your chance of complications like plugged ducts and mastitis. Doctors are often unaware of the mental health effects of weaning and are usually not prepared to adequately support their patients through this process, so lactation professionals are key here.
(If you’re in this situation but aren’t able to afford lactation support, please reach out to us. Many lactation professionals offer pro bono services for those who otherwise wouldn’t be able to access support, and we can try to connect you with the help you need.)
3. Understand the medication time frame.
As you make this decision, it can be really helpful to have realistic expectations about how long you might take medication if you choose to go that route.
I spoke with a parent once who felt betrayed by her doctor who recommended a 6 month course of anti-depressant medication. She felt that her doctor was ignoring her wish to take medication for as little time as possible and had been expecting him to recommend a 1-2 month course of medication. In reality, 6-12 months is considered a short-term course of anti-depression medication by many providers. One reproductive psychiatrist recommends staying on medication at least 9 months after you begin to feel more like yourself for the best chance at maintaining your healing long term.
When you and your clinician decide it’s a good time to end your course of treatment, expect a period of weaning off the medication (very important to help avoid unpleasant withdrawal side effects, and to help prevent a sudden relapse of your initial symptoms).
4. Remember that it’s not possible to know all the answers ahead of time.
Many people who are trying to make this decision find that they have many questions and doubts about how and whether a medication would affect them. Side effects are often part of the story around mental health medications, and many of us have heard stories that made us feel we’d rather avoid medications at all costs.
This kind of decision requires a kind of surrender to the unknown, one way or another. It’s not possible to know ahead of time how your body might react to a certain medication/dose, or how you might fare if you continue with other kinds of remedies and resources in your healing process without medications. It’s possible that you might turn a corner any day now. And it’s also possible that you might feel like this for months or years without other kinds of support. At any given moment, we make the best decision we can based on the information we have at the time.
Remember that side effects are often temporary and can sometimes be counteracted with other strategies. There may come a time when you feel that the unknowns of possible side effects or other complications from a medication might be worth the possibility of feeling more capable, more energized, and more like yourself. You don’t have to know how you feel about that right now, but it’s good to keep in mind as you move forward in your process.
5. Set a deadline.
It can be really helpful to make a deal with yourself (and any loved ones supporting you through this) that if you aren’t feeling better by a certain date, you will try something new. Whether the something new is therapy, nutritional shifts in consultation with a naturopathic doctor, or a psychiatry appointment, it can be a relief to know that you have a next step planned. You might even make a note on your calendar of the date you decide on so you can see it written down.
Of course you can always adjust your time frame or change what you want to try next. But I encourage you to give this a try while you’re in this decision-making process to avoid the feeling of just floating along with no end in sight - something that is often very easy to do amidst the whirlwind experience of new parenthood combined with mental health struggles.
6. Give yourself time and space to try other options first if you don’t want to start medication right now.
It’s perfectly ok to explore other resources to see if they will help you feel better before you decide to try medication. Some people work with naturopaths, functional medicine doctors, acupuncturists, nutritionists, therapists, EMDR providers, and many other kinds of professionals who may be able to offer support during a difficult time. Unfortunately, access to these services can be reserved for the financially privileged as many of these options are not covered by insurance plans.
If you feel called and are able to explore other avenues to healing, I want to acknowledge that there are some difficult feelings that can come up. “Am I just postponing the inevitable? Is everyone convinced I need medication and just humoring me? What if I spend the money to try this stuff, nothing helps, and I end up taking medication anyway?” It’s perfectly ok to explore alternatives to medication, and you don’t owe anyone an explanation about your desire to do so. And, if you don’t want to do this (or aren’t in a financial position to do so), that’s perfectly ok too.
You can also explore getting more practical help if you find day-to-day tasks difficult. Postpartum doula support, house cleaning services, babysitters, parent helpers, dog walkers, pre-made meal kits, and other kinds of practical support can sometimes make a huge difference in the amount of overwhelm new parents experience.
7. Talk to others who have been where you are.
Sometimes it can be really helpful to talk with other people who have been in a similar situation and made it to the other side. Hearing their experiences, doubts, questions, and stories of healing can help you feel less alone. And hopefully, this social support can encourage you to keep seeking the resources you need.
A few Facebook group options: Postpartum Support International, Mental Health Support for Non-binary and Trans Parents, and some secret groups maintained by Mx Seahorse including “LGBTQ+ Perinatal Mental Health Support” and “Gender Inclusive Perinatal Mood and Anxiety Disorders Support.” (To access either of these two hidden groups, send Mx Seahorse a friend request and then message them a request to join.)
8. Consider your context.
If you have run out of new things to try to feel better but you’re still not sure about starting medication, spend some time thinking about the external factors that maybe be influencing your thought process.
For many of us, the cultural messaging that we’ve received throughout our lives might be playing a big part. Remember, our society values rugged individualism instead of compassionate and equitable care. This often leads to silent lonely suffering instead of thriving communities. If you can name specific thoughts you’re having (“taking medication is a sign of weakness or giving up,” “good parents shouldn’t need this kind of help,” any other statement that includes the word “should,” etc.), it might help to actually write them down in black and white. Seeing these thoughts that have been handed down to us by others might help you realize whether or not these statements truly apply to YOUR situation.
Maybe you can begin to soften or even start to let go of these thoughts. Maybe you can even start to write your own version of these statements. “Good parents shouldn’t need this kind of help” might become “good parents do what is needed to keep themselves and their families healthy and whole.” Or “taking medication is a sign of giving up” might translate to “choosing medication could be one way to show up for myself and my family.” It’s ok if your new statements don’t completely resonate at first. Depression has a way of convincing you that nothing else is possible, after all. But try to spend some time soaking in the possibility of these transformed thoughts.
9. Hold yourself with compassion (easier said than done, I know).
When things feel this hard and you catch your thoughts beating down on yourself, take a few deep breaths. Remember that your thoughts in this moment are not absolute truths - they are simply thoughts. Thoughts can shift and change, just like clouds in the sky. If you have a mind full of dark thunderclouds right now, remind yourself that the storm will pass sooner or later.
If you find it difficult to fight that inner critic whose voice can be so strong during these times, I have a suggestion for you: talk to yourself as you would a dear friend. Hear me out - this can be a really powerful tool.
On a sheet of paper, write down some of the thundercloud thoughts that are coming up right now. This can be a stream of consciousness, no need for long paragraphs. Now, pretend that sheet of paper with those dark cloudy thoughts was given to you by a friend. Choose a person who is dear to you, and get ready to write back to them. On a new sheet of paper, write “Dear (friend’s name)” and then write a response to those dark cloudy thoughts they shared with you. Really imagine your friend while you do this Bring them to your mind’s eye, look at a picture of them, anything you need to do to keep a vivid image of them in mind as you write your response.
When you’re done with your letter, cross out your friend’s name at the top of the page and write your own name instead. Now read the letter to yourself (out loud if you can). How does it feel to hear such a warm, compassionate response to some of your darkest thoughts? Remember that you can access this kind and supportive inner voice anytime - you might just need to trick your depression/anxiety brain a bit to get there.
10. Remember that you are the hero/heroine of your story.
It’s important to remember that such a challenging situation might be inviting you to make some big shifts in response. And that goes for any type of remedy you might explore to improve your mental health! Committing to stop using electronics for 30 minutes before bed would be a really big ask for most of us these days. Same goes for minimizing sugar or processed foods in our diet, or spending significant time outside every day, or any number of things you might try to help your mind heal.
Taking medication might feel like the last big thing you were hoping to avoid. You may have set deadlines for yourself and tried other things along the way and still be feeling mired down. If you’re in that situation still have a lot of hesitation about making what feels like a very final choice of saying “yes” to medication, I have a suggestion for you to reframe where you are on the path to healing.
What if, instead of viewing medical support as a way of giving up or giving in, you think of this as a pivotal moment in your hero’s journey? Bring to mind your favorite epic story (Star Wars, Lord of the Rings, Harry Potter, a story from mythology, etc.). Picture the pivotal moment in that story where the hero/heroine has to make a courageous effort to do the thing they didn’t think they could do. In order to muster the willpower and bravery to do what is being asked of them, it takes all of their dedication, strength, and belief in a better future.
Now try to imagine yourself as the center of your story. What “enemies” are you encountering? Who are your allies? What have you and your allies already tried to heal from the wounds inflicted by your enemies? What remaining resources are still available to you? If you had to make a drastic choice in order to gain ground and move toward a brighter future, what kind of change would you be willing to make? Who can help you gather all your strength and courage to take that next step?
A few book recommendations you might find helpful during this process:
Feeling Good by David Burns
Here you’ll find practical strategies for coping with depression based in cognitive behavioral therapy (CBT). This book was written in 1980 so it can feel dated in places, but the strategies laid out are still applicable.Healing through the Dark Emotions by Miriam Greenspan
Written by a bereaved mother, this book investigates the lessons we can learn from our “dark emotions,” and offers actionable steps we can take to move through these difficult feelingsThe Body Keeps the Score by Bessel van der Kolk
More technical, this book explains the ways our bodies retain memories of suffering and trauma, and how we can use this knowledge to promote healing and recoveryThe Wild Edge of Sorrow by Francis Weller
This beautiful book centers around grief, but it has practical applications for depression too. In addition to acute personal experiences, the author also brings to light and validates larger cultural wounds we are all coping with on some level.This Isn’t What I Expected by Karen Kleiman and Valerie Davis Raskin
Focused on postpartum mood and anxiety disorders, this book normalizes postpartum mental health struggles and offers strategies for coping with them.Transformed by Birth by Britta Bushnell - skip to the postpartum section if you’ve already given birth. This book uses inclusive language.
This is one of our favorite books for meaningful birth and postpartum preparation. The postpartum section has so much to offer around the changes to our bodies, minds, and relationships that accompany after-birth experiences.Wintering by Katherine May
This book offers wisdom drawn from getting through the dark and cold of winter to help us cope with difficult times in our lives.90 Seconds to a Life You Love by Joan Rosenberg
This book offers a useful 90-second trick for coping with overwhelming feelings of anxiety, fear, and shame.
