How do I plan my pregnancy with depression and PMDD?

Question

Hello doctor,

I am a 31-year-old woman with major depressive disorder, currently managing my condition with antidepressant medication and therapy. However, I am struggling with how my mental health condition intersects with my reproductive health and overall women's wellness.

My depression symptoms seem to worsen significantly during certain times of my menstrual cycle, particularly in the two weeks before my period when I experience severe mood drops, increased anxiety, and sometimes suicidal thoughts. This has made me wonder if I might have PMDD in addition to my depression.

Additionally, my antidepressant medication has significantly decreased my libido, which is straining my marriage and affecting my self-esteem. My husband and I want to start a family, but I am terrified about managing pregnancy and the postpartum period with my mental health history.

I am also concerned about the safety of my medications during pregnancy and whether depression could affect my ability to bond with and care for a baby.
Could I have PMDD in addition to major depressive disorder, and how are they treated differently?
How can I address the sexual side effects of antidepressants that are affecting my relationship?
What are the safest antidepressant options for women trying to conceive and during pregnancy?
How does maternal depression affect pregnancy outcomes and fetal development?
What support systems and treatments are available for postpartum depression prevention?
Can depression and its medications affect fertility and my ability to conceive?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

I recommend consulting a consultant psychiatrist for a comprehensive evaluation and ongoing management, especially if you are experiencing symptoms consistent with premenstrual dysphoric disorder (PMDD).

PMDD is a severe, chronic, hormone-based mood disorder that occurs during the luteal phase of the menstrual cycle, typically one to two weeks before menstruation, and can cause debilitating emotional and physical symptoms such as intense anger, depression, anxiety, mood swings, and distress that interfere with daily life.

You should start taking Folic Acid 5 mg, one tablet at night, for three months before conception and throughout the first trimester.
You may also take a supplement containing Myo-inositol, Folic Acid, Melatonin, and Vitamin D3, one sachet at night for three months.
For mental health support, begin Escitalopram 10 mg, starting with half a tablet at night for the first four days, then increasing to one tablet at night for six months.
Once pregnancy is confirmed, you must do an ultrasound
1. At seven to nine weeks for dating.
2. At 11 weeks to almost 14 weeks for nuchal translucency.
3. At 18 to 20 weeks for an anomaly scan.
4. And then start growth scans every four weeks after 28 weeks.

It is important to acknowledge your role in caring for your baby and to provide support in a compassionate, non-judgmental way. Continuity of care should be ensured if you are transitioning from adolescent to adult mental health services.

At the same time, the needs of partners, families, and carers should be considered, including the welfare of the baby and other dependents, the support provided by your partner or family, and the potential impact of any mental health problem on your relationships.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.