Medication: A Both/And Conversation
Medication discussions during pregnancy and postpartum are rarely simple. Clients are often balancing care for themselves with deep concern for their baby and family. As PMH-C clinicians, our role is to approach these conversations with warmth, accuracy, and collaboration without pressure.
Medication is not the right choice for every client. At the same time, it is an essential and sometimes necessary part of effective treatment for many perinatal mental health conditions. When thoughtfully integrated with psychotherapy and lifestyle supports, medication can significantly improve safety, functioning, and long-term outcomes.
A Whole-Person Treatment Model
Perinatal mental health care is most effective when it is multimodal. In clinical practice, medication is best understood as one component of care alongside:
Psychotherapy (e.g., CBT, EMDR, IPT, attachment-based therapies)
Lifestyle supports (sleep protection, pelvic floor PT, nutrition, movement, boundaries, social support)
Medication management, when clinically indicated
Medication does not replace therapy. Instead, it often reduces symptom intensity enough for clients to engage more fully in therapeutic work, relationships, and parenting.
Why Clients Are Often Hesitant
Clients’ hesitations around medication is typically rooted in care and responsibility rather than resistance.
Common concerns include:
Fear of harming the baby during pregnancy or breastfeeding
Worry about feeling numb or “not like myself”
Concerns about weight changes or dependency
Belief they should manage symptoms “naturally”
Shame or fear that medication represents failure
These concerns deserve validation. The perinatal season carries immense pressure to “do everything right,” which can amplify fear and self-judgment.
What We Also Know Clinically
Alongside validation, it is important to name that untreated or under-treated perinatal mental health conditions also carry risk.
Moderate to severe symptoms can affect:
Daily functioning and quality of life
Sleep, appetite, and physical recovery
Bonding and felt sense of safety
Relationships and family stability
For some clients, therapy and lifestyle changes are sufficient. For others, medication is not optional, it is a critical component of effective care.
Perinatal Conditions That Often Require Medication
While treatment should always be individualized, the following conditions frequently require medication for adequate stabilization and recovery:
Moderate to severe perinatal depression, especially when functioning is impaired or suicidal ideation is present
Moderate to severe perinatal anxiety disorders, including panic disorder and severe postpartum anxiety
Perinatal OCD, particularly when intrusive thoughts and compulsions significantly interfere with daily life
Bipolar disorders, which cannot be safely or effectively treated with therapy alone, especially postpartum
Postpartum psychosis, a psychiatric emergency requiring immediate medication and often hospitalization
Severe PTSD with mood or dissociative symptoms, where medication supports stabilization for trauma work
Addressing Common Myths
“Medication will change who I am.”
When appropriately prescribed, medication aims to reduce symptom burden, not one’s personality. Many clients report feeling more like themselves.
“Once I start, I’ll never be able to stop.”
Many clients use medication temporarily in the perinatal period. With clinical guidance, gradual tapering is often possible.
“Medication automatically causes weight gain or loss.”
Weight changes are not inevitable and vary widely. Many medications are weight-neutral, and ongoing monitoring matters.
Collaborative Care Matters
Medication conversations are most effective within a collaborative care model. As a therapist, I do not prescribe medication. My role is to provide assessment, education, and therapeutic support, and to help you think through whether a medication consultation may be helpful.
In some cases, medication may not be what is needed. A functional medicine evaluation may uncover an underlying medical condition (such as thyroid concerns, anemia, hormonal shifts, or sleep disruption) or lifestyle factors that are significantly impacting mental health—factors a client may not have been aware of prior to assessment. When medication is indicated, our Nurse Practitioner is able to prescribe and monitor it thoughtfully; when it is not, other targeted recommendations can be made.
In my work as a PMH-C, I partner closely with our Nurse Practitioner (she is a gem of a clinician and a human-being!) so that therapy and medication management are coordinated, transparent, and client-centered.
This approach improves continuity of care, aligns clinical goals, and allows treatment decisions to be informed by both symptom data and therapeutic insight.
A Compassionate Reframe
Rather than asking, “Do I need medication?” many clients find it more supportive to ask:
“What do my body and mind need/deserve right now in order to heal and function well?”
Sometimes the answer is therapy and lifestyle change alone. Sometimes it includes medication as a stabilizing support during a uniquely demanding season.
Medication is not a shortcut, a failure, or a permanent decision.
For many perinatal clients, it is a vital and often time-limited support that allows therapy, connection, and daily life to become possible again.
When clinicians approach these conversations with clarity and compassion, clients are empowered to make informed decisions rooted in self-trust rather than fear.
References
American College of Obstetricians and Gynecologists (ACOG) (2023). Treatment and management of mental health conditions during pregnancy and postpartum. ACOG Clinical Practice Guideline No. 5.
American Psychiatric Association (APA). (2020). Practice guideline for the treatment of patients with major depressive disorder.
Howard, L. M., et al. (2014). Non-psychotic mental disorders in the perinatal period. The Lancet, 384(9956), 1775–1788.
Postpartum Support International (PSI). (2022). Perinatal mood and anxiety disorders: Clinical overview and treatment considerations.
Sit, D., Rothschild, A. J., & Wisner, K. L. (2006). Postpartum psychosis: A review. Journal of Women’s Health, 15(4), 352–368.