Medication Decisions During Motherhood: Reducing Shame and Fear
Guest Post by: Dr. Amy O’Donnell. She is the owner of Nature’s Flow Psychiatry, a boutique integrative psychiatry practice serving adults in FL, NY, and PA (soon TX too). She helps people de-prescribe as well as holistically manage anxiety, mood, and women’s mental health concerns. Learn more at www.naturesflowpsych.com IG: @naturesflow.psych.
Making medication decisions during motherhood particularly about mental health can feel scary and overwhelming. There is so much information out there - what is right? By definition motherhood means there is a little one to also consider - the stakes of making the right decision feel very high. And what does taking psychiatric medication during motherhood even mean? Often moms fear deep down that this makes them a bad or broken mom. They should be happy. They should be better. They just need to try harder. Taking medication can feel like admitting defeat or that there is something wrong with them.
The good news is that whether you decide to take psychiatric medication or not, you have options. Psychiatric medication can serve as just one of many tools to help you get to where you want and need to be. So let’s tackle some of the top three sources of fear and shame that moms face when trying to decide if a psychiatric medication makes sense for them.
Conflicting information and uncertainty
One of the tactics that lawyers will use on tv shows to hide an important piece of evidence is that they bury it in thousands of documents and make the opposing counsel search for it. That’s what the internet, particularly around women’s mental health feels like today. Yes, the correct, evidence-based information is generally available somewhere on the internet but it can be hard to know where to find it. Top websites with reliable information about mental health in motherhood I suggest my clients look at are: mothertobaby.com and https://womensmentalhealth.org/. These are an excellent starting place. Things chatgpt and instagram are appealing because they make things easy, but sometimes (or even often with social media) will contain incorrect or misleading information.
Additionally, the reality of research into perinatal mental health meaning during pregnancy and post-partum is that there isn’t a lot of research and much of it is poor quality studies. Not all research is created equal. Just because there is one study that concludes something, doesn’t also mean there aren’t another few studies that suggest something different. This can cause a lot of confusion. It means sometimes my clients will receive conflicting information from their different doctors. We saw it on a recent FDA panel on antidepressant use in pregnancy with lots of strong opposing opinions. When you work with your psychiatrist you want to make sure you are working with someone who has a good grasp on the research, what risks of medication do we have strong evidence for vs what risks are less likely to be real?
Like any decision you make in life, there will be uncertainty. No one can 100% predict the future. Having a mental health team that can help support you through the discomfort of the unknown and the uncertain is essential. Part of this means finding a provider or resource that gives you information about the most current understanding of how psychiatric medications may or may not help you.
Fear of harm to baby or mom
One of the most common and deeply felt concerns about psychiatric medication use during pregnancy and motherhood is the fear of harm to the baby. This fear consistently ranks as the top worry I discuss with pregnant and postpartum women considering treatment for mental health conditions. Common concerns include the risk of congenital malformations, long-term neurodevelopmental effects, miscarriage, and preterm birth. These worries are understandable and deserve careful, evidence-based discussion rather than dismissal.
It would be impossible to discuss all the risks and evidence around every psychiatric medication, but let’s look briefly at some of the risks of antidepressant use while pregnant. Like any individual taking antidepressants, mothers may experience sexual side effects, withdrawal symptoms if medication is stopped abruptly, or short-term effects such as nausea or headaches. The most well-established risk for baby is neonatal adaptation syndrome, a typically short-lived condition that may include jitteriness, feeding difficulties, or mild respiratory distress in newborns. Much less common are persistent pulmonary hypertension of the newborn (PPHN) and an increased risk of postpartum bleeding. Certain medications carry specific risks; for example, paroxetine (Paxil) has been linked to a small increased risk of cardiac defects, which is why I avoid its use during pregnancy when alternatives are available.
Crucially, the risks of medication must be weighed against the risks of untreated depression or anxiety during pregnancy, which are often underestimated. Studies show that low birth weight and preterm birth occur in both women treated with antidepressants and those with untreated mood and anxiety disorders, indicating that the illness itself may play a significant role. Untreated maternal depression has also been associated with neonatal behavioral changes and possible effects on childhood cognition. For mothers, severe depression can lead to poor physical health, impaired functioning, and, in severe cases, suicidal risk.
Ultimately, deciding whether to start or continue psychiatric medication in pregnancy is a risk-versus-risk decision, balancing the potential harms of treatment with the risks of ongoing mental illness. The most important step is working with a knowledgeable provider who listens, respects your values, and helps you make an informed, supported decision.
Fear of judgment and stigma
Fear and stigma around taking psychiatric medication are common for many people—but they often become even heavier once someone becomes a mother. From the moment pregnancy or parenthood begins, women are surrounded by both subtle and overt messages about what a “good mom” should look like: endlessly patient, self-sacrificing, emotionally steady, and able to do it all often without help. These expectations can make the decision to take medication feel like a personal failure rather than a thoughtful health choice.
And often, the harshest judgment doesn’t come from others—it comes from within. Self-judgment can be relentless, fueled by guilt, shame, and the belief that needing medication means you are somehow falling short. Many mothers hold themselves to impossible standards, believing they should be able to “push through” for the sake of their children, even when they are suffering. On top of this internal pressure, people close to you—partners, parents, friends—may have strong opinions about psychiatric medication. Even when well-intentioned, these views can conflict with your own values or medical advice, adding confusion and emotional strain.
As humans, the stories we tell ourselves matter. The meaning and narrative you attach to taking—or not taking—medication can shape how you feel about yourself as a mother. Is medication a sign of weakness, or is it an act of responsibility and care? Reframing this story can be a powerful step toward reducing shame.
Finding a support system is essential. Seek out people who truly know you—who understand your heart, your intentions, and how deeply you care for your family. Peer support can be especially validating; organizations like Postpartum Support International offer connection with others who have walked similar paths and understand the complexity of these decisions.
You cannot control how others react to your choices. You can only control how you respond, how you care for yourself, and how you honor your own needs. Choosing mental health support, including medication when appropriate, can be another way of showing up for yourself and your family
