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How Can I Find a Psychiatrist? I'm 5 weeks Pregnant with a Hx of Peripartum Psychosis

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  • How Can I Find a Psychiatrist? I'm 5 weeks Pregnant with a Hx of Peripartum Psychosis

    Hello and thank you for having this website. It is a wonderful resource.

    My question is how in the world I can find a psychiatrist who will not take me off all of my medication now that my current psychiatrist feels it is outside his field of expertise and should bring up these questions at my first prenatal appointment. I have one more month of my medication and won't be prescribed anymore. I'm on a higher than average dose of xanax, adderall, and lexapro. 3 mg a day of xanax, 30mg IR adderall BID, and Lexapro 20mg. This combination works very well for me and I've been on it for 9 years except for the 9 months I was pregnant with my second child. My first child, I was naive as to how considerate my OB was to find out all the facts and reduce but not take me off my medications through a slow taper. She took me down to 1 mg a day of xanax and 40mg of adderall by the time I was in my third trimester. In other words, it was a lovely pregnancy and experienced no issues with PPD which surprised given my heightened risk due to severe depression and anxiety throughout my life. My second pregnancy, two years later. My OB had moved to another state and no longer practiced. New OB said "absolutely none of what you've been taking, not if your baby's health is important to you". Cold turkey. I had depression, paranoia, anxiety, and OCD so severe I was having auditory and visual hallucinations. Not one day passed that I didn't consider suicide. I couldn't work, I couldn't get out of bed at all most days, I didn't shower, I stopped caring for the house and it became a rancid smelling junk yard and no longer a home at all. I went days and days without leaving the house. I made a decision shortly after the birth of my second son, never again. I can NOT go through that again, what if it's worse? My first pregnancy, lowered doses through tapering and second pregnancy, cold turkey discontinuation, psychotic woman who was scared of what she was capable of doing.

    This pregnancy was due to a birth control failure, now that I am pregnant I want to continue the pregnancy but feel it's an irresponsible choice for my children on this earth already if my mental health is not managed through medication. How can I find a psychiatrist experienced in treated women in pregnancy with medication management? I called the OB clinic and was told to NOT discontinue or change the dosage of my medications until being seen by someone but unfortunately they had no resources to give me. If I don't have any hope of proper treatment during this pregnancy, termination will be my only option. What kind of psychiatrist has this as a sub-specialty? I'm on the Maine/New Hampshire border and willing to travel to Massachusetts.

  • #2
    Hi, thanks for your post.

    I'm sorry, we don't have any resources that would help you to find a psychiatrist with those qualifications. There is no official sub-speciality or sub-board that covers women's issues, so you are unlikely to find such expertise advertised. I think your best bet is to find an OB that is willing to try something similar to your first pregnancy. That drug regimen was reasonable in my opinion. The American College of Obstetricians and Gynecologists, the professional think tank that writes practice guidelines for OB/GYNs, is very clear that maternal depression and/or psychosis should be effectively treated, despite the potential risks from the medications (See their statement in the link below). If your OB insists on stopping your medications entirely, seek a second opinion (or third or fourth).

    Please post again or call us at the InfantRisk Center if this has not completely answered your question. (806)352-2519

    -James Abbey, MD


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