ABSTRACT
Although the integration of pharmacotherapy and psychotherapy is important to achieve in the treatment of many, if not all, clinical presentations, it is particularly important to achieve in the treatment of perinatal distress. I define perinatal distress as the presence of clinically significant psychiatric symptoms of depression or anxiety in women who are pregnant or who are in the first year postpartum. The decision to medicate a perinatal woman is made with great care, as during pregnancy, medications cross the placenta and are absorbed by the fetus, and when postpartum women are breastfeeding, a portion of the medication can be measured in the breast milk. Thus, medicating a woman during pregnancy and lactation means that the prescriber is, to some degree, medicating the fetus or the infant. For this reason, many practitioners and patients, alike, unilaterally opt for psychotherapy rather than pharmacotherapy. That being said, there are numerous instances in which the medication of a pregnant or lactating woman is indicated on the basis of aspects of her clinical presentation. In other words, the decision not to medicate a perinatal woman is not so clear-cut and certainly not a rigid rule of thumb. Rather, prescribers consider a number of different variables in ultimately making a treatment recommendation.
