What we treat across the perinatal year
"Perinatal" covers pregnancy through the first 12 months postpartum — the window when hormonal, physiological, and life-circumstance shifts most often surface or worsen psychiatric conditions.
- Postpartum depression — persistent low mood, anhedonia, and functional impairment beyond the two-week "baby blues" window. Affects roughly 10–15% of new mothers.
- Perinatal anxiety — generalized anxiety, panic, and health anxiety that frequently emerge or intensify during pregnancy and the postpartum.
- Postpartum OCD — intrusive, ego-dystonic thoughts about harm coming to the infant, accompanied by significant distress and avoidance. Underrecognized; very treatable.
- Pre-existing depression or anxiety in pregnancy — including patients who were stable on medication before conception and need careful continuation, adjustment, or change.
- Bipolar disorder in the perinatal period — the period of highest risk for mood episodes; requires careful medication planning before, during, and after pregnancy.
- Adult ADHD that is unmanageable in pregnancy or postpartum — including risk-benefit decisions about stimulant continuation in lactation.
Medication decisions in pregnancy
There is no version of this conversation that ends with "totally risk-free." There are two real options — treat the maternal psychiatric illness, or don't — and both carry documented risks. The job is to compare those risks honestly to your specific clinical situation.
What we draw on:
- MGH Center for Women's Mental Health — the reference framework for reproductive psychiatry decisions
- LactMed (NIH) — current lactation safety data for individual medications
- FDA pregnancy and lactation labeling rule (PLLR) — narrative summaries that replaced the old A/B/C/D/X letter system
- Your obstetric and pediatric team — coordination via signed releases when helpful
For most SSRIs, the documented effects on the developing fetus are small and the risks of untreated maternal depression are well-characterized: preterm birth, low birth weight, impaired infant attachment, and maternal mortality from suicide — currently a leading cause of maternal death in the first year postpartum. We say all of this out loud rather than pretending the choice is between a "natural" path and a "medicated" one.
Medications & breastfeeding
Most psychiatric medications are compatible with breastfeeding when chosen carefully. Sertraline has the most robust lactation safety data of any SSRI and is frequently first-line for new postpartum starts. Other reasonable options include escitalopram, citalopram, and several SNRIs depending on the clinical picture.
Where we are more cautious:
- Stimulants in lactation — limited data, individualized risk-benefit decisions, with attention to infant alertness and feeding
- Benzodiazepines — short-acting agents only, used sparingly, with clear infant monitoring guidance
- Lithium — possible to use in lactation but requires careful infant monitoring and pediatric coordination
- Lamotrigine — generally lactation-compatible; we monitor levels and infant signs
When to call 988 or go to the ER
We are an outpatient practice. We do not provide emergency, crisis, or inpatient care. Call 988 (Suicide & Crisis Lifeline) or go to your nearest emergency room if you experience:
- Active thoughts of harming yourself or your baby with intent or plan
- Hallucinations, severe paranoia, or rapid-onset confusion in the first weeks postpartum (possible postpartum psychosis — a true psychiatric emergency)
- Inability to sleep at all for more than 48 hours, especially with rapid mood swings
- Any acute safety concern that cannot wait for an outpatient appointment
Postpartum psychosis affects roughly 1–2 per 1,000 births and has rapid onset, usually within the first two weeks. It is not the same as postpartum OCD. If you are unsure which you are experiencing, err on the side of emergency evaluation.
Insurance & self-pay
In-network with ten major plans: Moda, PacificSource, Regence BlueCross BlueShield, Cigna / Evernorth, Aetna, Providence, Multiplan / Claritev, First Health, First Choice, and Optum. Most patients pay a specialist copay ($20–$60 typical).
Medicaid / Oregon Health Plan (OHP) is not accepted. Self-pay rates: $350 initial evaluation, $180 standard follow-up. Superbills available for out-of-network reimbursement. Good Faith Estimates provided before your first visit.
Frequently asked questions
Is sertraline really safe while breastfeeding?
Sertraline has the most extensive lactation safety data of any SSRI. Infant serum levels are typically undetectable or very low, and large case series have not identified meaningful adverse effects on infant development. That makes it a frequent first choice when starting an SSRI in the postpartum period — but the right medication for you depends on your history, what's worked before, and other clinical factors.
I had postpartum depression after my last baby — am I going to get it again?
A history of postpartum depression substantially raises the risk of recurrence — somewhere in the 30–50% range depending on the source. The good news is this is one of the most predictable presentations in psychiatry, and pre-emptive planning works. We can build a plan before delivery: monitoring schedule, threshold for starting medication, lactation-compatible options identified in advance.
I'm having intrusive thoughts about hurting my baby. Am I dangerous?
If the thoughts are deeply distressing to you, contrary to your values, and accompanied by avoidance and shame — that is most likely postpartum OCD, not postpartum psychosis. Postpartum OCD is common, very treatable, and does not indicate risk to your infant. Please reach out — this is one of the most underrecognized and most treatable conditions in perinatal psychiatry. If the thoughts feel like commands you might act on, or if you are also experiencing confusion or paranoia, call 988 or go to an emergency room.
Can I take ADHD medication while pregnant or breastfeeding?
It depends on severity and function. For some patients, untreated ADHD in pregnancy or postpartum produces enough impairment that the risk-benefit favors continuation; for others, a trial off medication is reasonable. We discuss the options, the data limits, and coordinate with your obstetric and pediatric team.
Do you take patients trying to conceive?
Yes. The pre-conception window is often the best time to optimize a medication regimen — switching to options with better reproductive safety profiles, or building a stabilization plan before pregnancy.