Can Psychiatric Drugs Blunt the Mother-Baby Bond?

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It’s normal for expectant parents to worry if they don’t feel a strong connection to the baby right away. “Those kinds of mixed fears and anxieties are really common in most pregnancies, certainly first pregnancies,” said Dorothy Greenfeld, a licensed clinical social worker and professor of obstetrics and gynecology at Yale School of Medicine. Bonding is a process that takes time, and while it can begin in pregnancy, the relationship between parent and child mostly develops after birth.

Psychiatric conditions, and the medicines used to treat them, can complicate the picture. Antidepressants, the most widely used class of psychiatric drugs, do not seem to interfere with a woman’s attachment to the fetus during pregnancy, as measured by the amount of time the mother spends thinking about and planning for the baby, a 2011 study in the Archives of Women’s Mental Health found. On the other hand, the study found that women with major depression in pregnancy had lower feelings of maternal-fetal attachment, and this sense of disconnection intensified with more severe symptoms of depression.

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“Depression can definitely affect a person’s ability to bond with their baby, to feel those feelings of attachment, which is why we encourage treatment so strongly,” said Dr. Amy Salisbury, the study leader and a professor of pediatrics and psychiatry at the Alpert Medical School at Brown University. “That’s more likely to interfere than the medication itself.”

There is less research on the effects of other types of mental health medications on mother-baby bonding, but psychiatric medications can have side effects that might interfere with parenting. For example, a small percentage of people taking mood-stabilizing medications have feelings of apathy, and that could hinder the bonding process, said Dr. Salisbury. And some mental health medications, depending on dosage and combination, might make a person feel too sedated. But again, letting mental illness go untreated is likely far riskier for both the mother and the baby.

“It has to be weighed; how much her symptoms would interfere with her ability to have those cognitions and thoughts and feelings about her baby, or even physically, functionally take care of her baby once the baby comes, and how much the medications interfere with that process. That’s going to be specific to her diagnoses and her medications,” Dr. Salisbury said.

After birth, the process of attachment depends on parents’ sensitive and positive interactions with the baby.

“Mothers who have depression and other mental health symptoms tend to have less positive facial expressions, less verbalizations, and even engage in certain types of behaviors that don’t always focus on the safety of the child in the same way,” said Dr. Sheehan Fisher, a professor of psychiatry at the Feinberg School of Medicine at Northwestern University. “What our focus is on is how do we best treat the mother so that her symptoms don’t get in the way of her being able to bond with the child and the impact that can have on the infant long-term,” he said. Research shows that mothers who are responding well to antidepressant treatment feel more confident and satisfied in their roles as parents, similar to mothers without depression.

Individuals respond differently to different medications. A psychiatrist or therapist can help find the right drugs and the right balance in treatment, particularly during big life changes such as becoming a parent, Dr. Fisher said.