The crisp cool air

The smell of a wood fire

The sounds of nature

The feel of sticky burnt marshmallow on everything I touch

I'm talking about camping!

I love to camp. This is my jam.

We’ve been camping as a family for ages (or about 5 years) and I keep really good notes of what we wished we had (or don't want to lug with us next time).

That way each trip is just a little better, a little more prepared, a little more perfect for our Beachkofsky camp style.

But not everyone has the time or the experience (or the desire) to plan like me.

A few years ago our camp neighbors showed up in the dark with a brand new tent and air bed from the local Walmart. They used their car headlights to get everything put together well enough to get to bed by midnight.

Apparently they were from Columbia and here for an impromptu camping family reunion a few sites over!

We were happy to share everything we could: fire starters, lights, a corkscrew, bungee cords, even some (non-sticky) marshmallow skewers.

It was a success all around!

There are different ways to kick ass camping.

The planning way, and the let's-just-wing-it way, and they can both work out fabulously!

Not unlike pregnancy.

...of which 50% in the US are unplanned!

Some people are perfectly prepared (ha!) and get pregnant when they’re ready.

And some people get surprised and have to create a plan as they go.

So here are just a few tips about mental health, meds, and pregnancy that may be really helpful for the people we work with! And a link to an article about pregnancy and meds and one about the ethics of meds in pregnancy.​

First off, no matter what, we DO want to plan as early as possible whether that's a year before your client is trying to get pregnant or 6 weeks into a pregnancy. It may look a little different for each but it definitely helps to talk through a plan!

ANYONE who is capable of bearing children should NOT be prescribed meds that would be catastrophic in then event of an oops baby! Just in case...

A big one for psych is valproic acid/Valproate/Depakote, which is a mood stabilizer and KNOWN to cause a potential host of problems to a developing fetus. No active uterus is on Depakote in my clinic!

If we have time before getting pregnant here's what the recommendations say:

• Maximize dosing and minimize medications: try to get someone on as few meds as possible even if it means the dosage has to increase (with good effect and no side effects, of course!)
• Use the lowest EFFECTIVE dose knowing that it will likely go up as pregnancy progresses (this is the case for most medications due to physiologic changes in a pregnant body)
• Get a really thorough mental health history for the client and family with special attention to any history of bipolar disorder or other past reproductive mood or anxiety changes

The same holds true for someone who's ALREADY pregnant too! But here's the other important bits:

• Minimize switching!!! Every time something is changed during pregnancy it's considered another "exposure" for the fetus. So that means stopping one medication that was working when someone gets pregnant, maybe Paxil, and then starting something a month later, say Zoloft, when the symptoms get worse, is 3 exposures!!
  • exposure 1: Paxil, initial/previous medication
  • exposure 2: exacerbated mental health condition
  • exposure 3: Zoloft, new medication

There's something called a risk-benefit discussion that prescribers should always have with patients when starting any medications.

But in pregnancy it's not a risk-benefit discussion, it's a risk-risk discussion! That's because untreated mental health conditions are a clear risk themselves and the choice is between the risk of going untreated or taking a particular medication to treat the condition!

What risks am I talking about?

• Mom's risks without mental health treatment: preeclampsia, gestational diabetes, gestational hypertension, hemorrhage, c-section, increased mental health symptoms, and decreased adherence to medical care
• Baby's risks without mom being treated: preterm birth, intrauterine growth restriction, low birth weight and developmental impacts like higher impulsivity, poor social interactions, and cognitive and behavioral difficulties
• Postpartum psychosis is a medical emergency!! This is typically seen with patients who have a bipolar disorder with onset 2-4 weeks after birth. For women with bipolar disorder, 85.5% of those who discontinued mood stabilizers experienced a mood episode during pregnancy, compared to 37% of those who maintained treatment.

Now of course there ARE risks to taking medications, but in general the data is showing that an untreated mental health condition has more concerning and longer-lasting impacts on the mom and the baby.

The specific medication conversations should be handled by the prescriber because each medication has nuanced risks that need to be addressed.

And there are great non-pharm options too! Like...

• Therapy (duh)
• Bright light therapy
• Sleep management
• Nutrition support

And don't forget ECT! Other than the brief medications used for sedation during the procedure, this is a very safe and effective treatment for pregnant people with significant symptoms. (TMS is also probably fine but I didn't read anything about it specifically so I can't say for sure!)

Lot's of stuff here!

The main things to share are:

1. Untreated mental health symptoms have real risks to mom and baby!
2. Medications are generally safe and should not be changed if they're working!!

Ok this got way too long. There's a lot to say on this topic (even if it's not being told to your client!!)

And I have to get back to packing!

We’re going camping in north Georgia before Thanksgiving. Which will be totally new for us so even though we kind of know what to expect, it’s still a little anxiety provoking.

Just like pregnancy!

But where the biggest risk is forgetting a beanie or staying endlessly sticky from my kids' burnt s’mores.

Cheers to healthy brains,

Dr. B

Jess Beachkofsky, MD

Your friendly online psychiatrist!

P.S. TheraBundle is available right now!!! Check it out! I can't imagine you wouldn't find enough compelling, helpful stuff to make that 100$ feel more than worth it! And I'm counting on you for my affiliate commission so that I can retire 20 minutes early!

P.P.S. Respond to me with something funny or awesome that happened to you this week! It's been a rough one for me and I could use some smiles!!