A: You have brought up an excellent point, Casey. Many women suffer from panic attacks and anxiety. Pregnancy also tends to increase one's level of concern. Combining the two can lead to some very significant difficulties for pregnant women and their families.

I suggest you speak with your healthcare provider about your concerns. They may be able to alleviate some of your concerns about the baby, its health and your pregnancy. In some cases, they may suggest that you speak with a counselor, a social worker, psychologist or psychiatrist.

The decision to initiate therapy during pregnancy is based on you. How are you dealing with your partner, family, and work? Can you live with your fears and anxieties? If the answer is no, then medication can be considered. Today, a class of drugs known as SSRI (selective serotonin reuptake inhibitors) which includes Paxil®, Prozac®, Zoloft®, etc. is being used to treat anxiety, panic attacks and depression.

Although no drug has been given the green light for use during pregnancy, there are many studies following women who took these medications while pregnant. To date, there is no evidence that they cause birth defects in humans. However, there are a few reports of babies being born with mild, transient irritability thought to be related to the medications.

I have found many pediatricians reluctant to encourage breastfeeding for moms taking SSRIs. I think their concern comes from the fact that SSRI's are found in breast milk. They are also found in very low concentrations in the blood of nursing babies. However, the levels are very low and there are no reports of adverse effects upon the baby. The decision to nurse is very personal and very rewarding. Speaking with your pediatrician can help you make this decision.

In my practice, I have many women who use SSRIs during pregnancy and nursing. They have done very well and I encourage them to pursue their desires.

Casey, thank you for your question. I am sure many of our readers share your concerns.