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110: Perinatal Mental Health: Intrusive Thoughts, Medication Myths, and What New Parents Deserve to Know - with Lauren Collier


Perinatal mental health is one of the most misunderstood parts of pregnancy and early parenthood. Many new parents quietly struggle with anxiety, intrusive thoughts, medication fears, or resurfacing trauma — believing they’re alone or “failing.”

They’re not.

In this episode, I talk with Lauren Collier (she/her), a psychiatric provider specializing in perinatal mental health, about what’s actually happening in the brains and bodies of new parents — and why so many myths keep people from getting support.

This episode is not medical advice. Always consult your providers about medication and mental health decisions.


🌿 In this episode, we cover:

  • What Perinatal Mood & Anxiety Disorders (PMADs) actually include

  • Why stopping medication in pregnancy is not always necessary

  • The real risks of untreated anxiety and depression

  • The truth about intrusive thoughts (and how to tell them from psychosis)

  • Why trauma often resurfaces during pregnancy and postpartum

  • Signs it’s time to reach out for support


Listen to the episode now:


Perinatal Mental Health: Medication Myths, Intrusive Thoughts, and the Truth About Getting Support

If you are pregnant, postpartum, or supporting someone who is — this conversation is for you.


Perinatal mental health is one of the most misunderstood aspects of pregnancy and early parenthood. Many parents silently struggle with anxiety, intrusive thoughts, medication fears, shame, or trauma resurfacing — believing they are alone or somehow “failing.”


They are not.


In this episode, I spoke with Lauren Collier (she/her), a psychiatric provider specializing in perinatal mental health, about what’s actually happening in the brains and bodies of new parents — and why so many myths prevent people from getting the support they deserve.


This episode and blog post are not medical or psychiatric advice. It’s important to discuss your mental health and medication use with your providers.

Let’s unpack it all.


First: Perinatal Mood & Anxiety Disorders Are Common

Let’s start with normalization.

Perinatal Mood and Anxiety Disorders (PMADs) affect approximately 1 in 5 people, according to the Centers for Disease Control and Prevention.

That means if you’re struggling, you are not an outlier. You are not broken. You are not weak.


PMADs include:

  • Depression

  • Anxiety

  • Panic disorder

  • OCD

  • PTSD

  • Bipolar disorders

  • Psychosis (rare but serious)


It’s important to note: this is why we’ve shifted from saying “postpartum depression” to perinatal mood and anxiety disorders — because depression is only one part of the picture.


And yet, shame keeps so many parents silent.


Why?


Because many people internalize the idea that struggling emotionally says something about their character, their capacity, or their identity as a parent.

It does not.


Struggling during a major biological, hormonal, neurological, and identity transition is human.


The Medication Myth: “If I’m Pregnant, I Have to Stop Everything”

One of the biggest myths in perinatal mental health is this:

“If I find out I’m pregnant, I must immediately stop my psychiatric medication.”

This is not automatically true.

Here’s what often happens:

  • Someone has finally found a medication that works.

  • They discover they’re pregnant.

  • Panic sets in.

  • A provider (sometimes even a well-meaning PCP) says, “You need to stop.”


But medication decisions during pregnancy are not one-size-fits-all.


They require:

  • Individualized risk-benefit analysis

  • Review of research and safety data

  • Consideration of past medication history

  • Consideration of untreated mental health risks


Untreated Mental Health Carries Risk Too

We cannot evaluate medication without also evaluating the risks of untreated anxiety or depression.


Chronic stress, elevated cortisol, sleep deprivation, and panic states can affect:

  • Maternal functioning

  • Bonding

  • Access to prenatal care

  • Infant temperament

  • Overall nervous system regulation


The question isn’t: “Is medication bad?”

The real question is: “What are the risks and benefits in this specific situation?”

For many parents, continuing medication is appropriate. For others, tapering feels right. The key is informed choice — not fear-based reaction.


“Will Medication Change Who I Am?”

This fear is incredibly common.


Many parents worry:

  • “Will I lose my personality?”

  • “Will I feel numb?”

  • “Will I be less connected to my baby?”

  • “Will I become dependent?”


Here’s the truth:


The goal of psychiatric medication is symptom reduction and improved functioning — not personality suppression.

In fact, many parents report feeling more like themselves:

  • Laughing again

  • Feeling engaged

  • Regaining motivation

  • Experiencing less constant fear


What About Dependency?

Antidepressants are not addictive in the way substances are. They may require gradual tapering if discontinued — but that is different from addiction.

And no one is signing a lifetime contract when they start medication.

Treatment plans are reassessed regularly. Some people use medication short-term during transition periods. Others continue longer. Both are valid.


Benzodiazepines in Pregnancy & Breastfeeding: Another Misunderstood Topic

There is also a common myth that medications like benzodiazepines (used for panic and acute anxiety) are never allowed during pregnancy or breastfeeding.


In reality:

  • They can sometimes be used safely

  • They may be appropriate for short-term severe panic

  • Decisions are case-by-case


Severe, untreated panic also carries risk.


Again, nuance matters.


Intrusive Thoughts: The Topic No One Wants to Say Out Loud


This is one of the most important parts of our conversation.

Intrusive thoughts in the postpartum period are incredibly common — especially among people with anxiety or OCD traits.


These thoughts are:

  • Unwanted

  • Distressing

  • Ego-dystonic (they go against your values)

  • Often violent or alarming in content


Examples:

  • “What if I drop the baby down the stairs?”

  • “What if I submerge the baby during bath time?”

  • “What if I suffocate them accidentally?”


Parents often feel terrified to admit these thoughts.


Many fear:

  • Being hospitalized

  • Losing custody

  • Being reported

  • “Becoming psychotic”


Here is the critical distinction:


If the thoughts are distressing and unwanted, they are most often OCD-related intrusive thoughts — not psychosis.


Psychosis involves thoughts that align with intent or lack distress. That is very different and far rarer.


Approximately 11% of postpartum individuals experience OCD symptoms.

That is not rare.


Why Do Intrusive Thoughts Increase Postpartum?


Your nervous system is on high alert.

You are biologically wired to protect your baby.

Your brain generates “what if” scenarios as a survival mechanism.

The problem?Trying to suppress the thoughts makes the brain label them as important — which increases their frequency.

A helpful reframe:Instead of fighting the thought, try:“Thank you, brain. That was alarming. I know you’re trying to protect me.”

Shifting from reaction to response reduces physiological escalation.

And yes — therapy and medication can help significantly.


Trauma Resurfaces in the Perinatal Period

Pregnancy and early parenthood are identity transitions.


They often activate:

  • Childhood trauma

  • Attachment wounds

  • Birth trauma

  • Medical trauma

  • Grief about the childhood you didn’t have


Many parents express:“I don’t want to parent the way I was parented.”

This is profound.


The perinatal period can be destabilizing — but it can also be an opportunity for healing.


Trauma-informed care means:

  • Offering choices

  • Explaining procedures

  • Assuming vulnerability

  • Avoiding coercion

  • Practicing cultural humility

  • Checking provider bias


This should not be limited to mental health settings. It should be present across OB care, pediatrics, and birth settings.


Hypervigilance: When Does It Become a Problem?

Some level of hypervigilance is biologically normal.


You just brought a dependent human into the world.


But consider seeking support if:

  • Thoughts loop constantly

  • Fear interferes with sleep (beyond normal newborn wake-ups)

  • You cannot laugh or feel joy at all

  • Every day feels unbearable

  • You feel detached from yourself

  • You have thoughts of harming yourself

  • You feel paranoid or disconnected from reality


Zero symptoms is not the goal.


But persistent impairment is a signal.


Baby Blues vs. Depression

Baby blues:

  • Begin within days postpartum

  • Mood swings, tearfulness

  • Improve within 2 weeks

  • Often helped by rest, food, and support


Postpartum depression:

  • Persists beyond 2 weeks

  • Feels heavier

  • Includes hopelessness, numbness, and intrusive guilt

  • Doesn’t improve with a snack and a nap


If a snack and a nap don’t help — reach out.


Social Media, Comparison, and Unrealistic Expectations

Bounce-back culture.Perfect nursery posts.Filtered newborn moments.

These narratives fuel perfectionism and shame.

Your nervous system does not need comparison.It needs safety.

Ask yourself:Would I speak to a friend the way I’m speaking to myself?

If not — that’s your cue to soften.


When to Reach Out

Reach out if:

  • You feel unlike yourself most days

  • Symptoms feel consuming

  • You’re afraid of your thoughts

  • You’re constantly checking or ruminating

  • You feel alone in your head

  • You’re not having any “good days”


Reaching out is not weakness.


It is modeling regulation and self-responsibility for your child.


Resources Mentioned

Lauren practices at: Three Rivers Mental Health (Massachusetts)


She also recommends exploring provider directories through:


If you are outside Massachusetts, Postpartum Support International offers provider directories and helplines by state and country.


Getting Help Is a Gift to Your Child

Seeking support does not mean you are failing.

It means you are breaking cycles.

It means you are choosing awareness over silence.

It means you are teaching your child:

“When I’m not okay, I reach for support.”

That lesson may be one of the greatest inheritances you give them.


If this episode resonated with you, please share it with another parent who might need to hear:

  • Intrusive thoughts are common.

  • Medication decisions are nuanced.

  • Trauma surfacing is not weakness.

  • Support is available.

  • You are not alone.


And as always — if you’re in crisis or having thoughts of harming yourself or someone else, seek immediate emergency care. Postpartum Support International has some hotlines for urgent mental health support. 


Thank You for Listening

If this episode lights you up, I’d love it if you’d rate and review the show on Apple Podcasts, Spotify, or wherever you listen to podcasts. After you review the show, snap a pic and upload it here… and I’ll send you a little surprise as a thank you.


Your feedback helps this podcast grow, and I am so grateful for your support!


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