My wife and I are living in France. She is three and a half months pregnant and has started having panic attacks and depression. She is also fearful most of the time. We went to a psychiatrist, who felt that she was a danger to herself and prescribed antidepressants (Anafranil) and antianxiety medication (chlorpromazine). She is suffering, but it worries me to give such strong medicine to a pregnant woman. I suggested that in the United States, a psychiatrist would try non-drug therapies first, but he said that her condition is too serious and could be aggravated by therapy. Is it true that there are times when one should not try therapy? French medicine is extremely "chemical dependent," and I need another opinion.

Alan

I can understand your concerns. My resources indicate Anafranil and Thorazine (the trade name of chlorpromazine) should be administered to pregnant women only when the benefits clearly outweigh the risks, because of possible dangers to the developing fetus. Without knowing more about your wife's condition, or evaluating her personally, it's hard to weigh the risks of such medication against the possible benefits.

I'm not familiar with the state of the mental health field in France, but I'm puzzled by the psychiatrist's recommendations against therapy. Even people with severe mental illnesses, such as schizophrenia or bipolar disorder (formerly known as manic-depression), can benefit from psychological therapy.

I'm also wondering why an anti-psychotic (Thorazine) was prescribed, since you didn't mention your wife experiencing psychotic symptoms such as hallucinations. (Thorazine is, however, sometimes prescribed for symptoms other than psychosis -- doses of this powerful tranquilizer have been found useful in alleviating intractable hiccups, for instance.)

I recommend that you get a second opinion ASAP -- preferably from a clinical psychologist, who can evaluate the possible benefit of psychological and behavioral treatments for your wife, and make appropriate recommendations. If medication still seems warranted as an adjunct to any psychological therapy, the psychologist may be able to recommend a psychiatrist who could manage the medical treatment while also supporting the psychological therapy. Try contacting the psychology department of a French university, perhaps in Paris, for referral to a psychologist (or to a more psychotherapy-minded psychiatrist).