So you have a history of depression (or anxiety or bipolar disorder)and you’re trying to decide whether to have a child or not. OR you’ve gotten pregnant and now have depression (or anxiety or bipolar disorder) during your pregnancy, maybe even for the first time in your life. OR you are pregnant and you’re feeling fine but you’ve had antepartum or postpartum depression (or anxiety) with a previous child and you want to prevent it from happening again.
Let’s say you happen to know (from reading Postpartum Progress!) that research shows that the rate of relapse for women with depression who are taken off their medication while pregnant is 50 to 75%. You also already know that babies whose moms suffer untreated depression while pregnant are negatively affected, including having a higher risk of being born pre-term and with low birth weight. On the other hand, you’re worried about the risks of taking medications while you are pregnant. You’ve read about conflicting studies and you’re not sure what they mean. You’re starting to realize there is no 100% safe choice either way. So what the hell should you do?!
Most of us feel like we’re damned if we do take medication to treat or prevent depression or anxiety and we’re damned if we don’t take medication to treat or prevent our depression or anxiety.
You can freak out about it and make yourself sick over it. I’ve been there. It is no doubt a scary decision to make and one that I’ve had to make myself. But I’d like to suggest a different approach… a Warrior Mom approach, if you will.
As a Warrior Mom, you’re going to talk it over carefully with your psychiatrist and your OBGYN and come up with a plan that makes the most sense for you as an individual. Your plan may include therapy, support groups, medication, nutrition, and/or exercise. There are lots of options. What you need is a healthcare professional who has knowledge and experience, who is measured and balanced, and who can have an intelligent discussion with you about your unique history and situation.
If you have a doctor who hands out antidepressants like candy and doesn’t talk to you about the risks, get another doctor. If you have a doctor who refuses to allow anyone to take medication during pregnancy and doesn’t understand the risks to you and your baby of untreated mental illness during pregnancy, get another doctor. If the healthcare professional you’re going to is an extremist on either end, they’re not fully informed and that’s not fair to you. At minimum, you can have your doctor consult with another who has more expertise on these issues. Then you can make a decision.
The next step is to remind yourself that this will be only ONE of a million decisions you will make about your children that may (or may not!) deeply affect them. We make choices every day that can change our children’s lives, in big ways and small, for better or worse. Do we breastfeed or don’t we? Do we send them to daycare or do we stay at home with them? How much television? Public school or private? City, suburbs, or country? Do we sign them up for this sport or that one, this art class or that one, or do we sign them up for nothing at all? Do we let them spend the night or not? What’s the right curfew? Do we stand our ground or give them a break? Give them birth control or tell them to abstain? Do we let them go on that trip, borrow the car, wear that outfit, or get that nose ring?
There are no 100% safe answers to any of these questions. What you decide, based on your circumstances, may be very different than what I decide.
We can’t run off and hide, much as we might like. As parents, or parents-to-be, we have to decide. So we do the best we can each day. All you can do is try and make the best decision for yourself and your family on each of these issues, including the important issue of how to tackle mental illness and pregnancy.
For more on this, read this great article from Brain Child magazine titled “Between Depression And a Hard Place” by Anna Blackmon Moore on how she made the decision whether to take an SSRI during pregnancy, the resources she used, and the varying feedback she got from different doctors.
And this piece from Heather Armstrong at the very famous blog Dooce about her decision. And this post from me about my decision.
Also, these pieces: one from the New England Journal of Medicine titled “Use of Selective Serotonin Reuptake Inhibitors [SSRIs or antidepressants] In Pregnancy and The Risk of Birth Defects”. And this from the Mayo Clinic.
Also, you can check out the following books. Pregnant on Prozac by Shoshanna Bennett, Pregnancy Blues by Shaila Misriand What Am I Thinking? by Karen Kleiman. I haven’t had the chance to read Shoshanna’s or Shaila’s books yet, but I know they cover this topic in detail. I have read Karen’s, and as with all her other books, it’s very helpful.
Click here for the American College of Obstetrician & Gynecology’s guidelines on taking psychiatric medication while pregnant.
Dear Katherine:
Here's another point to add to your great post:
Sometimes people feel that a risk is greater if they "do" something or take action, as opposed to just letting things be. Like, "If I get on that airplane during the storm, the risk will be greater than if I don't go." That seems pretty clear.
Conversely, there are times when the risk is in fact higher when no action is taken, such as the decision not to do anything in response to having chest pains.
This is the case with women who are pregnant or postpartum. Women who are deciding whether or not to take medication are understandably unsettled by having to made this decision. Often they feel if they "take" the medication, they are taking an action, or engaging in behavior, or making a choice that increases the risk, or so they believe. Thus, they feel it would be better to do nothing.
But we know that in many of these cases, it is NOT better to do nothing and NOT TAKING ACTION can be detrimental; it can significantly increase the risk potential, particularly for women who are severely ill.
So it's a perception thing. We perceive the risk to be greater if we take action. It I put this pill in my mouth I will be hurting myself or my baby. But it's a faulty perception. Sometimes, the risk is much greater when we do not act.
Does this make sense?
Karen Kleiman
Hi Moms or moms to be,
I've been in this predicament myself…after my first born, I fell into the hellish arms of PPD and Anxiety. After rehospitalizaion, medication trials, therapy, etc…I finally found a balance of medication and group/individual therapy that worked. I stayed on my meds for 2 years and found out last June that I was pregnant…I FREAKED not knowing whether or not I could survive without medication. After meeting with some high risk doctors and weighing the risks and benefits, I decided to stay on my meds. I gave birth last week to a beauiful baby boy who is perfectly healthy and I feel pretty damn good. PLEASE don't spiral and go off your meds or rule them out before learning the risks and benefits. It is possible to have a healthy baby on medicaton, so if you need it to be a good mommy, then consider it. Just relax and take one step at a time…you will get through it and it will be easier the 2nd time if you happened to have suffered the first time. Keep reading this blog site…it got me through some VERY dark days…the sun will shine on you again. I promise!
Thanks for posting on this subject. I'm not even pregnant, and not planning on it in the near future, but this dilemma already occupies way too much emotional space. I waited too long to get treatment for PPD last time around (stubbornly not wanting to take meds while breastfeeding until I fell apart), and due to side effects and switching anti-depressants and stopping prematurely, my son is now almost 18 months and I still haven't gotten myself fully back. I'm beginning to wonder if this IS the new me. And yet, I see other mothers out there who are functioning, who regain their balance, so I'm trying to hold out hope that maybe this isn't just what motherhood's about.
I can't imagine getting pregnant now or in the near future. I can't imagine making it through a pregnancy without meds. And yet… it seems too good to be true that meds during pregnancy would be an option. It seems like the super human is what is expected of a mom-to-be, or at least what I expect of myself, to defy the odds….
Thanks, Katherine! As always, you are right on mark.
Thanks for an excellent article! I appreciate your insights and agree with what you wrote.
Thank you so much for posting this- you have made me feel so much better about things. I had PPD similar to you- hospitalization, support group, therapy, trying different meds- I had gone off meds- because I didn't want to take them while I was trying to get pregnant- But I am now 8 weeks and I am having a really difficult time with things and have been thing that I should go back on meds- I go to my Dr. Today so I think I am going to go back on meds. Thanks for sharing your story!!!