Last week an article came out in the New York Times Magazine regarding pregnant women with depression and anxiety that really has had me thinking (read it here). It’s long but also truly interesting, scary, uplifting and ultimately, very important. Good Morning America did a mediocre segment on this (sorry GMA, but it’s true) and I started feeling like I was busting at the seams to chime in publicly since the conversation wasn’t reflecting my experiences. So here it goes.
My relationship with anti-depressants/ SSRI’s began when I was 15. At that time I was in a hospital being treated for anorexia and ALL patients had to go on one of these drugs. I was given Prozac despite my insistence that I was not depressed. From the outside, that probably seemed laughable to the doctors and everyone else around me since I was so obviously slowly killing myself through starvation, but the truth was I wasn’t depressed. I was anxious. And that anxiety fueled a need for control and quest for perfection, hence, my eating disorder. Regardless, I stayed on that drug for years just assuming that it had helped me recover relatively quickly for someone suffering from that tough to treat disease and that staying on it was a preventative measure against a relapse.
Then in college I felt certain that I was fine and went off it with no problems. I was on a low dose anyways, and had no trouble quitting. Life was good, and I felt fine for a long while. Until I didn’t. This cycle has repeated itself constantly for the past 20 years. I’ve tried every SSRI on the market- some worked wonders (Paxil, Zoloft) and some made my life a living hell (Wellbutrin, Effexor). And I’ve fought being on them every, single round of treatment. For some reason it felt like a weakness to be on them, and an unnatural choice. In the past I’ve tried to just “handle” my anxiety with exercise, an organic, gluten-free diet, vitamins, supplements, yoga and meditation; an effort that would last a few days or weeks before I found myself back in my old habit of constantly worrying and feeling anxious with a giant Whole Foods bill to boot. All these things certainly helped my health and well-being, but none really touched the root of my anxiety. I’d still lie in shavasana worrying about my to do list and that funny ache in my knee (could it be cancer? I’d check WebMD later.)
Finally, at 35 I accepted that I need to take medication. Not a lot, actually I take very little, but that little bit helps me so much. Looking at my family tree, it’s easy to see that this is not something that struck me out of the blue or a personality quirk, as many members struggle with anxiety. There can be a biological cause, as studies show, similar to that of allergies or diabetes- and yet we stigmatize one and not the others. I started accepting this and thinking about how silly it was to struggle every day when help was readily available. And oddly, the person who strongly suggested I go back on an SSRI was my first fertility doctor. I was being prepped for a procedure and she was going over my medication list, of which there was none, except for a note that I had recently been on Zoloft.
I told her I had gone off it the day I found out I was pregnant last March since I was worried about what it would do to the baby. She looked at me and said “You need to go back on it. Infertility and IVF is incredibly stressful and there is no reason not to, it can only help.” I started thinking, this was a really stressful path to have to travel, maybe I should consider going back on it? But first I wanted to do some research. I had heard so much about how bad SSRI’s are for your baby during pregnancy in the media and that scared me (especially the hypochondriac side of me).
Luckily, she wasn’t the only doctor I had to talk to about this. I also had what I like to call my “gynochiatrist” (he specializes in the mental health and medication of pregnant women). Actually, he was quoted in the New York Times article above and is one of the leading doctors in the country on this topic. I am lucky to have such an intelligent voice to guide me on this decision. In no uncertain terms he has told me again and again that the risks of taking a low-dose (or even a higher dose) of these very well studied drugs is very low compared to the risks that high anxiety and depression have not only on the mother, but the growing baby too. Many people, including doctors, overlook the effect that untreated anxiety and depression have on the baby for some reason. I think vilifying drugs is much easier.
And so, I’ve been on my medication this entire pregnancy. Yes, I went back on before my second IVF procedure, and yes I stayed on long past seeing those two blue lines on my pregnancy test. In fact, I do think that it helped me get pregnant, since there also have been studies linking high stress to difficulty getting pregnant, which I do think could have been a factor in my own struggle. In my mind, there was no argument against it, only for it. But having the topic come to the forefront again right as I hit my second trimester sent me back into freak out mode and had me questioning my previously confident choice.
So I went back to my specialist last week and talked through my concerns with him after reading the article, and yet again he told me about the “soft data” in previous studies and that newer, better studies show that the risks of taking most SSRI’s during pregnancy (there are some exceptions, so talk to your doctor) are so low, in many cases in fact show no risk, that it’s a clear benefit to stay on them for someone who functions better on them. Like me. Staying calm, enjoying the pregnancy (as much as possible when you’re barfing) and having the desire to work out, socialize, eat well and laugh is so much more beneficial to the baby than the tiny risk that the drugs hold.
When you’re pregnant there are so many warnings and things you aren’t supposed to do. It can be triggering for people who struggle with anxiety. While dealing with morning sickness earlier on I had this random, insane craving for tuna sandwiches. And one day I was finally hungry, and all I wanted was a stupid tuna sandwich, so I ate one. And felt SO guilty since now they tell you to stay away from it. But I needed calories and protein and that’s all I wanted to eat and it was delicious. I told my OBGYN I was concerned about this craving and she was like “Calm down, as long as you don’t eat more than one or two a week you are fine! Don’t worry!” So many of the don’ts pregnant women are assaulted with are dated, over-hyped and alarmist (I just read Expecting Better and it was all about this, I recommend it if you’re interested).
The decisions each woman makes during her pregnancy are her own and very personal- be it a glass of wine here and there or taking medication. I really wish that there was more of a sense of compassion and understanding surrounding the incredibly complicated, emotional and varied circumstances each person deals with during the very long 10 months of pregnancy. So much judgement is passed on women who make certain choices, like the one I’ve made. In fact, some of you may be thinking that the choice I’ve made is a selfish one. But I am here to tell you it’s not, and in fact it’s not a choice at all- it’s a need. Maybe some of you made the same decision to stay on medication but are too scared to admit it for fear of that judgement. In fact, I’m kind of scared to slick “publish” right now for fear of what others will say, think and do. Am I worried something will be wrong with my baby because of my drugs? You bet your ass I am. But what’s far scarier is the amount of worry I would have NOT taking them and ending up standing on a ledge somewhere. So I really hope we can change the stigma one person at a time. If speaking out about my choice, and maybe encouraging you to speak out if you made the same choice, helps just one woman who is struggling and scared get help and know it’s okay to do so, then I will feel successful. We’re all in this together.