"I wish I could show you photos of all of the beautiful Zoloft babies I've seen born over the years," the psychiatrist told me with a gleaming-white grin. "And all the beautiful Paxil babies!"
I wanted to throw up all over her Manolos. It wasn't morning sickness. It was pure terror. After four months barely surviving the hell of tapering off antidepressants before trying to conceive, the last thing I expected to hear from a doctor ten weeks into my pregnancy was that I should go right back on them. I'd done more than my share of reading about the possible effects of SSRIs on my unborn child. First trimester use was linked to a small but real risk of some horrifying birth defects— holes in hearts, neural tube defects in the brain, and abdominal organs forming outside of the abdomen . Second and third trimester use was associated with breathing problems for newborns, withdrawal symptoms, and possible future cognitive impairments and behavioral issues. The research seemed to be conflicting and inconclusive, but nonetheless laid out some terrifying and high-stakes possibilities. I didn't want a beautiful Zoloft baby or a beautiful Paxil baby or a beautiful baby carrying any kind of pharmaceutical branding.
What I wanted was for someone to tell me I had other options. I had raced through LA rush-hour traffic that morning when I'd heard there was a last-minute cancellation at a clinic specializing in depression and anxiety during pregnancy. I had visions of a coven of ladies in flowing dresses. They would wrap me in a patchwork quilt of tales from the pregnant women who'd come before me—women who had conquered their own mental-health nightmares successfully and without medication.
But there were no flowing dresses or quilts on offer. Just drugs.
"Isn't there some sort of support group or something I could do instead of the meds?" I asked expectantly.
"Just for postpartum," the psychiatrist told me. "Nothing for prenatal. But you're at high risk for postpartum depression, so you can come to that group after you have the baby."
She sounded almost cheerful about it—like she was giving me something to look forward to. She also mentioned that if I declined to take the meds, I'd have to seek help somewhere else. The clinic didn't accept clients who refused medication.
I thanked her for her time, crumpled up the prescription she gave me, shoved it in my purse, and stormed out of the clinic in rage. I would find my own way. I lived in a city of 18.5 million people. There were support groups here for every addiction, compulsion, and trauma imaginable. There had to be one for pregnant women with depression.
But there wasn't, at least not as far as I could find. Not one. Just drugs.
Postpartum depression groups were all over the place. Since Brooke Shields outed herself about her own postpartum depression in 2005, the condition had steadily gained more and more press. Hayden Panettiere revealing her own postpartum depression in the past year only served to make me more frustrated. There were no celebrities talking about prenatal depression. I felt even more isolated by their stories, and then guilty on top of that for resenting the support and exposure women with PPD were getting. But PPD seemed to be featured in every magazine and on every talk show I saw. There were Facebook pages, inspirational YouTube videos, and a litany of memoirs about it on Amazon . Working moms had it. Stay-at-home moms had it. Celebrities had it. "You are not alone!" they all announced with triumph. PPD was "in."
Prenatal depression? Not so much. I dug up the statistics. In 2013, it was estimated that at least 13 percent of pregnant women suffered from prenatal depression. Where was everyone? Where were our Facebook groups, Dr. Phil episodes, awareness walks, solidarity T-shirts and wristbands? Nowhere. I searched for five months (and with a master's in social work, searching for resources like this used to be my full-time job) and turned up one lonely Facebook group called Perinatal Depression Awareness, last updated in 2010. As bad as my anxiety and depression symptoms were on their own, the fact that I couldn't find one single support group for pregnant women with mental health problems made it feel exponentially worse.
With or without support, I was determined to stick out my 40 weeks of pregnancy medication-free. In addition to the possible long-term risks to the baby SSRIs posed, one report had found that as many as 30 percent of newborns whose mothers took SSRIs experienced withdrawal symptoms including tremors, gastrointestinal issues, muscle tensing, and high-pitched crying in the days following birth. And those were the symptoms researchers could actually see. I was horrified by the idea of my newborn son being exposed to even a hint of the other withdrawal symptoms I'd experienced getting off the meds—dizziness, nausea, suicidal thoughts, terrifying nightmares in which Christopher Walken chased me through an Old West town driving a truck full of screaming cattle, and "brain zaps," little electrical-shock sensations at the base of my skull that are one of the trademarks of withdrawing from an SSRI.
However "beautiful" these Zoloft, Paxil, and Celexa babies looked on the outside, I knew there wasn't a doctor in the world who had any idea what was going on inside their heads. Brain zaps don't show up on medical tests. Nightmares don't either.
I spent my first trimester struggling against daily panic attacks and sobbing fits. Since I couldn't find a support group, I pursued every form of individual treatment I could find. I tried psychotherapy, meditation, yoga, cognitive behavioral therapy workbooks, stacks of reading on neuroplasticity and mindfulness, lightbox therapy, acupuncture, 3-mile a day walks, neurofeedback, hypnosis, journal writing, snorting aromatherapy oils, and, in my most desperate moments, prayer. Anything but medication.
"Eat more cashews," said a friend who lauded my efforts to stay drug free. "They have natural calming effects."
I ate more cashews. They didn't help.
"Make a gratitude list," suggested another.
I made a gratitude list. All it did was show me how twisted my mind had truly become. I had so much to be grateful for—an amazing husband, the baby I had wanted so badly, a good job. The voice in my head still just kept telling me I was better off dead.
Sometimes the weight of the panic and depression was so heavy I just curled up on the floor and whimpered like a torture victim in a prison cell. I woke up every morning with a crushing pain in my chest, my heart pounding like I'd just run a marathon. My OB/GYN said my constant stress was exposing my fetus to unhealthy levels of cortisol and that I was better off taking my chances with medication than white-knuckling it through the rest of my pregnancy drug free. But no, taking the pills was 100 percent out of the question for me.
Until it wasn't.
After 21 weeks of straight misery, I fished the crumpled Zoloft prescription out of the bottom of my purse and filled it. I swallowed my first pill feeling defeated, weak, and totally ashamed. And so angry.
I wanted to scream, but there was no one to scream at. No one was listening. Anyone I tried to talk to about it just sent me another link to a postpartum depression website, reassuring me: "See? You're not alone!" or "Look at all the postpartum programs you can go to after you have the baby!" I couldn't believe I actually felt jealous of the women going through the horrors of postpartum depression, but at least they had resources.
I was too ashamed to tell anyone about my decision except for my husband and my psychotherapist. I'd been preaching for months that this was one decision I would never cave on. I felt like a drug addict who'd fallen off the wagon. My sense of isolation grew deeper.
The meds did help though—almost immediately. I stopped curling up on the floor, stopped whimpering. I still had trouble breathing in the morning, but the squeezing chest pains that had pushed me to the point of hysteria started to ease up. I was torn between being grateful for the relief and furious that the meds were the only option I could find that worked.
Thirty-two weeks into my pregnancy, the pediatric Journal of the American Medical Association, JAMA Pediatrics, released a large study concluding that taking antidepressants during pregnancy nearly doubled the risk of autism for the unborn fetus, and appeared especially dangerous for boys. The headlines were everywhere. I was devastated. I talked to more psychiatrists. The risk of autism was still very small, they all told me—less than 2 percent. I tried to take comfort in that, but still felt like I was playing Russian roulette with my baby's brain. I cut my medication in half for three days. I cried more. I went back to my regular dose, hoping the odds would stay in my son's favor. I kept meditating and walking and going to yoga and psychotherapy and snorting essential oils. And I kept praying.
For a long time, I'd prayed that I'd get through the pregnancy without drugs. Then I'd prayed that the drugs would work. Now, I prayed that I'd have a beautiful Zoloft baby just like the psychiatrist I'd had so much contempt for had promised.
The day I gave birth, I told every doctor, midwife, orderly, and cleaning lady who entered the room to be on the lookout for any possible problems: "I'm on Zoloft. I've been taking Zoloft. Will they take him away right away? Will I get to hold him? I want to hold him right away, but whatever's best for him, do it."
In the midst of that triumphant moment when I finally pushed my baby out after 15 hours of labor, I thought of the meds. My son had already received a perfect bill of health at his five-month ultrasound, when the doctor had measured every organ and scanned every centimeter of him for problems and detected none, but as I held his slippery little body, I realized I was frantically counting fingers and toes—as if my decision to take Zoloft at 21 weeks had risked causing parts of him to fall off in utero. It hadn't. Everything was there. And he was definitely beautiful.
In the weeks after we brought him home, I found myself examining every sound and movement he made for signs of med withdrawals. An extra layer of paranoia pervaded my run-of-the-mill first-time parenting neuroses. Were the squeaking sounds he made normal? The spastic arm and leg movements? When he cried and I had trouble soothing him was it a newborn thing or a Zoloft thing?
Given the wildly differing research findings, it seems I'll never really know if I did the right thing. I'll never know if he would be healthier and happier if I'd stayed off the meds, trading my own suffering for his. If he does show signs of autism someday, I'll never know if it was from the antidepressants, or genetics, or the stress that festered inside me while I was drug free but miserable.
But I do know that if the laws of symbiosis apply, then I did what I had to do to get us both through those ten months in one piece.
Months after my son was born, I spoke with Caron Post, the executive director of Maternal Mental Health Now, an LA-based organization focused on training clinicians in prenatal and postpartum mental health issues. I told her about my struggle to find resources, and asked her for insight into why prenatal depression treatment is so scarce. She pointed to evidence that the stigma of prenatal depression is so deeply entrenched that those suffering from it may feel too much shame to even attend a group targeted toward helping them.
"You really identified a big disparity between prenatal and postnatal when you went searching," she told me. "In terms of support groups, yes, there is that disparity for sure. We've found that even with the postpartum support groups, if you call it a PPD support group, people don't want to come. If you say it's 'New Moms Connect'—it's different. The stigma is still really strong around the issue. You may [only] be able to find a 'Pregnant Mom Support Group' without the word 'depression' in it."
According to Post, the problem is even bigger than I thought—bigger than a simple lack of resources. The internalized stigma pregnant women with mental health problems feel is hampering their ability to get help when they most need it. Their self-doubt appears to be even more powerful than the pain of depression and anxiety themselves. If that isn't a sign that it's time for an awareness walk, solidarity wristbands, and an episode on Dr. Phil, then I don't know what is.
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