Beyond Blue

Beyond Blue


Exhale: On Antidepressants, Motherhood, and Pregnancy

posted by Beyond Blue

s-SLEEPING-large.jpgAwhile back Christina Gombar of Exhale interviewed me about pregnancy, medication, and motherhood. You can find the original interview by clicking here. Here’s what I had to say:

 

Christina: In your memoir, “Beyond Blue,” you attribute some of your relapse after a post-college, medicated recovery to a perfect storm of factors — moving, switching from on-site to at-home freelance work, the hormonal earthquakes of pregancy and post-partum, and the stresses of mother two very active, very small children. Could you elaborate a little?

Me: I think early motherhood provides the perfect storm for severe mental illness in that it combines several risk factors: sleep deprivation, social isolation, hormonal mayhem, and, for many, the loss of an important source of self-esteem (if a mom stayed home). I have never been a baby person. And I was surrounded by new moms that loved every minute of babyhood. I felt guilty for not enjoying these first days, but I was too tired to be happy about anything. David slept three hours at a time for five years. In hindsight, I realize that would drive anyone to the hospital. But at the time, all I could do was ask what in the hell I was doing so differently that this whole early motherhood thing was torture. I also took for granted all the time I had for myself before motherhood–hours that I could devote to working out, therapy, prayer and meditation, and other tools that assisted me in my recovery from depression and anxiety. As a mom of a newborn, you have zero time for yourself. So the things that kept me resilient were taken away from my schedule, and I became much more fragile. Finally, I suppose the early baby days also triggered my own childhood anxiety. I felt guilty for bringing a life into this world that might suffer like I do. David’s anxiety brought back memories of myself as a young girl crying and shaking in my mom’s arms.

Christina: When you decided to get pregnant were you on medication? If so, did you have fears about this? What advice did your Obgyn give you, if any? (I’m asking this because I have a sister who was on heavy meds for depression when she first got pregnant, went off them, became almost suicidal, and had a miscarriage. She then went on a very low dose of Prozac and had a normal pregnancy and a well-tempered baby.)

Me: Yes, I was on medication: Prozac and Zoloft. My OBGYN said that more studies had been done on Prozac, so she’d leave me on that and that I should try to wean off the Zoloft. I did that, but by four or five months of being off, my anxiety was so intense that I was starting to have preterm contractions. My OBGYN told me to go back on the Zoloft, because a mother’s anxiety is more damaging to a fetus than the risk medication. I think she’s absolutely right, because I stayed on both during Katherine’s pregnancy, and Katherine was a much calmer baby. I sense that my anxiety when I was pregnant with David may have definitely contributed to his emergency c-section and to his anxiety issues now. If I were to advise pregnant women regarding meds, I’d say that if you are doing well on them, stay on them.


Christina: Years ago, there were a lot of concerns about anti-depression meds and the effect they might have on a developing fetus. What were you told and what did you do? What is the view now?


Me: I don’t remember hearing any of that. My doctor told me that the anxiety/depression of a mother does far worse to a fetus than possible effects of medication. Again, having tried to wean myself during David’s and getting a very anxious kid, to staying on the meds with Katherine and getting a chilled out babe, makes me agree with my doctor.


Christina: Do you have any advice for women who are trying to get pregnant, but are afraid because they need to take anti-depressants or other pharmaceuticals?

Me: Personally, I wouldn’t let the medication question scare you. I guess I say that because I see so many dangers of NOT taking medication. I’ve seen lives destroyed and taken because people have been advised against medication. With mild to moderate depression and anxiety, I do think you can treat those with alternative therapies: yoga, acupuncture, meditation, herbs, massage. I think cognitive-behavioral therapy and psychotherapy are helpful for everyone. But if you have a severe mood disorder–especially bipolar or schizophrenia–I think you’re playing with fire trying to treat those with yoga and meditation. Now I’m not sure about mood stabilizers and pregnancy. I was only on antidepressants at the time. But since Lithium and others have been around for a long time, I’m sure there is plenty of research out.

This is the piece of advice I’d scream to all prospective moms: If you do have a mood disorder and know you suffer from anxiety or depression, YOU ARE GOING TO NEED EXTRA HELP. You can’t afford NOT to have time for yourself. You need to exercise, sleep, eat right, and so forth in order to stay resilient. You are going to need extra support the first year of motherhood. SO BEG FOR IT NOW. Have it in place so that you don’t have to go looking for it when you are exhausted. DON’T BE A MARTYR. Get a night nurse one or two nights a week so that you can sleep seven consecutive hours. Supplement with formula on those nights, so that you and your lactating boobs can have a night off. Sleep is your insurance against sanity. It is not a luxury. It’s an essential. Some research to back me up: during the first ten to nineteen days, new mothers were seven times more likely to be hospitalized with some form of mental illness than women with older infants. And while there has always been some data to suggest that sleep deprivation may increase a mother’s vulnerability to depression, some experts today claim that chronic sleep deprivation can, in fact, CAUSE postpartum depression. In other words, secure your oxygen mask before putting on your child’s because if you do it the other way you’ll run out of air.

Click here to subscribe to Beyond Blue and click here to follow Therese on Twitter and click here to join Group Beyond Blue, a depression support group. Now stop clicking.



  • Elizabeth

    Fascinating interview. I had no idea one could stay on their meds during pregnancy. Not that I am anywhere near that phase of my life, for I am not even married and not dating any one either. Yet, I do want to have children some day and I did worry about the medication issue since I am doing so well on them! They have so improved the quality of my life. Thanks for this post.

  • SacredWoman

    Therese, I wanted to add my own personal comment to your wonderful and informative post. I suffered from depression most of my life, and late fall/winter was always my worst time of year. I was very concerned about having a baby during that season so I used basal temperature charts to time all of my pregnancies for springtime deliveries. All 5 of my children were born in the spring (4 c-section deliveries including a set of twins), and to this day I believe that the time of year when I delivered made all the difference for me! Leaving the hospital with my newborn in my arms, the long pregnancy and delivery done, and the physical world awakening to the sights, sounds and sunshine of spring…my spirits just soared!
    As an aside, I would like to mention that my husband’s job moved us to sunny West Texas when I was about 35 years old, and the nearly constant sunshine has been very healing for me. (I had grown up in Cincinnati and suffered through many dreary winters.)
    Therese, I want to thank you for all of your wisdom and courage in sharing your struggles with fellow sufferers. You are an angel!!!

  • Allison

    This was so helpful! Thank you!

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    This is not the write link but I just wanted to say that I have just read Fifteen Ways to Stop Obsessing and that it has been a great help. I feel relieved and a bit more relaxed after reading the article. The tips are helpful, wise and I’m going to use them.
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  • Reeny

    I think this article is irresponsible. You are not a doctor and have no place telling other women what they should and shouldn’t do during their pregnancy. I am unsubscribing to this newsletter. I hope you realize by praising the women who stayed on their medication, you really insulted the ones who didn’t.

  • Katherine

    I had an “oopsie” first pregnancy and I am so glad I decided to stay on my meds. It was the right thing for me. I just knew in my heart that I would not do well w/out my meds and this would be bad for my child. Interestingly, my chosen pediatrician told me flat out that I shouldn’t take anything. I had her speak to my OB (who had recommended her) and my psychatrist and she agreed that it was best for me to stay on meds. She was fairly young and I think she just didn’t have the experience with women yet who were on meds. Education is everything!
    To the woman who says she’s unsubscribing…You don’t get it. It is a personal post not a PSA. When someone says “I think” or “I believe” that is different than “You have to” or “You should.”

  • Mimi

    Thank you so much for your honesty. Your thoughts reflect what I felt during the first months and years of motherhood so long ago, (my children are in their late 30’s)and I was undiagosed at the time. My mother who had struggled for most of first 20 years to understand me, couldn’t understand why motherhood didn’t come naturally to me. I felt inadequate and constantly a failure because my baby cried constantly and I couldn’t soothe him. If I’d known then what I know now…I wouldn’t have had children at all. In simple terms, it was hell. And history does repeat itself, one of my children suffers as I did. She shouldn’t have had children either. We do/did the best we could, but it’s never quite enough and the children suffer for it.

  • Minnie

    I wish I knew of your blog before I had my children. This is such an honest and important piece of information that could help all new mothers. I chose to not take any meds during pregnancy and after due to nursing as the idea of causing any adverse effects caused me more anxiety than I had been experiencing prior, but I greatly feel that as time went on with nursing and sleep deprivation that I should have started meds earlier…the whole risk/benefit is truly an important decision that each mother needs to go through and come to what they think is best for both them and baby. Your article didn’t offend me at all as someone who chose not use meds during the most vulnerable times. Each mom has to go through what they feel is best and what would cause more anxiety for them. This just presents what you chose and your opinion around it and I think that your honest account can really help those to know that they aren’t alone when grappling with such decisions. There is a lot of pretending everything is just lovely among moms…even the ones who really do love every moment…they might feel pressured to cover up when they have a bad moment or day. The more truth is revealed by some the better for all. Thanks for being a truth teller!

  • http://heatherwhistler.wordpress.com/ Heather Whistler

    Thank you for sharing. I’m pregnant right now, and it’s actually my husband who has the mental illness (bipolar disorder). I’ve been worried about how the new baby will affect his sleep schedule (his psychiatrist always stresses the importance of sleep in maintaining normal moods), and I really appreciate your reminder that it’s okay to ask for extra help.
    At any rate, I just started a blog myself, and would love to get your feedback if you ever have a moment to check it out: http://heatherwhistler.wordpress.com/
    Thanks,
    Heather

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  • Paul Rowan

    Thanks for posting this. I want to add a bit more to one dimension to the whole issue. Paroxetine is recognized, now, to increase likelihood of a heart defect. This evidence base is far from perfect, and we have two other factors creating another perfect storm: one, that the studies done only look for major, fairly easily detectable birth defects – so it truly is not known the degree that babies are being harmed. It is an increased risk, not a sure thing, but the data say that a heart defect may be twice as likely – 2/100, versus the ‘base’ rate, abt 1/100; TWO: practicing ob/gyns are busy – they do not quite have the time to read everything on this topic, so they depend upon summaries and curricula – that are in nearly all cases sponsored if not outright developed by the pharmaceutical companies.
    For women of child-bearing age, what to do with a depression, anxiety, or PTSD problem? My opinion, having read a great deal of lit, and thought about this, is – just like women work to watch their health for the time when they may intend to get pregnant – women should pursue psychological treatments for these mental health problems.
    The author has a great experience with the range of things it takes to handle these problems. That is what it takes. To avoid or minimize the risk from meds, a psychosocial approach is what is needed.
    The evidence is there: mental health counselors, well-trained, and following what the evidence indicates, can deliver treatments that are equal to or better than medications.
    Do it now, before you get pregnant, because it takes some time to get the effect of psychotherapy – you might need to find the right counselor and so on — but once you get that experience, you are a lot better prepared to deal with recurrence of depression, anxiety, and so on. It is not dependence on a pill, but self-improvement, or life-coaching success.
    The docs often do not know and trust local counselors to tell you as a referral. It takes a lot of time to develop a decent referral network, and other hassles interfere like insurance coverage. So, docs ob’s and other docs, often take the easier route: giving you a prescription.
    I am a dad, and the sleep deprivation from having a newborn at home was having a rough effect on me — all the other stuff the mom goes through is much more thsan I had to deal with. The author’s advice is awesome. Take care of yourself, get good sleep, ask for help.

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