When my husband and I began to think about starting a family,
I decided to wean off the antidepressants I'd been taking for several years to
manage my depression and anxiety. The medication I took was a Class C drug, which
meant it hadn't been proven to be safe for use during pregnancy. With consultation
from my therapist, primary care physician and an acupuncturist, I tapered off
over a period of several weeks.
SSRI withdrawal isn't pleasant — even done
slowly, it can bring on "brain zaps," the unsettling sensation of having an
electrical current pass through your head, as well as nausea, fatigue and other flu-like
After weaning off the meds, I felt weepy and extra
sensitive, but not depressed. But a few months later, when a stressful work
situation worsened, the familiar feelings of hopelessness returned. My doctor
recommended trying another SSRI that was deemed a safer option for pregnant and
On the new medication, I began having frequent heart
palpitations, increased anxiety and insomnia. After a few weeks of the
miserable experiment, my doctor and I both agreed that I should return to the
previous medication, since it had worked well at keeping my depression at bay and posed no notable side effects.
I returned to my old medication, but at a lower dose. Within
several days, I started feeling more like myself again.
A year later, when I found out I was pregnant, I again began
tinkering with my meds.
My son was a cranky, frequently nursing, infrequently sleeping infant. Had I caused this? Was I already, in these first days, a bad mother?
Maternal guilt showed up with my first positive pregnancy
test. How could I take a medication that could possibly harm my child?
At each prenatal appointment with my midwives, I guiltily grilled
them about the antidepressants. I felt scared that they'd judge me for risking
my baby's health in favor of my own. They did the opposite. "There's a small
but unknown risk to your baby," one admitted. "But there's a well-known risk of
maternal depression, which negatively affects you and your child."
Another midwife told me she used to work with pregnant teens,
and many of them were on antidepressants among other drugs. "Their babies were
all fine," she promised me. "I never encountered a negative outcome because of
antidepressants. And many of them weren't taking prenatal vitamins and were making
other unhealthy choices."
I was soothed by their words, but remained haunted by my
choice. In dark moments, I googled "antidepressants during pregnancy," my belly
beginning to pooch over my laptop's keyboard.
Concerned, I tapered down to a dose that was 20 percent of the
minimal prescribed dose — just enough to keep me from enduring another
After my son's birth, I quickly developed postpartum
depression. My midwives suggested I increase my medication to a therapeutic level.
With the tweak in dosage, I felt better within days, but now I worried about
the breast milk being passed on to my baby. My son was a cranky, frequently
nursing, infrequently sleeping infant. Had I caused this? Was I already, in
these first days, a bad mother?
Over time, I began to feel better — both mentally and about my
choice to take antidepressants. I attended a weekly postpartum adjustment group
and went to therapy. My son was hitting all of his milestones and developing
Just as I finally weaned my son after breastfeeding for two
years, I found out I was pregnant again. This time, depression descended
quickly, and unexpectedly. I'll never know if it was caused by the hormonal shift
that occurred when I weaned my son or from the new pregnancy. But caring for my
busy toddler while feeling nauseous, exhausted and hopeless was too much.
Again, I reached out to my health care providers, and again, we increased the
dosage of my antidepressants. I felt terrible — I'd managed to lower my dosage significantly
during my pregnancy with my son. Now, I was increasing it.
Part of coming to terms with my choice to take a Class C drug during pregnancy and breastfeeding was also coming to terms with my condition.
And yet, with this pregnancy, the choice between my health
and that of my unborn baby was more complicated. It wasn't just choosing
between my health and my babies. I also had my son to take care of, and I was spinning
toward an immobilizing depression. This time, it didn't feel so much like a
Throughout my second pregnancy, I saw a psychiatrist, both
to help me plan for another bout with postpartum depression, and to help me
feel more comfortable with my choice of medication. He reassured me, gently
suggesting that my overwhelming worries about the issue was a symptom of anxiety.
After our daughter was born, I again developed postpartum
depression and we raised my dosage. Again, the symptoms subsided. Again, my
new baby was healthy and thriving.
Part of coming to terms with my choice to take a Class C
drug during pregnancy and breastfeeding was also coming to terms with my
condition. I have a tendency toward depression and anxiety, and hormonal
shifts are a trigger. It's part of me, like being near-sighted or having asthma.
Though the decisions I faced about medication were very challenging, I'm
grateful that my depression is so treatable.
Looking back at my pregnancies, I can see that I did my
best. I tried valiantly to treat my depression without drugs, and when that
wasn't possible, I took the next best route. I was so scared that as a
mother-to-be, I was failing to protect something holy. What I couldn't see
clearly was that my babies' mom deserved protection too.