Let’s Talk About Sex (and PPD)

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postpartum depression helpSex after baby. We all know the cliche about its nonexistance – after all, the sleepless nights, the leaky breasts, and the lack of personal space that accompany a newborn aren’t exactly aphrodisiacs.

But sex after postpartum depression? Is a uniquely difficult experience for many mothers.

With my husband’s permission, I wanted to take the time this week to share my own experiences with sex, depression, anxiety, and medications. I know I’m not alone – and I want you to know you’re not alone either.


At first, relations with my husband were slowed only by the physical limitations that follow a vaginal birth: pain, scar tissue, and sleep deprivation. You see, I started my first weeks as a mother with postpartum anxiety and it wasn’t until months later that the depression took hold. But as it slowly invaded my brain, my interest in sex waned. This is a common symptom of depression and, for me, the numbness I felt toward my child and my life spread into my marriage.

It took months for me to accept that I was suffering from postpartum OCD and postpartum depression and to seek help. When my doctors put into place both talk therapy and medication plans, I finally began to feel just the smallest bit like myself again. But as my happiness returned, my libido only diminished. And though I knew that couples typically experience a temporary drop in marital satisfaction after the birth of a baby, I couldn’t help but feel concerned. It was more than just a decrease in desire.  I found the thought of having sex completely repulsive.

After some research, I learned that the antidepressant I was using (an SSRI) is linked to sexual dysfunction in a high percentage of patients. I nodded my head as I read about the symptoms, including loss of desire and inability to climax. It felt like I was being punished for treating my depression, and I wondered how a marriage is supposed to survive both mental illness and celibacy.

So as hard as it was, I brought up my concerns with my psychiatrist. Over the two years that followed, we worked through a series of medication trials, finally settling on a mood stabilizer that seemed to alleviate the depression without such a severe impact on my sex life. When I became pregnant with my second child, however, I chose to return to my SSRI, knowing there was more research to support its safe use during pregnancy. I made that decision knowing I would be sacrificing my libido, but fully aware of the risks untreated depression carry for both baby and mother during pregnancy.

I wish I could tell you that the sexual side effects were limited to my first postpartum period. But, sure enough, they returned as the medication took hold and I felt the depression and anxiety lift. I also wish I could tell you that this is a story written entirely in the past tense, but almost 3 years postpartum, I still take the SSRI daily, and it continues to impact my desire and performance.

At times, it feels as if I have to choose between sanity and marriage. I hate that the medication that works so well — that allows me to feel like a calmer, more rational version of myself — takes something so important away from both me and my husband. But I am also grateful for the life it allows me to lead. My doctors and I speak about the sexual side effects of my medications at each appointment and are constantly balancing them with the therapeutic benefits – and we have tweaked dosages and timings to help as much as possible. (I won’t get into the details – that is something for you and your doctors to discuss.) For now, we’ve found a plan that, while far from ideal, allows me to continue treatment for my medical condition.

I hope that if nothing else, these last 6 years negotiating the world of antidepressants, mental illness, and sex allow me to help someone who may be suffering in the same way:

I want you to know that if you are experiencing sexual side effects from your anxiety, depression, or medications that you are not alone.

It’s important to be honest and open with your doctors about all side effects and symptoms you are experiencing, including loss of libido and lack of performance.

Finding the right medication and other treatments for postpartum depression (and other mood and anxiety disorders) can be a complicated process, but there are many options out there and probably one that will fit your needs.  Don’t give up.

photo credit: fotolia.com

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Reward and Risk: My Decision to Stay On An SSRI During Pregnancy

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postpartum depression medicationNearly two years to the day after my overdue diagnosis of postpartum depression and anxiety, I found myself pregnant and still on an SSRI antidepressant. We had been trying; I had done my research, consulted my OB and my Pediatrician for their thoughts on wether or not I should taper off of my medication prior to becoming pregnant again. They both agreed that the risk was outweighed by the reward-a healthy me was the best way to guarantee a healthy baby in the long term. When I specifically asked my pediatrician about the increased risk in heart and lung defects, she stated that we could handle it on the back end, IF it needed to be handled.

Fast forward three weeks. To our complete surprise, we discovered we were expecting not one baby, but two. Fast forward a few more weeks, a lot of tears, panic, a couple of therapy sessions, and dozens of honest conversations with my husband, doctors, and some other Warrior Moms later, and I had decided that the best thing for me and my babies was to remain on my Celexa until the third trimester of the pregnancy.

SSRI antidepressants do cross the placental barrier during pregnancy. This means that the fetus will be exposed to the medication while in utero. My doctor suggested that I wean off of the medication during the third trimester because some babies exhibit “‘withdrawal’ symptoms such as breathing problems, jitteriness, irritability, trouble feeding, or hypoglycemia (Psych Central, 2006).” However, she stressed that many of these symptoms, specifically irritability and trouble feeding, are normal for newborns and would likely be hard to discriminate from the normal behavior of newborn twins. [Read more...]

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A Guide to Waiting

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No matter what brings us here, we have waiting in common. We wait for a diagnosis, for a doctor’s appointment, for medication to start working. Eventually, we wait again; new doctors, new medications, new diagnoses. Am I better? Will it come back? Our families wait. Our friends. In fact, there is very little action in this whole mental health and healing business. Getting a name for what is happening, a new medication, a new appointment–the exciting, newsworthy stuff happens so quickly, compared to the time between. I am impatient. I hate waiting. I have no choice.

If we’re lucky, some people who really understand wait with us; this website can help you find some of those people, if you don’t know any, and you’re looking. I have found some pretty amazing women to wait with me, through the toughest times. We will wait with you, whether it is you who suffers, or someone you love. Whether you understand, or don’t understand. We are really good at waiting. We have practice.

Nothing takes away the insidious pain of waiting. It sneaks reminders into my days; one day, the light changes, and a pill can look like a taunting little joke, filled with more doubt than medicine. My toddler’s tears inspire annoyance, or even rage, in me, and the best I can do is wait for feelings of sympathy. I catch myself going through the motions of motherhood, without feeling inspired, and resolve to keep doing that, until I can ride a wave of love through an entire morning.

I have found a way to trick the trickster, and I’ll tell you my secret. It’s a trick I saw once for making a To Do list less overwhelming–I add small things to the list of the things that I am waiting for, tiny events that will definitely happen, soon. When things feel really badly, I get really tiny. I wait for the next time my son makes me smile, and I count that one smile as a victory against depression, even if it lasts for one second and it is followed by tears. That one might not work for you, but my twenty-month-old tiny man has a pair of dimples that have been making his smiles contagious since he started showing them off.

I wait to see proof that my child is thriving, because that is how I know that we are meant to be together, mother and son. If you do the right kind of learning about child development, those signs are there every single day. I remember the first time I held up a blanket in front of my face, and he pulled it away. That meant that he knew I was there, behind that blanket, and that he had the motor skills and motivation to move away the obstacle. He laughed, and I laughed. Every time his block towers get taller, I try to remember: tell yourself that this means he is thriving, learning, growing.

Lately, my husband has been “doing” bedtime. He used to do the bath and the nighttime diaper, and then I would read a story and sing and nurse the boy to sleep. Then, he got bigger and demanded more nursing, more playing, until my patience gave out. I wait for bedtime in a new way, now, because I get to listen to the little conversations he has with his dad. He says “boat!” and his dad makes the noise for the motor, and they both laugh. I wait for bedtime, because the way he waves his hand exactly once and says a staccato “bye!” just kills me. He sounds just like a grown person heading out to run the most mundane errand. At first, I saw this change in the bedtime routine as a sign that I had failed, again, and I wished that my anxiety would stop long enough for indefinite nursing sessions, just once a day. Now, I wait for the overheard laughter and the casual goodnight (preceded by many hugs and kisses) because I see them as signs that he enjoys his father and trusts that I will be there for him, if he needs me. He hates to be without either of us, but he adapts. When a child’s mother is failing, he is afraid. My son is not afraid. Therefore, I do not fail.

I wait for the next success. If all I can feel is despair, I wait for that next success, however small, and I hold on tight. It may be small, but it is my proof that the waiting is worth it.

We do a lot of waiting, and we move slowly, but each step matters. Even in the rain.

We do a lot of waiting, and we move slowly, but each step matters. Even in the rain.

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