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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Educating mamas-to-be one story at a time

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I think of mental illness the same way I view cancer. It can strike anyone at anytime. For me, the time came at the age of twenty-six. I was blindsided. Two manic episodes two weeks apart; two stays in two different psych wards at the end of 2005.

If the first time was a complete and utter shock, the second reinforced what I guessed was happening to me. My family and I were in denial after the first incident, totally unprepared for the road ahead. The second bout of mania solidified the fact that this was real.

Even after living with bipolar illness for two years, I had yet to fully understand the disease. When my husband and I reached a point where we agreed I was stable enough to try for a baby at the end of 2007, I read everything I could get my hands on about postpartum depression, the only postpartum mood disorder I knew about. I had lived through a year of debilitating depression following my diagnosis of bipolar type one, and was terrified of falling into the darkness again. Especially with a new baby who would be depending on me for survival.

Impressed with what I thought was a great job preparing for my postpartum experience,  you can imagine my confusion when instead of the intense case of the baby blues I had expected, mania began taking over my mind in the weeks following my son’s birth.

The pressure I had placed on myself to succeed at breastfeeding made everything worse. Instead of turning over my sweet, swaddled little boy to my husband so he could give a bottle of formula and I could get some decent rest, I pushed my body further than I ever have, on top of having just given birth via emergency C-section after a sixteen-hour labor. I was not allowing others to help me care for my baby, which in turn contributed to the swift deterioration of my mental health.

It was only the third time in my life that I had felt full-blown mania, and now having been there four times I can easily say that it’s like an out-of-body experience. You have the strangest thoughts, such as the time I believed every song that came on the radio was a sign specifically meant for me and my life. Sleep and food became things I needed very little of to function, my energy level soaring through the roof. I felt invincible.

Until everything fell apart and I spent the fourth week of my son’s life in a psychiatric ward of our local hospital suffering from postpartum psychosis.

I’m very lucky in that I respond well (and fast) to medication, and so I was back at home before I knew it, returned to my precious baby who had no idea I had gone away. My recovery was slow and steady, and within a few months I felt like myself again, and was settling into my new role as a first-time mom.

These days I am so glad that Postpartum Progress is a community of women who share their experiences. I know there are people out there who have read these stories and who have become more educated about postpartum mood disorders (PPD, postpartum anxiety, postpartum psychosis, postpartum OCD, postpartum PTSD) from visiting the site. By sharing to educate and to inspire, we can prevent or minimize the occurrence of postpartum mood disorder hospitalizations by catching the symptoms early. Keeping more mamas and babies together by sharing one story at a time.

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Postpartum Psychosis Doesn’t Equal Failing as a Mom

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A few days ago, I walked into the grocery store holding hands with my three and five-year-olds. The delicate scent of baby powder overwhelmed my nostrils the second we stepped into the diaper-filled walkway of the baby aisle for pull-ups. Immediately and without warning, my memories drifted back to my first postpartum experience. A fresh pack of Pampers always does it.

In September of 2008, I was eagerly awaiting the impending arrival of our first child. I thought we had prepared for everything – nursery, diapers, clothes, breastfeeding supplies – we were ready. I had even read up on postpartum depression. I thought I might be more susceptible to the illness since my mom had a touch of the baby blues after my brother was born and I had been diagnosed with bipolar disorder two years before becoming pregnant. Little did I know it would be the complete opposite end of the spectrum that would grab ahold of my mind the day after our son was born.

I ended up having a C-section because my progress stalled after the epidural and the baby’s heartrate was becoming deeply affected by the contractions. My OB made the quick decision to do the surgery and get him out, to be safe.

It was scary, but over quickly and seeing my son for the first time was a dream come true. I was shivering uncontrollably from the epidural meds, but gave him a kiss and stared at him for a good ten minutes while a nurse took pictures for us and then whisked him off to the nursery. I was wheeled into Recovery for a few hours where I called our friends and family with the good news. The mania hadn’t set in yet, but by this time it was 1am and I had been in labor since 5:30am the day before. By the time I got settled into my room and my son was brought to me so we could try nursing, I had been up for a full twenty-four hours and I was yearning for rest.

But at the same time, I couldn’t take my eyes of my baby boy. This little life grew inside of me for nine months and I finally had the chance to hold him and feel his teeny fingers in mine. I was awestruck by what had just happened, and sleep was the last thing I wanted to do in that moment. I wanted to get to know my baby. I tried nursing him, and we did some skin-to-skin, but by that point I was dizzy with exhaustion. My best friend who is a labor and delivery nurse and who had been with us the entire time, urged us to send him to the nursery so I could try to sleep. I took her advice the entire time we were in the hospital, but with the hourly checks on my vitals, there was no way to get any real rest.

I had been medication-free during my entire pregnancy and planned to stay med-free so that I could breastfeed him. We were sent home after three days in the hospital, and even though I had felt the onset of mania while we were there, I didn’t dare tell anyone because I didn’t want to fail at my first attempt at being a mom to my son.

We arrived home and after the initial wave of exhaustion had passed the morning after he was born, it became fuel for the fire of the vicious escalation of my symptoms. I remember being so anxious about my milk coming in that I would wake up from short stints of sleep covered in burning hot, puffy red hives all over my legs and mid-section. The baby’s schedule made sleeping long stretches impossible, so my sleep deficit grew with no end in sight.

I wasn’t willing to let anyone take over night feedings and my symptoms kept getting worse. From the intensity of my anxiety over not being able to provide my baby’s nourishment, to my sudden sense that I could be supermom and extremely productive on barely any sleep, to auditory hallucinations which eventually were what tipped off my husband and parents that I needed to go to the hospital. I was admitted on October 22nd for Postpartum Psychosis.

Being taken from my four-week old son two days after he was baptized was one of the most grueling events of my life. Nothing can bring back that week we lost. I saw him grow and change so much in one short week via photos my family brought me in the hospital. It broke my heart to be away from my newborn.

But believe it or not, looking back now I can appreciate what we went through. I have embraced my past because it has brought me here. My hope is that sharing my story will help educate people so they can understand that postpartum mood disorders are brain illnesses are like any other illness that can affect the body. We can treat them and we can recover from them. And we will emerge stronger because of them.

No one should ever be afraid of admitting and asking for help. Help starts here. You are not alone.

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Hope Is What We Come Looking For — Part II

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Even though it was 18 years ago, my memory of postpartum depression and anxiety feel as fresh as if it were last week. There was a nurse in the hospital, Mardi, who cared for me in the days after Alec was born. She sensed something was wrong and checked on me at home with a phone call. When she asked how I was, I tried to answer but my voice choked with tears. “I’ll be there in twenty minutes,” she said. I hung up the phone, and let the emotion I’d been holding back, flow. I was filled with such a degree of sadness, that I could only clutch my chest, and cry. I didn’t understand why. I loved my baby, but this feeling of immense melancholy pushed him into the background. The tears streamed down my cheeks as I stood at the window and watched for Mardi. All I had to do was make it twenty minutes, just hang on until Mardi got there. My life had become one of surviving life small blocks at a time. Finally, this nurse, who was intuitive enough to see what no one else could see, rushed up to my front door. When she saw me, she pressed my head into her chest, and in the loudest voice possible without screaming, she spoke into my ear, “I promise you, you will get better.”

I wanted that promise of “better” and I was desperate to believe her. But my thoughts, my fears of the worst, held me back. I knew something was very wrong, and I was scared enough to be worried. In the pitch black of the night, my  heart raced, I prayed over the pounding in my chest that I would be normal again. But what if I would always feel this way? Panic would rise into my throat, as I thought, what if I never get better? What was I going to believe? Was it her promise that was my hope? The part of me, too terrified to believe, scared that I wouldn’t get better shouted back no– you won’t be one of the lucky ones. You’re just too far gone. I was afraid to believe in case she was wrong. But I had to. I had a baby now and I had to do something for him. My days blurred into nights and sleep deprived, every moment felt like I was standing on a cliff, looking out over my life and the world whirred on with me lost in the middle of it. Thoughts roared in my head, Just Give Up. Run away, he’d be better off without you. I imagined myself leaving my baby in the better care of my husband, and I wondered if Alec would know that I left, for love of him. But through all this, Mardi’s voice was louder, and I heard it. She was telling me I would get better, that she had seen people like me get better, and that it would happen. But I knew it was me that had to decide —  either I would believe and try, or I wouldn’t make it. I couldn’t leave things to chance, I loved my son so much.

I remember that moment of decision with Mardi. She was sitting next to me on the sofa, I had Alec in my arms. I sat with my baby, holding him so close I could smell his breath. While my tears fell on his little face, I tried to talk but I could only sob. She understood what I couldn’t say. I heard her voice, firm and determined, break through the deafening defeat in my mind. The word “promise,” again. And then, somehow through the darkness, something in my heart lifted. A resolution, and my soul took on the fight for me and my baby. I decided to believe what she was telling me. What I felt was more than optimism, it was far more powerful than positive thought or statistical probability.

What I felt was real HOPE. With Mardi there, I called my doctor and went in to see her. Within a few minutes of talking to me, she got on the phone and called a mental health specialist. I had an appointment for that afternoon. I was started on a prescription medication that was safe while breastfeeding and had therapy sessions three times a week

I write here today, having been fortunate enough to have held hope in my arms at a time when I can say it is the only way I survived. It’s the personal experience I’ve had with hope that makes me know hope is not on a continuum, that it’s not measured in degrees or a dash marker on a spectrum. It is that complete hope, the desperate belief in something when you have nothing else. My postpartum depression and anxiety remain the blackest period of my life, and I survived.

Eighteen years ago, when I became a mother for the first time, I needed that kind of hope, more than words here can describe. I had to believe that Mardi was right. I would get better. I had to take that HOPE into my terrified heart and make it mine. From that moment on, I knew I had to wake up every morning and claim that hope for me and my son. I believed Mardi, that living spark of knowing that I saw in her eyes. I still feel that white hot commitment to hope that lit up my soul. That seed took root, and I gave it no time limit or ultimatum for when. I accepted hope on its terms and believed in its promise.

Hope gave me determination and became that tangible thing I held on to when my sanity was disappearing. The early weeks of new motherhood cracked my world in half. I needed a life saver, and I needed to never let it go. Hope is that thing that told me to look at my child with a smile on my face — always. Hope led me to the library to find CDs of Broadway show tunes so I could learn songs to sing loudly, happily, earthily, to my baby.

One morning, as I held Alec, singing “Oklahoma!” to him off-key but with my whole heart, he looked up at me and smiled. He was ten weeks old, and my heart bounded out of my chest with JOY. This was his first smile and he had it for me. I saw how beautiful, indescribable, and true, hope is. In the days to come, hope kept showing me its face with flashes of the gift that life is. And would be like.

It is this gift of hope that is flesh and blood real to me now. When I speak to new mothers’ groups, I talk honestly about my slow, struggling climb out of the depths of my early days as a new mother, about the pain of hopelessness. I tell them, in a voice that still breaks from the fierceness of the memory, my true unprettied up story from the past with the hope that they’ll believe this seemingly put-together woman standing now in front of them when she confesses about the days she thought she’d never feel normal again. That once, I was right where they are.

When I look out, teary-eyed, into the faces of the women sitting in front of me, I see them listening — and there is always that one there. The face I instantly recognize. I know what she’s come looking for. Her desperation for belief in my words so visible, so clear in her eyes, in the same way I wanted my nurse’s promise of hope for me to be real — like it’s the only thing we have.

In the loudest voice I can without screaming, I look into her eyes, and just like Mardi did for me 18 years ago, I beg her, never give up. Never give up HOPE.   

 

*This is Part II of an original series written for Postpartum Progress. Part I was published January 14, 2013.

 

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