Reward and Risk: Choosing to Stay on an SSRI During Pregnancy

Choosing to Stay on an SSRI During Pregnancy

Nearly 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 and consulted my OB and pediatrician for their thoughts on whether 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 the 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 medication 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.

None of the people I involved in this decision took the discussion lightly. After all, this was a deeply personal decision based on several factors. One, I was a full time working mom of an active little boy who was quickly morphing into a threenager. My patience was already wearing thin due to the physical demands of a twin pregnancy, and battling the will of a small tyrant is much harder when you aren’t sleeping, can barely keep your lunch down, and can’t take any medication for anything that ails you. Two, there was an unmeasurable amount of stress that would soon be wreaking havoc on my body and my mind. Three, I was, as my OB kindly joked, the “poster child for relapse” due to all of these factors and an increased risk of having a repeat experience.

Had I not chosen to remain on my medication, I was at risk for major depressive episodes, which could lead to improper nutrition needed to keep the babies healthy, maintain the pregnancy to a date of viability, and the lack of ability to do my job or be a functioning mom to my son.

At the start of the third trimester, I weaned off of the medication. My irritability increased, I slept even less than I already had been, and I had little to no patience or energy for my son and husband. The medication that had helped regulate my roller coaster moods and anxieties was no longer there to do its job, which was only exacerbated by lack of sleep, cramping, ligament pain, shortness of breath, and all of the other fun symptoms that come along with a multiple pregnancy. The physical stress weighed heavily on my mental state. I am normally a very independent person, so not being able to carry loads of clothes to our upstairs laundry room, clean the house, or carry my son nearly broke me. Getting out of the house to see friends and family was daunting, and I only left my desk at work to waddle to the bathroom.

We all trudged through it until two weeks before my scheduled c-section, when my doctor suggested starting the medication again to make sure it would be effective by the time the baby blues would subside and real PPD may kick in. I was so down at that point; I knew it was the best thing for all of us.

The girls’ birth was somewhat traumatic. They were both born healthy and needed no NICU time, and we were successfully able to establish a breastfeeding relationship that had been my lifeline to normalcy during my PPD/A with my son. I, however, did not fare so well. My body was worn from 37 weeks of growing 12 pounds of baby in my 5’3″ body. Had I not been on the medication and had the tools of therapy in my back pocket, I might not have been able to handle my experience with as much grace as one can muster during a five day hospital stay brought on by a series of complications related to twin delivery. I’m still working through my emotions and feelings on everything that happened to me, but for now my hands and heart are full enough to make that experience worth it.

Choosing to Stay on an SSRI During Pregnancy

Five and a half months later, my girls are healthy, happy, and meeting their milestones. I have good days and bad days, but the good outweighs the bad by light years. I feel so much more like myself than I ever did in the six months between the birth of my son and my diagnosis. I passed my postpartum screenings by my OB, pediatrician, and therapist. I am completely at peace with my decision, as difficult as it was.

The risk was definitely worth the reward.

Depression Is the Leading Cause of Disease Burden For Women Worldwide

International Day of the GirlI’ve said it before. Postpartum depression exists all over the world, despite what some people might have you believe.

I also believe 1 in 5 women get postpartum depression worldwide. That’s 20%, which is a hell of a lot of women. Not the oft-quoted 10%, or 15%, but TWENTY PERCENT.

And yesterday, for World Mental Health Day, the World Health Organization (WHO) reiterated that. In their media note to mark the 20th anniversary of World Mental Health Day, they specifically mentioned postpartum depression, which I thought was fantastic:

“Depression results from a complex interaction of social, psychological and biological factors. There is a relationship between depression and physical health, for example cardiovascular disease can lead to depression and vice versa. Up to one in five women who give birth experience postpartum depression.”

In a 2012 paper on depression, the WHO states, “While depression is the leading cause of disability for both males and females, the burden of depression is 50% higher for females than males (WHO, 2008). In fact, depression is the leading cause of disease burden for women in both high-income and low- and middle-income countries (WHO, 2008).” Let me repeat that: Depression is the leading cause of disease burden for women. Not diabetes. Not hypertension. Not heart disease. Not chronic obstructive pulmonary disease (COPD.) Depression. And yet, almost half of the world’s population lives in a country where, on average, there is one psychiatrist or less for every 200,000 people. There are no services. There is no help. Can you imagine?

Postpartum depression cannot be ignored. So many of the people I talk to who are carrying out maternal child health programs around the world tell me those programs do not include provisions to assess and support a new mother’s mental health. This has got to change.

And it’s not only women and PPD we should be concerned about. Today is International Day of the Girl. Much of the focus of this event is on issues — important ones — of equality, child marriage, sex trafficking and access to education.  But did you know the WHO found the leading cause of disease burden among adolescents age 10-19 across the world is depression, too?

Let’s make sure our girls grow up healthy and strong in body and mind. Let’s make mental health a priority instead of an afterthought.

Postpartum Depression Statistics: One in Five

postpartum depression statisticsI’ve been saying for years that I believe more women in the US get postpartum depression than the oft-quoted “1 in 8.” That postpartum depression statistic is based on data from the CDC that found a range of anywhere from 11 to 20% of moms get PPD.  Most people like to say it’s 10% or, if they’re really adventurous, 15%. I know one expert who, after saying to the powers that be that he believed the numbers were higher, was told not to get hysterical. Sound familiar, ladies?

The truth is that people aren’t really tracking the numbers as closely as they should here. Good postpartum depression statistics are hard to come by. There is the information from the CDC, which looked at only a handful of states and at only self-reported cases. Given what we now know about how untreated postpartum depression affects both mother and child, I hope to see measurement being ramped up.

I recently reached out to both the CDC and the National Institute of Mental Health to find out how many women die of suicide in the first year postpartum in the US, and where suicide ranks among the leading causes of maternal death here. And you know what? No one had any idea, because they haven’t tracked it. They will now, hopefully, since I made so much noise about finding out. (MUCH gratitude goes to Kathleen O’Leary, head of the women’s program at NIMH, et al, for really making a concerted effort to look into this for me.)

A study came out this week from the Australian Institute for Health and Welfare which surveyed 29,000 mothers and found that one in five said they had postpartum depression, or postnatal depression as it’s called there.  One in five. Could the numbers be that large here in the US? There’s no reason to believe they’d be much different.

One in five.

One. In. Five.