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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Psychosis During Pregnancy and What It Taught Me

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Baby Viv

My postpartum psychosis episode in 2008 after the birth of my first child provided me with a deep understanding of the importance of medication in my long-term recovery plan. But it was the severe psychosis I experienced during the early weeks of pregnancy with my daughter that taught me the extent of the deficiency of certain chemicals in my brain and how I would need to adhere to my medication if I wanted to there for my kids. And I did. Without a doubt.

We had been trying to give our son a sibling for about nine months without luck, but in March of 2010 I saw the definitive pink lines on the home pregnancy test and I knew it was real. I’d been visiting my family in Florida over Easter with just my little man since my husband had to stay home to work when the timing was right to take a test. I couldn’t wait, so I did it late at night and when the lines showed up I called my husband right away, texting him a picture to show off the proof.

“Well, don’t get too excited in case it doesn’t stick.” he cautioned, reminding me of the miscarriage we had before our son was conceived.

“I know, I know. I just have a good feeling about this one. I think it’s going to work out.” was my honest reply.

He encouraged me to try to sleep, sensing how amped up I was by the news. And I was. My skin was buzzing with anticipation for the nine months ahead of us. I couldn’t stop thinking about the fact that there were cells dividing and multiplying inside of my belly and those cells would grow into our baby. I didn’t take my usual medication that night since I had discussed coming off the med upon learning I was pregnant with my doctor. The miracle of life was starting within me, I needed to protect it, and I was so incredibly happy.

So happy I barely slept that night. My son and I had to be on a flight home at 7:15 in the morning, so we were up packing away the last of our stuff at 5am to get to the airport on time.

The hypomania was in full effect, but I kept it well-hidden from my parents as we kissed and hugged goodbye, my stomach in knots because I wanted so badly to tell them the exciting news, but also wanted to get home and confirm it with my OB-GYN before telling them they’d be grandparents again in December.

They didn’t have to wait long though, because the following week I was manic to the point of psychosis and had to be hospitalized. I was five weeks pregnant. They immediately flew up to help.

After returning home from our visit in Florida, I could barely sleep at night I was overwhelmed with the expectation of another baby joining our family. To try to get myself to fall asleep, I’d run through baby names in my head, my husband snoring melodically beside me. My technique didn’t work and the three hours of sleep I was eventually able to get each night weren’t nearly enough to prevent the mania from taking over my mind.

By the time my husband called 911 to safely get me to the hospital, it was evening and we had already put our little guy to bed. In hindsight I bet he did this to prevent our son from witnessing an event that may have been traumatic for him. But at eighteen months old and with his obsession with police officers and police cars, I remember thinking the exact opposite in the moment the officers stepped into our bedroom to talk me into going with them to the hospital. I even asked them if they would say hi to him before we left the house, as ridiculous a request it was, at the time it made perfect sense to me. That was how far gone I was without my meds.

My mother-in-law arrived to take care of our son, and my husband followed the police car to the hospital where I was held under a temporary detention order until the doctor evaluated me. By this point I was experiencing extreme dissociation and confusion along with hallucinations. The following morning I was finally admitted to the psychiatric ward, and was stabilized with medication over the course of the next four days.

No medication is completely safe during pregnancy, but together with my doctors I chose one I felt comfortable. One that brought me out of the psychosis and back to reality. Back to life, with a life growing inside me. I saw a High-risk OB-GYN, my psychiatrist, my therapist, and my regular OB-GYN throughout the duration of the pregnancy.

Taking medication during pregnancy is a gut-wrenching decision for a mother. But in my case, the benefit of me being on the medication that allows me to function as a human being greatly outweighed the risk to the fetus. Having kids while living with a mental illness has its challenges. The obstacles I overcame during my childbearing years were ones I wouldn’t wish upon anyone; rather, I hope people can learn from what I experienced.

There is no ideal way to do this. There is only the intense desire to have a family and the need to work closely with your doctors and therapist to achieve the best, safest, most ideal outcome possible.

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Creating a Future after Postpartum Depression Erases the Past

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This is a guest post is written by Kim who blogs at The Truth About Homeschooling. She writes on her days teaching her kids at home, her faith, and on her severe PPD after 3 children. 

In April 2010 I woke up.

I was sitting on the sofa in my living room, still in my pajamas, with my three children on the floor watching TV. Violet and Sarah were talking about wanting to switch bedrooms. We’d been talking about doing this for over a year. I just couldn’t do it, though. It would take at least a month to switch bedrooms for three kids and sort out all the toys.  I looked at them through my usual fog, and then it ….just happened. I was absent. And then I wasn’t.

December 2013

This past January my husband and I started talking about home schooling our kids.  There are so very many reasons we wanted to do this, and ultimately decided to do it.  One of the reasons I was so for it was the feeling that I’d get to make up for the years I lost to postpartum depression. The idea that I’d have my kids back with me, back to doing all the daily things and activities I missed  with them because I was so sick was very appealing. I wanted to read with them, to paint and craft, to cook and bake. I wanted to be silly and have them like me. Not just love me because I was their mom, but I wanted then to like me because I was a good, kind and fun person.

I have a two year gap where there are very few true memories. When I see pictures from this time period (about January 2008 until April 2010), I really don’t remember much.  Sometimes I have what I call ‘shadow memories.’  It’s as if I dreamt it. Colors are muted or black and white, the images in my head are fuzzy and there aren’t any scents associated with it. Can’t you look at a picture of your child and smell that fresh from the bath baby smell? After about eight months of age I don’t have that with John.

So I was worried about regressing with the depression, absolutely. This was going to be a huge change to both our physical world (All three kids back at home with me every day) and our emotional world (All three kids plus me, together. All day. Emotions. Hormones. All day.).

Since ‘waking up’ in April 2010 I have back slid. But everybody does. This healing is a process. It began with my daughter Violet and the PPD after her, and it did not end in April 2010.  I have had to learn that every fall and spring my meds will need to be adjusted and that’s ok. Obviously I have to be aware of obstacles- and homeschooling could be a major obstacle.

Since that April I’ve been trying to soak up every single minute of every single day. I have such intense guilt about the time that I lost. If John is cuddled up next to me and we’re reading a book, I think, “Did I do this with Violet when she was six? I don’t know. I can’t remember.” I play this little game all day long with all three kids.

Now home school is in full swing. We are up to our necks in everything. It’s been a little crazy, and we’ve had some pretty awful days. But we are loving it.  Throughout this adjustment I’ve seen my hopes coming true.  I’m getting to know my children – as people, not just as my kids. And while I can’t hold a six year old Violet on my lap and read her a favorite book, I can still sit with her –and she’ll read to me. I can’t rock Sarah to sleep the way I hope I did, but I can cuddle with her and watch Star Wars for the first time. I might not remember John learning to dress himself but I can watch with pride as he learns to write his own thoughts down.

Postpartum depression robbed me of precious time with my children & husband. But as I continue therapy & keep taking my meds, I’m gaining in the memory department . Today I’m building a life that is more than shadows, more than soft edges. I’m meeting each day with clear eyes & a loving heart. In the end, I win.
I’m awake.
And that’s a beautiful place to be.

Find Kim on her blog The Truth About Homeschooling.

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When the Risk of Not Getting Help for PPD Just Isn’t Worth It

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Babies are resilient. There’s no doubt about it. But babies and children may be negatively affected by a mom’s untreated depression, anxiety, or other mood disorder during pregnancy or postpartum. And it seems to me that this might not be a risk worth taking.

Please note carefully the specifics of what I said above: “Babies and children may be affected by a mother’s UNTREATED depression, anxiety, or other mood disorder during pregnancy or postpartum.” Many, many of you can attest to the fact that children whose mothers suffered from prenatal or postpartum depression or anxiety and received treatment are just fine- even thriving as so beautifully highlighted in a blog post by Katherine Stone.

Moms who make it a priority to get support, follow treatment recommendations from a trained professional, get well, and take care of themselves do so to benefit not just themselves but also their children. And most of these kiddos go on to be happy and healthy preschoolers, teens and adults.

What we worry about is when a mom’s depression or anxiety goes untreated. It is these instances when there is high potential for emotional, social and developmental delays in babies and children. I say this fully knowing that this fact may bring additional layers of anxiety to women who already suffer, and I am hopeful that those women understand that this post is not a condemnation or a finger shake. It is, instead, a compassionate offering through a realistic look at the risks that may come to those who do not reach out for the support that they deserve.

I am motivated to write this after reading an article in the New York Times Magazine that talks about Depression in Preschoolers. While we know that there are many factors contributing to the development of depressive symptoms in children this young, and that often these children do not have parents who are depressed themselves (and, conversely, having a depressed parent does not necessarily mean that a young child will also be depressed), we do know that many of these little people may not have received the empathetic attunement and emotional mirroring from their mothers that they need to thrive. Babies need to be attended to and heard, they need to be held and comforted, they desire eye contact and voice recognition, and if a mother is unable to provide these things because she is depressed or anxious, a baby may suffer the consequences.

So, here are some of the risks for babies and children whose mothers suffer from UNTREATED antenatal or postpartumdepression and anxiety:

  • Pregnant women who are depressed are less likely to take adequately care of themselves and their unborn babies.
  • Preterm labor has been linked to depression and anxiety in pregnant mothers.
  • Preeclampsia has been linked to depression and anxiety in pregnant mothers.
  • Depression and anxiety during pregnancy has been linked to low birth weight in babies.
  • Babies whose mothers were depressed or anxious during pregnancy are more likely to have eating and sleeping challenges and are more likely to be difficult to soothe.
  • Attachment and bonding may be negatively affected and this can have an impact on a child’s ability to form healthy relationships during school-aged years and on through adulthood.
  • Fathers, whose partners are depressed, are also more likely to develop depressive symptoms in the postpartum period. If this happens, neither parent may be able to attend to the emotional needs of their newborn.
  • Mothers who have postpartum depression tend to spend less time engaging in eye contact, mirroring facial and voice expressions, and casual play with their babies. All of these activities are important for bonding and attachment.

With this said, we know that other caregivers, such as a father, grandparent, other family member, friends, and nannies can provide the emotional reciprocity that is needed if and when a mom is temporarily unable. While a baby needs its mother first and foremost, that child will absolutely be okay if, temporarily, it is getting all of its physical and emotional needs met by someone else. What matters most, truly, is that mom gets the support that she needs to feel well so that she can care for her babe in the ways that are important to both of them.

So, moms, if you are suffering, please get help. For you and for your little one.

Kate Kripke, LCSW

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