Mommy and Meds
January 14, 2016 7:09 PM   Subscribe

Oh, so much this. Depression has always been a part of me, but postpartum, I was actively psychotic. I'm not saying that lightly. With over a decade of hindsight, and proper medication, I can see how bad things were. Really, really bad.
posted by Ruki at 7:34 PM on January 14, 2016 [3 favorites]

Juggling meds is its own special hell. And when did we start treating moms like criminals for being human? (rhetorical question). I really hope her journey involves being a little easier on herself. She writes beautifully about her experiences...I wish I could tell her but she probably wouldn't believe me.
posted by datawrangler at 7:35 PM on January 14, 2016 [2 favorites]

Hmm. I know my friend was on antidepressants during her pregnancy, because she's joked that her very happy little girl must have gotten that way because she got antidepressants during gestation. So there must be some antidepressants that are thought to be not dangerous?
posted by tavella at 8:14 PM on January 14, 2016 [1 favorite]

A friend of a friend ended up with psychosis after a recent pregnancy. She had pre-existing issues with depression as well, and I can't imagine the complications that would be added by medication changes, let alone pregnancy itself.

I'm not a doctor (if anyone here is please chime in) but a few minutes searching PubMed indicates SSRI use during pregnancy can cause various complications for the newborn. So, no wonder a lot of expecting mothers stop their meds.

It would be great for moms if there was a treatment for depression that was effective at a year between doses (there was a recent thread about ketamine and I think it mentioned 6 months between treatments.) And having run the full gamut of psychiatric meds myself, I strongly suspect that treatments that require infrequent application are in some way addressing problems better than once-a-day meds.
posted by iffthen at 8:18 PM on January 14, 2016 [1 favorite]

I'm reading this with trepidation. I briefly switched antidepressants only to switch back quickly. I know what works for me and my brain. Then I got pregnant by choice and learned that the drugs I take that keep me sane and make my life possible are category C, meaning that it's unclear whether they're safe for the fetus or not.

Sometimes I feel like a monster, for selfishly choosing my mental health over the possibility that exposing an unborn child to my meds will harm them, or that as someone with a mood disorder, I'm likely to pass that on to an innocent. Sometimes I feel really down about this and other things about pregnancy.

And yet. I want this person and I can't have the person if I do not exist. Choosing life without antidepressants for me might mean choosing not to exist. So I try to let go and let God. "Let God" what, I'm not 100% sure. But I hope the person and I find out, together.
posted by kat518 at 8:22 PM on January 14, 2016 [12 favorites]

In the olden days, moms could drink. A little. My mom's glass or two of wine at dinner did not impede the wildly happy and successful lives of her six children.

IMO, moms should be able to stabilize their moods during pregnancy and afterwards (during breastfeeding, if that applies) without medical guilt-tripping. Common sense dictates that happy mothers are the best in ensuring happy babies. The uncertain results of psych meds on the process of pregnancy and early childhood development should not only be taken with a grain of salt; they should be mostly disregarded, especially in light of how little docs and shrinks know about how anti-depression meds work. Be happy; your child will benefit. Happiness is palpable; drug reactions are wildly unreliable in the mechanism and results of their administration.
posted by kozad at 8:41 PM on January 14, 2016 [11 favorites]

Jeez I eyeroll at these stories. I've literally filled an order for antipsychotics for a new mother with a baby in the NICU in a hospital pharmacy, and there are pregnant women who take antidepressants. As a new pharmacy student, I've even had the interesting discussion with talked my preceptor pharmacist about why we don't flag these, because the benefit to the mother of taking the med is greater than the risk to the (wanted) fetus or baby.

Many healthcare practitioners do care, especially the new generation, and that's what we're taught and that's what we do in clinical settings. There are many mothers who are on SSRIs or have psychiatrists who are concerned and work hard to figure out what might be less harmful at what point in the pregnancy.

There's straightforward information all over the web by reputable sources on Taking SSRIs during pregnancy aimed towards the layperson. The FDA even introduced changes to be made in drug labeling to improve how risk-benefit information for pregnancy and lactation is communicated last year (final rule appeared in June 2015).

I'm not saying there aren't docs that could improve their way of communicating concerns about antidepressants during pregnancy, but it really isn't uncommon for a doc to work with a patient to figure something out to minimize risk to mother and (wanted) fetus,
posted by discopolo at 8:50 PM on January 14, 2016 [16 favorites]

Lots of children were exposed to psych meds while in utero; there's certainly no clear evidence that they've been harmed or the tabloids would be all over it. I looked at some studies suggesting otherwise and the effect, if there is one, is pretty small. The better ones acknowledge that their results weren't obtained through blinded studies but by comparing populations (mothers on meds vs mothers not on meds) and they weren't able to separate out the effect of the medication from other factors. For instance, mothers who need meds may be generally less healthy, they may have interrupted their medication regimen because of the pregnancy, they may be from different social cohorts ... and all this is for a very vague and inchoate effect that might not be there anyway. Also, as the FA implies, suicide and other forms of self-harm are risk factors too ...
posted by Joe in Australia at 8:59 PM on January 14, 2016 [1 favorite]

It also often comes down to what's going to be the least worst outcome.

I'm on anti-depressants and when we started trying to conceive I went to see a psychiatrist who specialises in pre- and post-natal depression*. He said that whilst taking anti depressants can cause newborn withdrawal issues (pharmacologist he suggested I talked to said that for this particular drug there was a 12% chance the baby would be hard to settle for the first 6-8 weeks), anxiety and depression have been shown to have effects such as premature birth, low birth weight and, obviously, a detrimental impact on the mother such that the baby's care is affected.

It's just not cut and dried. The media and scaremongering and scrutiny of women just make the whole thing so much harder.

(I also haven't managed to get pregnant yet, so haven't tested out the choice (stay on them) that I made.)

*who, incidentally, was a friend of a friend and also finished school the same year I did -- talk about a "realising just how old you are" moment!
posted by prettypretty at 9:13 PM on January 14, 2016 [9 favorites]

And, let me add that I definitely feel for any pregnant woman who has felt shamed, feels shamed or afraid that she'll be shamed for taking SSRIs by a doctor, or is already feeling shamed into keeping her anti-depressant use a secret since pregnant women seemingly encounter opinionated randos at every turn, but (as you can see in the Mayo Clinic link for the average patient in my previous comment), there are many healthcare practitioners that do recognize that the mental well-being of the mother is essential to a healthy pregnancy.
posted by discopolo at 9:31 PM on January 14, 2016

Thanks for the follow up, I guess, discopolo, but eyerolling at these stories? I mean, thanks for your understanding, but to be trite, the struggle is literally real. I'm taking the charitable reading and assuming you're eyerolling the doctors, but I do want to point out that your initial comment could easily be read as dismissive.

Why do I think that? Because women tend to have their health issues dismissed. When I was pregnant, and this is the first time I'm stating this in a public space, I was taken to the ER after a suicide attempt. The contempt I was shown still staggers me, 14 years later. My daughter is healthy and fine, thanks for asking. So, I'm politely asking that when you say these stories make your eyes roll, you are absofuckinglutely clear in what direction your contempt lies. Thanks.
posted by Ruki at 9:56 PM on January 14, 2016 [33 favorites]

And I do appreciate what you do. And I am genuinely glad for you that you seem to have never been on the other side of this.
posted by Ruki at 10:03 PM on January 14, 2016 [1 favorite]

There is some evidence SSRIs can affect sperm, too.

God, depression sucks.
posted by persona au gratin at 10:46 PM on January 14, 2016

I'm really sorry you went through that, Ruki.
posted by persona au gratin at 10:47 PM on January 14, 2016 [5 favorites]

Ruki, I respect your right to interpret and react to my comment however you choose. I honestly wish you'd read all of it and not interpreted it as me denying that you were treated poorly 14 years ago.

I will clarify my comment for you, but I do want to be crystal clear: I do not appreciate, and I absolutely do not deserve, the aggressiveness and thinly veiled bullying you chose to direct at me in your comments. It is not okay with me.

That being said, I'm truly sorry for what what happened to you. That sounds horrifying and I wish it had not happened to you. But What I would like to for you to realize Is that much has changed with how depression is treated in pregnant women in the past 14 yrs, even in the past 5 yrs. I alluded to as much in my above comment when describing my discussion with my preceptor.

my eyeroll was for the writer. She's made inaccurate claims re the current standard approach to treating depression in pregnant women. It is not, as she says, to stop taking antidepressants no matter what. That is not a common approach, it is not what I'm being taught, it is not what medical students are being taught, it is not what is being practiced and endorsed by leading hospitals (again, see the link in my original comment). Furthermore, and most importantly, it is not what is being communicated in information that is prepared by leading hospitals targeting the average patient seeking health information on the Internet.

Furthermore, it would be regarded as irresponsible to do so by many doctors,
posted by discopolo at 12:30 AM on January 15, 2016 [11 favorites]

(I had something else after that comma but I guess I deleted it before posting and don't have the the energy to repost. It was something from my textbook. And something about the article's style and how she denies she's doing promotion but nearly exclusively uses sources from the film.)
posted by discopolo at 12:44 AM on January 15, 2016

I'm eternally thankful that my entire OB team - three doctors and a nurse practitioner - responded with "no, there is absolutely no need to go off your antidepressants. They're safe, and untreated depression is much worse for your pregnancy."

And yet I still asked all four of them.

When you're pregnant, you run into so much fearmongering, and potential shaming if you don't do things exactly right, and even if you're a pretty level-headed person it can get to you. Things I was supposed to avoid during pregnancy, according to various dubious sources: eating frozen yogurt, eating salad, drinking any caffeine at all ever, taking hot baths, doing any yoga poses on my back/on my stomach/requiring balance/where my head was lower than my hips (but, like, yoga is also the one exercise everyone recommends for pregnant women), lift anything heavier than a gallon of milk, and dozens of other things I don't remember. All bullshit. OBs are there to provide reassurance as much as to set the record straight. If there had been even a shred of doubt in my doctors' responses, I probably would have tried to go off my medication, out of fear and "just to be safe," and who knows what would have happened.
posted by Metroid Baby at 3:37 AM on January 15, 2016 [8 favorites]

kat518, depression and anxiety run in my family like wild miserable horses, and I was worried about passing them down to my kid too. But the good thing is I know what they look like, what they feel like, and how to help. Mental illness is common, and if it happens to a kid, I figure there's no better parent for them to have than a parent who's been through the fire themselves.
posted by Metroid Baby at 3:44 AM on January 15, 2016 [3 favorites]

I was never advised to go off my antidepressants during either of my pregnancies. I chose to dose down but any medical advice I read/heard was to weigh the risks, that Prozac wad extensively studied (I'm on Lexapro / cipralex ) and as noted by pretty pretty that there are risks of being anxious or depressed while pregnant. I had horrid pregnancies but it wasn't due to depression. I'm angry that cosmo published this without stating that current practice does not always shun women needing mood disorders treated and I ache for women who have not received better medical advice or been shamed.
posted by biggreenplant at 5:50 AM on January 15, 2016 [1 favorite]

I'm really appreciating hearing from the other current/expectant mothers on antidepressants in this thread!

When I found out I was (very happily!) pregnant, I made an appointment with my psychiatrist the morning before my first meeting with the obstetrician because I wanted to make sure I could go in armed with information from a doctor who knew me and I trusted about what was actually best for me and the baby. My psychiatrist told me "there is no evidence of potential harm to a developing baby from anything you're taking. If the obstetrician tells you to go off any of these medicines (except one non-psychiatric one) find a new obstetrician" and like I've been super grateful to her for a long time (she's FANTASTIC and has helped me immensely through some very, very challenging times) but the confirmation that she thinks my health and well-being are important was huge. She was also very reassuring about other women she's known on similar or more-intensive medical regimes and how they and their kids turned out fine.

In fact the Nurse Practitioner* was immensely kind and supportive as well and only told me to go off that one non-psychiatric medicine and we like her a lot and she's been great and I'm hugely, hugely relieved AND afraid that if for some reason I have to see another doctor they'll tell me to go off the medicine I need to be even a moderately functional adult and I'll either scream at them or just kind of shut down emotionally because being told I'm potentially a bad mother for doing what I, with the advice of medical professionals, decide is best for my family is something I'm not sure I can handle.

Anyway, my heart aches for everyone in here who has had their very real mental health needs dismissed or understated by doctors (or who has gotten condescending warnings about what's "best for the baby" based on no evidence) AND my heart leaps with joy for all the people in here who are or will be wonderful moms who are making choices about what's best for themselves and their families, and I am eternally grateful to the medical professionals like mine and Metroid Baby's who are supportive of women as well as babies.

*And some of our good experience may, in fact, be that she was a Nurse Practitioner; it may not be universal but I've had immensely positive experiences with every Nurse Practitioner I've seen which is profoundly NOT true of doctors.
posted by Mrs. Pterodactyl at 6:15 AM on January 15, 2016 [4 favorites]

What my OB told me at the beginning of my second pregnancy was that the C category drugs were essentially "C if you need them" and then make a call.

I hate that there is moral judgement on what drugs pregnant women need to take to be healthy. There is a certain societal requirement for asceticism that we impose on gestating women: no drugs or medicines, no alcohol, not too much food, not too little, clean diet, just the right amount of exercise, and love every second of your deprivation.

The anti-depressants are just one facet of it, one that unfortunately has dramatic consequences on women who need them. It's a cultural problem, not just a medical one.
posted by lydhre at 9:26 AM on January 15, 2016 [1 favorite]

As a new pharmacy student, I've even had the interesting discussion with talked my preceptor pharmacist about why we don't flag these, because the benefit to the mother of taking the med is greater than the risk to the (wanted) fetus or baby.

Sure, but we also should not shame women for doing research and deciding that the meds are too dangerous for their child to risk.
posted by roomthreeseventeen at 9:35 AM on January 15, 2016

I personally have had family members whose doctors told them in the past 3 years that they should taper off Lexapro. None of the research says that this is necessary, and when it was a horror show and they went back on a smaller dose & told the OB the response was "Sure that works!" Kthnx?

I think the takeaway for prospective parents is: ask a psychiatrist not your OB. Or ask both and do as much research yourself as possible. In my experience OBs think of themselves more like surgeons than like Pregnancy Coaches--they're not going to give you advice about defeating heartburn either.
posted by Potomac Avenue at 9:43 AM on January 15, 2016

I certainly apologize if I came across that way. This is a very sensitive topic, obviously, and I felt that there was an underlying dismissiveness of the experiences shared in your post.

I'll be bowing out of this thread now. I deeply regret making that post, both for the way you construed it, and also because it was not wise of me to share an incredibly personal story here.
posted by Ruki at 10:23 AM on January 15, 2016 [2 favorites]

I deeply regret making that post, both for the way you construed it, and also because it was not wise of me to share an incredibly personal story here.

Ruki, nothing you said was wrong.
posted by roomthreeseventeen at 10:29 AM on January 15, 2016 [11 favorites]

Sure, but we also should not shame women for doing research and deciding that the meds are too dangerous for their child to risk.

Absolutely. No one should force an expectant mother to do anything she's not comfortable with.

I deeply regret making that post, both for the way you construed it, and also because it was not wise of me to share an incredibly personal story here.

Ruki, it's okay. You've been through something really awful and painful, and sharing is more important than not sharing. It's helpful for people to know what happened to you and to know that what happened was wrong, so they can be aware of how not to be treated.
posted by discopolo at 11:52 AM on January 15, 2016

(tw: for loss)

Last May, I was advised by both my psychiatrist and ob/gynto go off my medications at least six weeks before trying to conceive. Last November, my psychiatrist wrote what he called my "last prescriptions" after he learned that my wife and I were planning the timing of our first pregnancy attempt. He said I wouldn't need the meds once the pregnancy hormones kicked in.

Six weeks before trying? With no guarantee that I'd get pregnant on our first (or second or third or...) attempt? Not to mention the duration of the pregnancy and breastfeeding attempts? That feels like a long time. If I'd "be fine" off meds for a minimum of a year, why am I on them now?

There is so much uncertainty surrounding medications and pregnancy. It may be becoming more common (standard, even) for pregnant women to take medications, but it is not across the board. How can it be? Decisions like this involve opinions, and doctors who come from various lived experiences, philosophies, medical schools, cohorts and so forth. How exactly are the "benefits vs risk" determined? Whose judgement?

The post on the pregnancy and ethics of drug testing touched on this. The not-knowing part is what pushes decisions surrounding medications into opinion territory. Ditto for a bunch of other pregnancy recommendations.

Months before we began trying to conceive, I started screening ob/gyns. As someone with mental health issues, I'd experienced problems in the past, and I wanted reassurance that I'd find a doctor who would be willing to work with me. I received reassurance, and felt understood. Attempting to go off medications, at least initially, made sense. I felt supported, and as if the professionals I selected would be able to handle any situation that came up. I was reassured.

Instead of six weeks, I chose to discontinue my medication the day before our first alternative insemination attempt. To me, the uncertainty surrounding medication meant that I wasn't going to put my life on hold, but that I wouldn't take unnecessary risks either. As it turns out, I conceived on our first attempt- and I felt fine. Initially. Things weren't great, but we were adjusting and taking it one day at a time. I felt no need for medications.

Six weeks in, I was put on hormones. I was probably already miscarrying, but that's another thing we don't know. I. Suddenly there were huge shifts in my moods and I was very liable. Being off meds meant that I didn't have access to the resources/coping tools that I developed, and I'd lost my old coping skills due to disuse. I started feeling, rage, desperation, isolation, and didn't think I could cope without medication. I was also frightened that level of my distress would be harmful to the baby as well. More uncertainty.

I spoke to the ob/gyn, trying to see if there were alternative dosages/treatments we could try. She gave me a list of therapists and recommend CBT so that "I could feel supported in my pregnancy". I found this deeply upsetting, and enraging. I fixated on the implications that the problem was me. That the problem was my difficulty in handling sudden mood-swings 48hrs after starting 400mg of progesterone, not the medication.

In addition to rage, suddenly I felt alone and misunderstood. I was already in therapy, and I thought she understood my treatment. CBT is great, when medicated, I employed it constantly, but CBT does NOT work for me when unmedicated. I have a long history of CBT failures (& the damage to my self-esteem this caused me) before finding meds that allow me to access the executive functions needed to perform it. I thought she understood this. I let this silence me for a few days, fearing the reactions and potential for misinterpretations were I to keep pushing.

(I also wasn't able to process clearly enough to contact my shrink. I hadn't seen him in six weeks, so he didn't know that I was pregnant, let alone on hormones, and since I was seeing him later that week, it seemed wrong to call. Especially since he didn't know. I was also certain that he wouldn't ok any medications. Yes, I realize now that I was wrong - it's easier to see when, y'know, medicated).

I miscarried the day of my psychiatrist appointment and cancelled, informing him why. We stopped the hormones. My wife and ob/gyn suggested I stay off the medications, and I did, for a few days. Then I was angry again. This seemed incredibly unfair. I started the meds again, and immediately became more pissed off.

Pregnancy changes things. It changes routines, relationship, interactions, diets, sleep, and our entire body/mind. It's a huge shift, and somehow, suddenly women who use medications in a familiar setting are expected to magically cope & function at similar performance levels without meds?

I can't think of any other situation where change occurs and there is an expectation that people will cope better with less tools. People who no longer take meds, sometimes go back on during moves, job changes, sudden loss. People on meds, sometimes suppliant during those events, but pregnancy? Go off everything. It's an unrealistic expectation. This is based on the not knowing, and accentuates the need for testing medications on pregnant women.

Choosing to get pregnant was an enormous undertaking. It involved a lot of work, introspection and processing. My wife and I have spent years talking about it, and then deciding that we were ready. We were prepared and had plans to help compensate for my lack of medication and potential complications. It wasn't enough.

Now, we're in a place of greater uncertainty. We managed for six weeks. Was the seventh difficult because of pregnancy, the hormone pills, or the miscarriage? The ob/gyn says I should start the hormones after our next attempt "just in case". I can't risk not taking them. Psych meds are now on the table "just in case" too. I'm working with my psychiatrist to find the lowest, least uncertain meds for pregnancy that also work for me. However, I've also been reminded that given my age, uncertainty about hormones, and potential need for meds, that the least uncertain outcome is for me to not get pregnant.**

(there's always my wife or adoption, right?)

*I realize now, that she didn't understand my treatment or situation, and how could she? I'm in somewhat unfamiliar territory which has led to multiple misdiagnoses (discussed here and here and elsewhere.). Also, Iffthen mentioned the ketamine post upthread, saying It would be great for moms if there was a treatment for depression that was effective at a year between doses . In that same post, I commented about these difficulties, my treatment, and how I wound up being heavily sedated after I miscarried and anger about this situation kicked in, while I simultaneously wasn't being treated/given my usual medications, because of potential pregnancies.

** please, please, please, don't turn this into a discussion about our decision/my fitness to have children. - The lack of support I experienced involves the inadequacy of treating the mental health of women who are pregnant, not questions related to my fitness. Remember, my doctor even told me that "I'd be fine" without meds.

posted by bindr at 12:13 PM on January 15, 2016 [5 favorites]

I'm sorry, bindr, that's terrible. I had an extremely hard time emotionally while pregnant, and I sympathize so much with what you must have been feeling.
posted by internet fraud detective squad, station number 9 at 5:48 PM on January 15, 2016

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