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Antidepressants during pregnancy: Why I had to stay on Zoloft

We sat in the OB/GYN’s office – Paul in the chair where I usually chucked my bra, and me on the edge of that mechanical bull thing with stirrups. Being there for a pre-prenatal appointment, we knew one question stood between a healthy baby and us.

Four years earlier, my pediatrician had warned me during my final checkup. A recent college grad, I had outgrown the clip-on monkey around his stethoscope and no longer believed he was Phil Donahue, but I still trusted his advice. He had been among the first to recognize my symptoms of Generalized Anxiety Disorder.

“Now remember,” he’d said, “when it comes time for you to have children, you won’t be able to take Paxil during your pregnancy. But don’t worry, I’m sure they’ll have something else by then.”

Somehow then had become now, and “something else” was a new medication we had to find. Paul and I were fortunate just to be looking. Before 2005, couples like us didn’t have the Food and Drug Administration’s warning that Paxil could lead to heart defects in babies. Women had been told that Paxil, a type of antidepressant called a “selective serotonin reuptake inhibitor” or “SSRI,” was safe.

Thankfully, Paul broke the ice that morning. “We know Paxil isn’t safe for babies,” he said to Dr. Bess, “so we’re here to discuss our options.”

There, it was out.

And Dr. Bess didn’t look worried. “You’re right that you can’t stay on Paxil if you plan to become pregnant,” she said.

There were two choices. The first, I knew, might kill me. I had tapered off Paxil once before, during my senior year of college. Filled with new zeal for Christ, I had decided I would live by faith alone. Within four months, I was suicidal. Sitting in a hotel room on New Year’s Eve, I had imagined myself slipping – dissolving, even – into the cold tiles of the bathroom floor.

So living life unmedicated wasn’t really an option for me.

“The other option, which from your history sounds like the best one, is to wean off Paxil and then taper onto Zoloft,” Dr. Bess said.

My history is more than I could ever explain to Dr. Bess, more than a nervous breakdown my senior year. As a kid, I always thought I was sick. My chest pulsed deeply at night, but my heart made beautiful lines on the EKGs. My head throbbed with an aneurysm, yet each MRI came back normal.

Dr. Bess continued, “Zoloft’s been around for a long time. We have the most research on it.” But she cautioned that no medicine comes without risk. “The only thing we watch for is when the baby’s born, sometimes it needs more tactile stimulation to start crying.”

That wasn’t so scary. I could handle a quiet baby. One with big round eyes who wouldn’t cry until the doctor presented it with building blocks or Lincoln Logs.

“The reason we want babies to cry is because they start breathing when they cry. Not often, but sometimes, babies whose mothers have been on Zoloft need a little more help to start crying. We would just have a neonatologist in the delivery room with you in case.”

Neonatologist? Help breathing?

I envisioned us in the midst of a high-wire act, Paul pedaling a bicycle across as I stand on his shoulders, holding a baby in one hand and an orange vial of Zoloft in the other. Dr. Bess and the neonatologist wait on the opposite platform, and the audience below is silent. They’re unsure whether the drama is real or invented, whether they should clap or gasp.

Psychiatrists today aren’t certain, either. “The problem is there’s no real good data about any of it,” said Dr. Mary E. Salcedo of the Ross Center for Anxiety and Related Disorders. “I think the real question is not necessarily how safe [antidepressants] are, but how safe are they in comparison to being depressed during your pregnancy?”

Maybe we should have waited for an epiphany – or at least, better research. Instead, I left Dr. Bess’ office and ordered the Zoloft. I’d take two weeks to taper off Paxil, two weeks to reach 100 mg of Zoloft, and three months to let my body adjust. There were enough unknowns -including how I’d respond to a new drug – to keep us paralyzed past my childbearing years. So Paul and I settled on the one thing we did know for certain: we wanted a family.

Several months later, I celebrated my 27th birthday with a headache. Soon I stood frozen over the toilet as a second pink line emerged on my urine-soaked stick. After the silence, after Paul’s boyish grin, after his walk down the hall to gather his un-gatherable thoughts, we knelt and prayed. We prayed that no illness would transfer from us to her. I knew we were both thinking about mine.

On December 1, 2010, around 3:45 p.m., we meet her. Her lips are a deep rose, her skin a shade lighter than almond, and her eyes a gray hazel. She has been suctioned by the neonatologist and returned to us. Small bubbles form on her bottom lip as she breathes, and her eight pounds and two ounces weigh far less in my arms. Eliot Mae. My God, she is beautiful.

It’s late that night when Paul wheels me through the bland hallways, each bend and corner looking the same as the last. You have to be screened to enter the NICU. I imagine they look for faces of stunned parents.

A nurse leads us to the room and explains everything – the oxygenated globe around her head, the arterial line that measures her saturation levels, the beeping monitor. As she talks, I focus on my baby’s chest. She heaves in and then lets the air stagger out. Retraction. She is fighting already, and none of the medical journals, none of the doctor visits, none of the pills could have prepared us.

Eliot has pneumonia, not SSRI withdrawal. The doctors can’t give a definite cause, but antidepressants never enter the conversation. Instead, words like “aspiration” and “infection” steal the show. We’ll leave the hospital days before she will. We’ll drive home with an empty carseat and stare at an empty bassinet. My Zoloft, even if I don’t like it as much as Paxil, will come in handy.

I imagine that audience from the high-wire act again. Its collective mouth is agape. Folks have paid for one show and seen another. They don’t regret spending the money; they regret having expectations.

In that NICU, Eliot learns to breathe without extra oxygen. My tightrope widens as she responds to antibiotics. And it’s on the fifth day of her life, with a board taped to her arm and a set of wires creeping over a white metal crib, that she smiles. Her eyes are closed, and maybe it’s a gas bubble. Maybe a reflex she can’t control. But maybe those sweet rose lips are responding to a dream that we will take her home and love her and that will be enough. Enough to beat the unknowns. Beat the fear.

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