It’s always seemed to me there’s something about having babies that drives women insane. Not insane in the colloquial sense of “frustrated” or “really pissed off,” insane as in certifiably, googly-eyed, talking-to-oneself-on-public-transit, insane. Maybe it’s hormonal. Maybe it’s the chronic sleep deprivation. Maybe it’s the crushing anxiety of being responsible for every aspect of another human being’s health and happiness. Maybe it’s the pressure society puts on mothers to be perfect and utterly beyond reproach, the sun around which their children’s universe revolves. Or maybe it’s my imagination – the fact that I’ve been struggling with depression and anxiety for most of my life and have always wondered how the transition into motherhood might alter the delicate mental balance I’ve worked so hard to achieve.
Whatever the cause, when I became pregnant this past December, I was just as afraid of losing my sanity as I was of losing my lunch, largely because I assumed I would have to go off of the anti-depressant I’d been taking since the age of nineteen. I did remember reading somewhere that this was not neccessarily the case, that some women were able to continue on their medication throughout pregnancy. But somehow this piece of information didn’t jibe with the general tenor of hysteria that seemed to be surrounding pregnancy and all things chemical: anyone who’s been pregnant recently knows that every substance an expectant mother could possibly put inside her body from pain-relievers to Camembert is subject to scrutiny, so if imported cheese and over-the-counter pain relievers were now off limits, how could selective serotonin reuptake inhibitors (the name alone sounds as baby-safe as Drano) be innocuous to my fetus’s tender neurons? I didn’t know, but I needed to find out as soon as possible.
For me, anti-depressants have never been the “happy pill” some of my well-meaning but pharmo-phobic friends have made them out to be. More like a coping pill, it’s helped me to deal with my mood-swings and anxiety rather than buckling under them, helped me to maintain my status as a (more or less) normal person. This personal history, coupled with a family history of postpartum depression, didn’t seem to bode well for my quality of life prospects should I go off my meds, particularly in the midst of a hormonal roller-coaster and massive life-change. On the other hand, I wasn’t thrilled about the prospect of medicating my unborn child. After all, despite having inherited its genetic material from two writers who knew the inside of a therapist’s office before mastering multiplication tables, surely the little one had some small chance at a healthy psyche if we just left its brain alone.
Most anti-depressants, particularly the most commonly-prescribed variety, SSRI’s, are considered Category B drugs, meaning that, while animal studies show no risk, there have been no studies conducted on pregnant women. This seemed much less ominous than, say, Category X drugs, which sound as if they should come with a skull and crossbones on the label. There are probably many women who would have been relieved by this piece of information and not given the issue another thought. Unfortunately, I’m not one of those women. I immediately began picturing my infant with bloodshot eyes and a bad case of the shakes. I envisioned a memoir written thirty years in the future that began, “My first encounter with psycho-pharmaceuticals began just minutes after conception.”
I was somehow able to hold off on a decision until meeting with my OB, Dr. Cowett, but in the meantime, I prepared myself for the possibility that there might be no choice but to let my mental health go the way of my waistline. Oddly, this wasn’t what Dr. Cowett recommended at all. At our first appointment, she explained that, despite the lack of controlled studies, thousands of women continued taking anti-depressants during pregnancy and, at least so far, there wasn’t any indication that this caused harm to the baby. On the other hand, she pointed out, we do know that depression and stress during pregnancy as well as postpartum depression can have numerous undesirable consequences. Some studies show their may be a link between maternal depression and low birth weight, and a lot of attention has been paid to attachment disorders in the newborns of depressed mothers.
This seemed logical enough, and yet at the same time my doctor was reassuring me, my friend’s obstetrician at the hospital across town was strongly urging her to stop the very same medication. His evaluation of the issue was as straightforward as it was unsettling: “Unless you’re going to be crying in your bedroom all the time, unless you’re going to be catatonic, I don’t think it’s worth the risk.”
This type of contradictory advice sometimes seems the norm when it comes to opinions on what pregnant women put into their bodies. The thing that makes the decision of whether or not to stay on anti-depressants different from the decision of whether or not to eat that spicy tuna roll or pop some Advil when the little one tries to put on a puppet show with your round ligaments, is that depression maintains a stubborn stigma of being not quite real. Even knowing how much better I’m able to take care of myself, not to mention my loved ones, with the help of medication, even having absolutely no Puritanical qualms when it comes to taking advantage of modern medicine (I’m six months pregnant and already have an epidural on ice), there have still been more than a few moments when I wonder: how much could this little pill really be helping? Is it really not possible to get through a bumpy plane ride or a stressful family outing without the help of my friends at Pfizer?
It’s become rather easy for mothers to lose sight of the fact that their health and that of the fetus are, for better or worse, intertwined. And if I, who have had so much first-hand experience with depression still, at times, feel incredulous toward the disease, is it really surprising that some obstetricians are downright disbelieving, that like my friend’s doctor, they’d still characterize depression in the belittling terms of “crying in your room all day?” When I made this observation to Dr. Cowett at our next appointment, she was in complete agreement. “Believe me,” she said. “The medical community is not immune to bias about mental illness.” And more often that not, she confided, the decision to continue or discontinue a course of anti-depressants was often made before she came on the scene. “We’ve had a lot of success in identifying medicines that cause birth defects and warning women to stay away from them. Many women, as soon as they find out they’re pregnant, stop medications they don’t necessarily need to stop, or sometimes that they should not stop. This happens all the time with anti-depressants, but also with things like blood pressure medicine. I wonder if we haven’t gone too far.”
The roster of potential dangers to a tot not-yet-born has become so lengthy that it’s become rather easy for mothers to lose sight of the fact that their health and that of the fetus are, for better or worse, intertwined. It’s true that I have no way of knowing for sure the subtle ways in which my medication might be affecting my baby’s development. But then again, I don’t know what effect opening the floodgates of Cortisol and a stress hormone cocktail would have either. What I do know is that I have both friends and relatives who really couldn’t enjoy much of their pregnancy because of depression and who often struggled with the condition postpartum – my own mother claims to have wept for a week after I was born. I know this is not how I want to welcome my baby into the world. So – uncertainty it is. The silver lining seems to be that, with so many women talking openly about depression, the struggle to balance my own well-being with that of my baby’s hasn’t been a terribly lonely one. Perhaps it’s this sense of camraderie as much as anything else that keeps me from going googly-eyed while I wait for everything in my life to change.