It was always my intention to come off of antidepressants before I got pregnant. Over the years, as I grew closer to wanting to start a family, the frightening headlines linking antidepressant use during pregnancy to any number of undesirable outcomes convinced me and my husband that continuing my use of Paxil while pregnant was out of the question.
My struggle with depression, generalized anxiety and OCD began very young, and the pharmacological interventions began around age 16. In hindsight, there are many things I wish my parents and I had done differently, but the services weren’t readily available and the open dialogue about mental health was only just beginning.
Twice after my husband and I married in 2009, I tried to come off of my SSRI (selective serotonin reuptake inhibitor) with the view of getting pregnant. I made a lot of mistakes and assumptions about what would happen as I reduced my dose, and my biggest regret is that I didn’t ever get the right therapy to give me the coping skills I would need once my reduced medication left me vulnerable. Both attempts at coming off my meds were unmitigated disasters. I ended up on a higher dose than before. The year 2011 was an excruciating existence. My anxiety became debilitating. Being in my head at this time was hell. If you’ve never suffered from clinical anxiety (not just a bad case of nerves before an exam), it’s like your body, both mentally and physically, is constantly in a heightened state of alert. You know that feeling when you notice a pedestrian at the very last second and slam on the brakes, narrowly avoiding a bad accident?
You know how your heart is pounding, your mind is racing, your palms are sweaty, your stomach turns? That was how I felt unless I was asleep, except there was never an actual threat. Beyond the mental anguish, my body responds to my anxiety with disastrous digestive difficulties (I spend a lot of time in the bathroom), a total lack of appetite, and naturally severe weight loss. I have a hard time making even the simplest of decisions, and social situations are horrific. I cried every day for almost a year. Feeling this way for so long led me to have suicidal thoughts.
I got better thanks to a combination of returning to medication and finding the right therapy. (I’ll save that for another post, but Exposure Response Prevention was my golden ticket to conquering my anxiety and OCD.)
So at the end of 2011, when I got pregnant with Cub, I would say that I had been well for just shy of four months. My psychiatrist had essentially assured me that the one suspected side effect of Paxil, a heart defect, was not a huge concern. Essentially, even if my child were born with the heart defect, it was fixable. After our two experiences trying to get me off of my meds, my husband and I agreed we were not prepared to try it a third time. We wanted to start our family!
When I found out I was pregnant, I still felt a great deal of guilt about not having been able to come off of my medication. When I told my obstetrician at our first visit about my Paxil, she pulled some strings to get me in with a psychiatrist at the Maternal-Child Health Centre.
This psychiatrist helped me and my husband understand the current research on using Paxil during pregnancy, and she also helped me to understand that the risks of being off of my SSRI and in the very dark place I described above were much greater for my child than being on my medication. The same applied to breastfeeding. The benefits of breastfeeding outweighed the consequences of passing some of the medication to my child. In fact, there is so little concern about Paxil in breastmilk that I am approved as a milk donor.
My Maternal Health Psychiatrist helped put the heart defect warning into perspective. She explained that although you would read alarmist headlines like “Paxil Doubles Risk of Heart Defects,” the true numbers on paper are not so scary. For every 100 births, 1 baby is typically born with the heart defect. In a small group of pregnant mothers studied, 2 babies were born with that defect to mothers taking the drug. My psychiatrist told me that the study that sparked the headlines and the warning from Paxil’s manufacturer was based on a small study that was not peer reviewed. You can read more about it on the Mother Risk website.
She explained that the biggest concern for a baby born to a mother taking Paxil would be withdrawal symptoms after birth. In Montreal, Cub was born in hospital and I don’t recall any particular measures that were taken to check him for withdrawal symptoms. He was completely healthy and normal. I had hoped to give birth at home in Calgary with Little Miss Cub, but when my midwife consulted an OB about my Paxil dose, the OB would not approve me for a home birth because she wanted to be sure the baby was monitored in hospital for any withdrawal symptoms. The nurses discontinued their withdrawal-symptom checklist very quickly as there were no abnormalities detected. (For example, they were measuring Little Miss’s blood sugar levels.)
I’m finally getting around to writing this blog post because of a recent news story that made the rounds about antidepressant usage during pregnancy being linked to autism.
It’s hard to ignore headlines like that, and with social media, it’s really easy to just read a few lines and start panicking. I know I would’ve been freaking out about a headline like that during the time I was trying to get pregnant. Obviously, we need to be very careful about getting our health information from mainstream media, whose prerogative is selling copies and ad space. I wish every future Mama taking an SSRI or other medication linked to her mental health (and her partner) could sit down with a specialist to help her truly weigh the risks and benefits of taking her medication during pregnancy.
I didn’t think twice about continuing my SSRI dose during my second pregnancy. I know that being well mentally and emotionally is directly linked to my physical health, and thanks to genetics and the chemical imbalance in my brain, taking Paxil keeps me well.
I do want to try again one day to come off my antidepressants. With a young family to take care of, the psychiatrist I saw in Montreal during and after my pregnancy with Cub was adamant that I not play with fire. We did reduce my dose after Cub was born since I was doing so well, and it has remained stable at 60 mg since September 2012. I have had almost no episodes of anxiety since then, and my coping skills have helped me through any (very minor) rough patches.
Until I met with my maternal health psychiatrist, I felt guilty about putting my baby at risk by taking Paxil. When I understood the benefits of MY well being on my unborn baby, I understood that I was doing the right thing. Antidepressants are not Thalidomide.
One of my goals for 2016 is to write a lot more about mental health. No taboos, no secrets, no shame. I spent many years hiding my mental health issues from everyone except my immediate family, and this only made it worse.
If you are struggling, Mama, reach out and seek help. You are not alone.