Pregnant with her second child, Anna Blackmon Moore had to make a hard decision: stay on her meds or go off?
Talk about a shit sandwich.
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Five Star Friday's Edition #84
15 hours ago
Tuesday, December 23, 2008
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35 comments:
Excellent, excellent article. Thank you for publishing it. This really nails it on the head:
"The medical community should direct and inform my taking of them as much as it is able to, but for now I have to keep my expectations of their knowledge and especially their support fairly low."
We may not know (or ever know) the long-term effects of SSRIs on children, but we sure know the effects of depression on moms and families, and they are no good.
This was one of the least worthwhile articles I have ever read. Your psychiatrist is a trained professional and a doctor, not someone who needs to give into your fantastical whims and hopes about Prozac being okay for your baby because you need it. Even patients with diabetes are discouraged from just getting pregnant without planning. It's not discrimination, my dear, it's common sense, like making sure a pregnant woman is not smoking cigarettes or around second hand smoke during pregnancy.
This sounds harsh and I apologize for it, but you should have put two and two together. I hope your baby is healthy. But why should healthcare professionals be supportive of people who don't plan and are careless because of their ignorance. How could you possibly be more important than the baby?
This is a wonderful article about a very difficult situation. Kudos to the author for sharing her struggle!
Btw, I found Lindsay's comment to be downright offensive. Talk about ignorance...
How accurately you have captured the struggles of motherhood and depression. I had a very difficult pregnancy and if I had gone off my SSRI, I really don't think I could have survived. My doctor was extremely supportive and recognized that my health was mental health was vital to the overall health of my child.
My daughter is now a healthy, happy five year old. There were no withdrawal symptoms when she was a newborn. I was and remain fully engaged with her. I do not believe that this would be possible had I chosen to go off my meds.
Shame on those who criticize us for ignoring the medical community. That community deals in the theorheticals and tries to cover its ass wherever possible. Diabetics would never be discouraged from taking their pills or injections. The stigma of our disease is harsh and insidious. The medical community perpetuates this when it suggests that our health is secondary to that of our unborn child. I applaud those mothers, like the author, who make informed choices that will benefit all concerned in the long run.
Great article! I am dumbfounded not only at the way your psychiatrist reacted but at Lindsay's comment as well. My experience was so much different! When I had my now five year old son, I was not on antidepressants because I had lost my health insurance. It seemed logical not to go back on them. I would never do anything to harm my babies whether they were on the outside or inside, but my pregnancy with my son was an emotional roller coaster. I remember lying on my apartment floor and crying for hours. As soon as my son was born I went back on Zoloft. In 2007 when I got pregnant with my daughter, I thought much differently. My OBGYN and my very accomodating psychiatrist sent me to a psychiatrist who specialized in prenatal/post natal care in women with depression. She along with every other doctor that I saw encouraged me to also consider the risk to the baby if I did not take medication. The prenatal psych stressed how low the risks of taking Prozac were; neither of my children had them. I took twenty milligrams of Prozac every day and delivered a very health ten pound baby girl who is now 16 months and still thriving.
Unlike cigarettes or coffee, an antidepressant is vital and necessary for keeping the mother healthy and alive. In order to bring a baby into the world it would be helpful if she was both. Mothers and children are equally important. If we don't take care of ourselves we can't take care of them. You put your own oxygen mask on first when the plane goes down!
Thanks for sharing your experience, it was great to hear your story.
I just emailed this article to my therapist. While I did not experience the exact mental health issues discussed in the article, it goes a long way in describing what many women deal with in a very honest and true way. Again, thank you Brain, Child for being the one oustanding place for thoughtful parents.
I went off Prozac when I started trying to conceive at the advice of my doctor. It sucked, but my feeling was basically that when I decided to get pregnant, my needs and feelings were no longer that important and I needed to do what was best for my babies (I ended up pregnant with twins). So I made the best of it for nine months of pregnancy and then a year of breast feeding. I was sad and miserable much of that first year, but they have no memory of that time so it didn't hurt them. And by the time I stopped nursing, I no longer wanted to go back on the Prozac. So - in summary - when you have kids you need to suck it up and sacrifice for them, because it's not all about you anymore. If you can't deal with that, don't get pregnant.
I didn't want to stop reading this article, even as my kids tugged the magazine away from me. I found the author's description of depression (...a cavernous sense of negativity....") and associated maternal guilt to be dead on accurate.
Moore's essay rings true and is therefore informative and touching - and necessarily controversial. Thanks for provoking.
Kudos to you for realizing the importance of researching this and for sharing the information with all of us via Brain, child.
**Lindsay, your comment is really appalling - condescending, uninformed and judgemental! I am surprised that someone with your perspective reads this mag.
This is an absolutely vital article.
Not only do women who have major depression struggle with the issue of medication, so do women with bi-polar disorder, schizophrenia, and other serious mental illnesses.
The sad fact is many doctors, including psychiatrists are ignorant to the real issues of living with a mental illness. They talk well, they hand out pills well, but they don't know the struggles. The other sad fact is many psych's jam their schedules so full, it's impossible for them to even remember their patients' names.
Lindsay's comment is the result of the stigma attached to mental illness. She, as do many others, believes that somehow mental illness in general, depression in particular, are controllable. "If only you'd snap out of it, all would be o.k. and you wouldn't need those nasty drugs."
I've bookmarked this article to share with others. Thank you for sharing.
You know I had a different experience with my ob/gyn. I had been on an antidepressant before and after the birth of my twins, so when I found out I was pregnant again when the twins were only 4 months old, my doctor advised me that the Prozac I was on could be used whenever I needed it and to just let her know. She was very understanding and went on to say that if you need the medicine and begin to have symptoms then it is best for the mother to take the medicine. The side effects are minimal to the baby. Being a master level clinical social worker who has worked in mental health centers I know this to be true as well. Please don't make any assumptions about anything as the first commenter did, she obviously has little compassion and or knowledge of the subject matter. It does not have to be that way. For the record the pregnancy after the twins I started very soon into the pregnancy and I do not regret it...
1st of all, thank you so much for sharing your life with us.
I am not diagnosed as being in depression but i know that i stand on the brim of it - i know i was depression when i was in my early 20s but never went to a doctor & i know now again that it's likely i am depressed but again i fear to face it - your article has given courage to seek help.
2nd, i think Lindsay's comments are appalling & i would ask if Lindsay suffers from mental illness or not - if not, she really does not know what she is talking about. Just like telling a cancer patient, "i understand your pain" but we can't really understand that sort of pain till we have been true it - if this is true of physical pain, what more emtional pain?
3rd, i fully agree with you that a child whether still in the womb or already born - they all need fully functioning mothers who are there for them, to love them, teach them, care for them. Children do suffer if their mothers are not up to par - i would never say this before having had my little boy - but now that i'm a mum i understand the need to care for self as much as your family. i know friends whose mothers are less present than they should be & they have grown up with a slightly strange idea of love & caring for others.
4th, i encourage you to continuing doing what you have been doing - the best that you can.
God Bless you & your family.
Have you considered the possibility that your depression is a "learned behavior" from your mother?
Also, in my view, there is something wrong when 65 percent of a nation (USA) now takes a drug available only by prescription. Aggressive marketing has turned what were once normal life events into maladies that can be treated with a pill. Therefore,
I am much more weary of the drug industry today than the medical profession.
I too feel all those frustrations, irritations, despair of parenting but it seems to me that a lot of it is part of life and these things represent challenges to us as parents, spouses, friends, colleagues, managers, etc.
Luckily, I have not had to deal with taking meds while in pregnancy. But I do think it is interesting that after my C-section with my first, I could take all the pain killers I wanted while nursing.
Also, maybe if we really knew the truth about all the OTHER toxins that we all give to our babies as a result of living here on planet Earth (and definitely in the ole' USA) we wouldn't be so upset over meds. (When I say we I think I mean society in whole).
Lindsay says, "How could you possibly be more important than your baby?". She's not, but she is equally as important as her baby, and her health directly affects her baby's health. Woman are not simply vessels but living human beings who need to be taken care of appropriately. And, anonymous's comments have merit for the overall population, but not for the unfortunate portion who have serious, chronic and debilitating mental illness.
This was an incredibly well-written article and I applaud the author for sharing her story.
What a great article. I applaud your honesty!
I did not have depression during my pregnancy but my husband has been struggling for years. I thought your comment about how doctors worry only about "the safety of the baby in my body but forgot entirely about the needs of the one already here" hit the nail on the head.
Thanks for sharing, I learned a lot.
fantastic article. i also did not want to stop reading. i very much appreciate the descriptive honesty and research that provided such details. having experience with mental illness and diabetes, i must admit, i would also give more contemplation prior to getting pregnant. i personally would not allow myself to accidently get pregnant and if, of course, it happened anyway, then yes, i would do similar things that the author did: much homework, professional consultation and weigh the risks to the unborn child and make a decision with my spouse.
very difficult decisions. thank you so much for sharing.
fantastic article. i also did not want to stop reading. i very much appreciate the descriptive honesty and research that provided such details. having experience with mental illness and diabetes, i must admit, i would also give more contemplation prior to getting pregnant. i personally would not allow myself to accidently get pregnant and if, of course, it happened anyway, then yes, i would do similar things that the author did: much homework, professional consultation and weigh the risks to the unborn child and make a decision with my spouse.
very difficult decisions. thank you so much for sharing.
fantastic article. i also did not want to stop reading. i very much appreciate the descriptive honesty and research that provided such details. having experience with mental illness and diabetes, i must admit, i would also give more contemplation prior to getting pregnant. i personally would not allow myself to accidently get pregnant and if, of course, it happened anyway, then yes, i would do similar things that the author did: much homework, professional consultation and weigh the risks to the unborn child and make a decision with my spouse.
very difficult decisions. thank you so much for sharing.
Don’t you think it's important to ask difficult questions when considering children? Other readers may not like the comments or questions but still much needed information to think about including Lindsey’s comments. If the writer is in so much pain/turmoil on such a constant/daily basis why add kids to the mix?? I mean it's hard enough to raise children without pulling out my hair, their hair, yelling or staying sane, I just couldn't imagine doing it with a mental illness. I would not get pregnant. Wouldn’t it be great if everyone did as much contemplation prior to getting pregnant?? And please insulin for a diabetic and antidepressants are not even comparable - sorry.
Some more information to add to the debate; anyone ever read that article from Mother Jones “Is it Prozac? Or Placebo?” by Gary Greenberg? Very interesting. http://www.motherjones.com/news/feature/2003/11/ma_565_01.html
I thought this was a wonderful and honest piece. I appreciated reading it.
The author asked her doctor: "But isn’t there any evidence that a depressed mother can also be harmful to her fetus?" A Canadian psychiatrist has written a book to that effect that some might find useful. It's called Pregnancy Blues: What Every Woman Needs to Know about Depression During Pregnancy by Shaila Misri.
For what it's worth -- I had a negative experience of my own with a psychiatrist influenced by Dr. Misri. Suffering from a mild depression while pregnant, I felt greatly pressured by the psychiatrist to start antidepressants for the first time in my life because she implied 1.) that my depression while pregnant was already harming my baby in utero; and 2.) that left untreated my depression had basically no chance of improving after the baby was born and that it would likely only get worse so I should start treating it now. Like the author of this article, I "walked out" of that psychiatrist's office by never returning & decided that in my case my depression did not warrant the medication. Just as pregnant women who need to take antidepressants need support from their health professionals, so too do women for whom anti-depressants might not be the best or necessary solution.
The variety of comments on this article point to a central difficulty in talking about this problem: many people disagree about whether mental illness is in fact an "illness."
A few years ago, when I was first considering taking Prozac, I agonized over the choice. I told a friend that I wished there was a test the doctors could give me to determine whether my anxiety was actually a disease or something I should just "get over." There are symptoms of depression, anxiety, and so on, and some cases clearly need immediate intervention. But some readers read about Moore's symptoms and feel that it's nothing worse than their worst day. Since they manage without medication (whatever "manage" means), Moore should also.
In my case, Prozac was the right choice. And when I was ready to become pregnant again, I could discontinue without a crisis. But some people can't. And just because we can't run a test for mental illness doesn't mean that it's not real, that it's not harmful.
I was not on Prozac when pregnant with my daughter in 1997. However, all the signs and symptoms were there. Post delivery, I experienced a very deep Postpartum depression which spiraled untreated for more than three years. My daughter spent her Infancy and Toddlerhood in the presence of a Mom who "looked" like she was attentive - but who was high functioning enough to pass. My daughter was failure to thrive - which should have been a giant red flag - But with a Mom who had a MS in Child Development and a Dad with a PhD in Education - a VERY planned child of two professionals, our doctors were willing to overlook MY role in Emily's issues and look to her for organic deficiencies.
My Therapist - who honestly saved my life, and most likely at least the life of my child - told me straight up that I would NEVER be off of Prozac. She, in consultation with my midwife and GP all agreed that I was not going to be a woman who could be off medication - that a second post partum episode would be wholly more damaging to my first child - my potential second child and Me.
While I had a very good medical team who worked together to manage my health issues, it has never failed to amaze me that mental health issues are still regarded as a fundamental weakness of character. I, like the author, have a deep familial history of mental illness in all branches of my family tree. Does this mean I should have ruled out having children - ruled out having a fulfilling family life because I'm "Infected" with the crazy?
No one ever says to a diabetic that if they just tried REALLY HARD that they would start producing insulin - you know, think good happy thoughts toward their pancreas to make it kick in... It is the same with people who manage a chronic health condition such as mental health issues.
Additionally, the idea that one has to "trust" a medical person because they hold the title of Doctor is Laughable in 2009. I have "broken up" with a number of doctors or therapists because they weren't listening to me. At age 38 - I know my body. I know what is going on. I will not be ignored by someone who is supposedly there to help me. The last therapist I broke up with suggested that maybe I wean off the Prozac. I know INTRINSICALLY that my depression and anxiety are not Phases that I pass through.
Finally, A Mother who is all sacrificing is an ideal which began in the 1800's. It traps women into a ridiculous box of self sacrifice which is unhealthy, unnecessary and wildly dangerous.
Women don't need other women to help them feel worse about the difficult decisions around motherhood. However, all too often it is the Cult of Motherhood who is the first to ride in with judgments about what is Right and Good for everyone.
When I was pregnant 6 years ago I was on a low dose of zoloft (50mg). Every doc I consulted with told me that it was fine, I could keep taking it, not to worry.
My daughter was delivered 4 weeks early due to my pre-eclampsia / HELP syndrome. Her Apgar score was 9/9. However, a few minutes later she blew holes in both her lungs and spent the next week on a respirator in the NICU.
Luckily she is fine now. No one ever explained why this happened, it seemed to be a mystery to all the docs.
However, last year I read in the NY Times and several other sources that these days docs advise against zoloft during pregnancy - that it has been shown to cause severe lung problems, and even death, in newborns.
Depression is not a bad mood, or having a bad day. It is not something you can talk yourself out of. A silly movie or a good laugh with friends won't fix it. Only people who have suffered with depression understand that it is like being trapped inside this other mind. I remember before being treated I couldn't stand being around my own children. I asked my husband not to leave me alone with them. With medication I can now look back at that poor woman and thank God that my children no longer have to deal with her. Now they have their real Mommy back. Thanks for the article!
I think part of the problem in taking depression seriously as a mental illness by some is that often the same symptoms of the illness characterize those who have not learned healthy coping skills to a lesser degree. It seems to me that the line is blurred a bit; and only easy to identify at the extremes of one side or the other.
Using diabetes as an example, not all diabetics need medical applications of insulin. Some have their disease controlled by their life choices on a daily basis.
I say this, having suffered bouts of serious depression off and on and living with someone who should have been on medication. I watched them suffer endlessly. For myself, my depression is more controllable by daily choices (sunlight, eating right, exercise).
When people see that you can make a choice that doesn't involve a drug that changes your illness, they often discount the illness exists at all.
I have dysthymia and I've had four episodes of major clinical depression. That means I have a 97% chance of having another time in my life where all I can do is lie on the couch and have fantasies about cutting myself out of my depression. It's terrible when you know you're depressed, and yet are powerless in spite of that knowledge.
I remember the first time I was placed on antidepressants. I was a junior in college, and my mother had come to visit me. I would wake myself up by crying in my sleep. My mother put me in the car and drove me 4 hours to her psychiatrist. I remember in the interview, the psychiatrist asked my mother, "Is she always like this?" And my mother replied, "Pretty much, yes."
I had no expectations of what an antidepressant would do. What it did do was almost indescribable. Perhaps a metaphor is best. When I was 8, someone figured out that I was extremely nearsighted. We went to town to buy glasses, and it was late at night when we got back to the house. I remember looking up, and seeing the stars for the first time. Feeling happy for the first time in my life was like that night, of looking up, and realizing that what other people saw was beautiful and fantastic. I had no idea that other people felt like this. No wonder they could easily be with each other!
About a decade later, I looked at my dearly beloved husband and said, "Honey, if we want to have kids, now is the time to do it. My eggs are aging even as we speak."
I thought long and hard about antidepressants while I was pregnant. I even set up a therapeutic team for after my daughter's birth: a therapist who would be familiar with my situation, a psychiatrist on call, a psychologist with admitting privileges. I did intensive research on antidepressants during pregnancy and during breastfeeding. Did you know that there are actually more drugs passed through the breastmilk than the placenta? I even calculated the percentage of Effexor that would pass through the placenta and through breastmilk. (7.5% of my daily dose through breastmilk, if you're interested.)
I am reassured that I did the right thing by continuing Effexor while I was pregnant. At 15 months, my daughter has shown no ill effects. I am here for her, happy (by my standards) and ready to be silly with her, and change her diaper, and read books to her. Those critical first three years, I am here for her. Maybe, just maybe she will be the one to break the cycle of depression in my family.
My greatgrandmother, my grandmother, and my mother all had severe post-partum depression. My greatgrandmother and my grandmother were both hospitalized, it was so severe. My mother probably should have been. She recently recounted to me how she would lay in bed and cry with me all day the winter I was born. (Read Why Love Matters for more on why maternal depression during early childhood is bad.)
Hopefully, if I'm here for my daughter, she will not suffer this devastating illness.
a type 1 diabetic does not have the same choices. it is very black and white. if you do not take insulin, you will die.
i like the camparison between a type 2 diabetic and depression. totally curable depending on your choices. the 'prozac or placebo' article i just read clearly outlines that antidepresents are not statistically significant. what great news to those of you wanting your cake and eating it too. now you can get pregnant, take a placebo and have no side effects. i'm not being sarcastic, i'm serious, it's a win win for everyone. how wonderful!
why does our culture suffer from postpartum depression (and other disorders for that fact) that other cultures do not?
knowing this, i worked extra hard at beating mine. it took time, amoung other things but it happened - with no drugs!!
Children Seriously Affected When Parent Suffers From Depression
ScienceDaily (Mar. 6, 2009) — Life is hard for the children of a parent suffering from depression. Children take on an enormous amount of responsibility for the ill parent and for other family members. It is therefore important for the health services to be aware of this and have support functions in place for the whole family, and not just for the person who is ill.
http://gupea.ub.gu.se/dspace/handle/2077/19047
Thank you. We are not alone.
Amazing article. I think people need to keep in mind that everyone experiences varying degrees of depression. While some may be able to endure pregnancy without meds, there are those who absolutely should remain on their medications. It is important for Dr's to explain the risks and make sure that mother's understand the risks but it is equally important for Dr's to HEAR/LISTEN to their patient's. As mentioned in previous posts, noone WANTS to be on meds while pregnant. Depression is a very serious condition and should not be treated lightly. Anyone who feels a mother is "selfish" to remain on their meds while pregnant does not understand pregnancy. A mother's health is of upmost importance. This comes from an R.N. who has witnessed the emotional turmoil of many mothers. Take care of yourselves.
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