Every woman wants to be as healthy as possible during pregnancy. We give up alcohol, take up prenatal yoga, remember our vitamins, and try to get enough sleep. We also stop taking most over-the-counter medications, as well as many prescription drugs. For people with chronic health concerns, this can be an incredibly fraught decision. We’re asked to decide: Do we continue with this treatment, even if we aren’t sure what it will do to our fetuses? When I realized I was pregnant, I had to grapple with these decisions. But ultimately, I decided to stay on antidepressants during pregnancy, and I don't regret it.
I’ve come to terms with the fact that my anxiety and panic attacks are a chronic illness. When they started hitting me out of nowhere when I was 23, I'd hoped that it was a one-time fluke, an odd switch in brain chemistry. After a year of therapy, six months of antidepressants, and the occasional anti-anxiety pill, I thought that I was cured. I was back to my “normal” self. So I weaned myself off of antidepressants, because I knew I wanted to try to conceive. I thought I was making the healthiest decisions I could for a baby who didn’t even exist yet.
My first pregnancy was a breeze. I felt really great, both mentally and emotionally. Again, I assumed I was cured. But when postpartum anxiety swept in with a vengeance, I knew I had to get more help. It was so devastating. I’d already been through this, and now I had all new worries and fears because I wasn’t just taking care of me; I was also responsible for a child.
My lowest moment came when I saw a psychiatrist for the first time. I had an HMO and I didn’t have any choice about who to see. The psychiatrist was cold and no-nonsense. She told me that I’d probably have these issues for life. I’d probably need to be on antidepressants for life. At this point, my son was 1 year old. He’d just celebrated his first birthday. I had been suffering in earnest for months, and I was desperate for the help. When I asked about breastfeeding, the doctor asked how old my son was. I told her, and she flippantly told me that he didn’t need to nurse anymore, even though he still relied on breast milk for food, since eating solids hadn’t come quickly to him.
I felt like being on antidepressants made me a better mother.
“You need to make a decision about what’s better for him: continuing to breastfeed, or having a healthy mother," she said. In her view, doing both was not an option.
I did a lot of my own research. I found help by joining online breastfeeding groups and researching medications and breast milk. I learned that many mothers breastfeed and take antidepressants at the same time, because only trace amounts of certain medications are transferred to the baby. So I went back on antidepressants and continued nursing my child. I felt like I was reclaiming the life I had before I had panic attacks, and that being on antidepressants made me a better mother.
Before too long, my husband and I began discussing having another child. We were new homeowners. Our son was 2 and thriving. And I was feeling good — maybe not quite as good as when we’d first conceived our son, but certainly stable and no longer having panic attacks. I had a wonderful new psychiatrist. When I raised concerns about medicating and breastfeeding, she pulled up the research and reassured me that I was on Zoloft, which is considered very safe to take while breastfeeding.
Once I discovered I was pregnant with my second child, I went in for another appointment. I was still anxious about being on medication and being pregnant. My psychiatrist said that if I was nervous, I could try stepping very slowly down off Zoloft. But after stepping down to half a dose, I sort of stalled out. I was more anxious day to day. And I was still experiencing unpleasant withdrawal symptoms. Going completely off of antidepressants was looking impossible.
Medicating throughout pregnancy and nursing wasn’t an easy road, but eventually, I made my peace with it.
My wonderful psychiatrist reassured me it was fine, and that we could go right back up to my full dose as soon as I delivered my baby. Still, I was anxious about it. I’d heard about antidepressants being linked to congenital heart defects. I was also bitterly disappointed that I didn’t feel as stable and vibrant and healthy as I did during my first pregnancy.
But when my daughter was born, I went right back to my full dose, just as we had planned, even though I was nursing a newborn. And with my psychiatrist’s blessing, I took anti-anxiety medication when I had to travel. The worst thing that could happen, she told me, was that my daughter might get a little sleepy.
I realize that the decision to go off antidepressants during pregnancy varies mother to mother. It also depends on numerous factors, including what kind of medication the mother is taking. But I know that it wouldn't have worked for me. I wouldn’t have been as healthy. I wouldn’t have been as good of a mother to my son. Medicating throughout pregnancy and nursing wasn’t an easy road, but eventually, I made my peace with it.
If you struggle with depression during pregnancy or postpartum, please seek professional help or contact Postpartum Support International (PSI) at 1800-944-4773.