This piece previously appeared on ELLE.com.
Six weeks after I went off my medication, the terror at night set in. Not night terrors, which would have required that I had gotten some sleep, but the feeling that I had been given a shot of adrenaline. I would lay down in bed next to my husband, too scared to have sex, too scared even to talk, and I would toss and turn for hours on end. I felt debilitated, defeated, and incredibly alone. One such night, I looked down to see my forearms covered in small red bumps. My skin felt like it was on fire, and I wondered for a brief moment if I could pull it off.
I had been taking Citalopram for ten years when I decided to take a break. At 18, I was diagnosed with Generalized Anxiety Disorder, a constant and persistent sense of worry about everyday things. I think of GAD as inchoate and needy, willing to attach itself to any normal set of circumstances regardless of whether there is actually a threat. I carry a constant pit of worry in my stomach no matter how well things are going or where I am—at the grocery store or at home—like a dark cloud of a companion. I bite my nails until it hurts, and then I bite some more. If I had been born 70 years earlier, I would have been called a worrier and medicated myself with alcohol or been debilitated by constant fear. Instead, I have had another constant companion: An oblong pink pill that I have swallowed every morning for a decade.
As a religious person, I liked what the theologian Lewis Smedes says in his memoir about faith, My God and I: “God also comes to me each morning and offers me a 20 milligram capsule of Prozac. He clears the garbage that accumulates in the canals of my brain and gives me a chance to get a fresh morning start. I swallow every capsule with gratitude to God.” And I did that every morning, unhesitatingly, an afterthought between going to the bathroom and brushing my teeth, until I decided not to.
When my husband and I began to think about having a kid, I was faced with a choice: Stay on the drugs, possibly hurt the unborn baby, but remain relatively calm; or go off the drugs, reduce the risk to the baby, but potentially become a prisoner of my own anxiety.
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Pregnancy advice can sometimes feel like a barrage of conflicting information. Eat lots of protein; but avoid cold cuts, unpasteurized cheese, or seafood with too much mercury. Get lots of rest, but also exercise. Make sure you’re all set up for the seismic shift of parenthood, but don’t stress!
When it comes to taking medication and pregnancy, the advice is not much clearer. The most common type of anti-anxiety or antidepressant medications is an SSRI, or Selective Serotonin Reuptake Inhibitor—a drug that increases the levels of a neurotransmitter that has to do with the feeling of wellbeing. Citalopram is one such SSRI; Paroxetine (Paxil), Sertraline (Zoloft), and Fluoxetine (Prozac) are some common others. The research about SSRI use during pregnancy is inconclusive at best. A 2009 study of children born in Denmark found that babies whose mothers took SSRIs were no more likely than their unmedicated counterparts to suffer “major malformations,” but they were slightly more likely to be born with a septal heart defect—a hole in the wall that separates the heart’s upper or lower chambers. Often this defect heals on its own, but if it doesn’t, it can require medication or surgery. It can lead to pulmonary hypertension; a stroke; death. These are unlikely situations but these are also real risks.
Needless to say, it’s difficult to do a controlled study when the subjects are pregnant women and babies. When I looked for specific information on Citalopram, I found similarly confusing information. From everydayhealth.com, “Citalopram may cause problems in newborns following delivery if it is taken during the last months of pregnancy.” From the Massachusetts General Hospital Center for Women’s Health: “There is also one report on the safety of Celexa (citalopram), indicating no increased risk of major malformation in exposed children.” I felt stuck, and so I did what so many forces in our culture instruct women to do and I put the child—even the not-yet-conceived child—first.
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There were days during my drug-free spell when I felt happy, cheerful, myself. I still did all the things my therapists have recommended I do, I do: I exercised regularly; I talked to my support network; I occasionally journaled. No one who knew me would have said they couldn’t recognize me.
The author and her husband
But in addition to the terrors at night and the strange skin rash and the nail-biting and the shortness of breath, I also felt the normal pressures any person considering a child would feel. I was anxious about the effect a child would have on my career, my marriage, my body, and my time. I was consciously contemplating the uncertainty of my future, which is both a symptom of and cause for anxiety. My family and my husband were concerned for my well-being. “You know I support you whatever you choose to do,” my husband said. “But I wonder if being off the medication is the best choice.”
I made an appointment with my family doctor and talked with a longtime family friend who happened to be a psychologist. My own doctor was somewhat reassuring about my ability to stay on meds while I was pregnant. She asked me to make an appointment with an OB-GYN and ask them which SSRI I should be taking. “Maybe if you lived in Hawaii with no stresses at all, you could have gone off the medication and everything would have been fine,” our family friend said. An island in Hawaii sounded nice. “But short of that, this sounds like a neurochemical issue to me.”
“YOU KNOW I SUPPORT YOU WHATEVER YOU CHOOSE TO DO,” MY HUSBAND SAID. “BUT I WONDER IF BEING OFF THE MEDICATION IS THE BEST CHOICE.”
Seven weeks after going off, I resolved to start back on the Citalopram. I told myself that it would be less risky to take something during pregnancy than to grow a fetus steeped in cortisol and adrenaline. My husband and I are putting off trying for a while to allow my neurochemistry to recalibrate.
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Anxiety will always be a part of my life. I have come to accept its presence and think of it at times like a companion or a teacher. It gives me the gift of empathy—I am more open to the beauty that can be wrought from pain, both in myself and in other people, because of my anxiety—and because my natural state is close to fight or flight, I am always prepared in a crisis. I remind myself often that if I didn’t struggle with anxiety, I would struggle with something else. I’ve learned not to work to unburden myself of difficult things, but to take those things and hold them up to the light, understand them, and, if I’m lucky, learn something from them.
Our society treats medicine as the cure for what ails us—which, of course, it often is. Still, control is never guaranteed, even as I return to my routine of swallowing the small pink pill every morning. This has been a useful lesson to internalize as I contemplate having children. Because there is no control when it comes to having a child, at least not in a meaningful sense. I could try for years and never get pregnant. I could go to hypnotherapy and have a natural birth and paint the baby’s room in peaceful pastels and play it Haydn ten hours a day. Still, there is no guarantee that I will not pass my anxious mind onto the child I hope to have. The illusion of control comes to us in many forms.
