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.
***
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.
***
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.
***
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.
Thank you so, so much for writing this.
Thank you for writing this. We’re tossing the idea around of conceiving and I worry that my currently mild anxiety that I can handle with a PRN will spiral, and I’ll just have to live with that spiral.
I’m currently pregnant and also taking an SSRI. I felt like a MONSTER when my midwife mentioned that my baby will be monitored after birth for “withdrawal symptoms” but I know I am doing the right thing, both for myself and for my kid. I’m certain that gestating in the body of a person off her head with depression is not good for fetal development.
Or if I’m honest, I’m 95% certain, 5% beating myself up and convinced I’m dooming my child forever. But hey! If I weren’t on the meds, it’d be more like 5% certain, 95% beating myself up!
Pregnancy hormones mess with your head enough on their own without adding untreated depression/anxiety to the mix. You are absolutely doing the right thing!
Thanks. My mantra (and I am joking, but I mean absolutely no disrespect to mothers who struggle with other kinds of drug addiction) is “at least I don’t do crack”.
Well, and remember all that panic about “crack babies”? It turns out that, when the statistics corrected for the negative effects of poverty, those children did just as well as anyone else. Babies are resilient.
tangent, but when the statistics are corrected for the negative effects of poverty is a HUGE aside, esp in the US, land of find-your-own-bootstraps
When I was in midwifery school, my wisest mentor once told me, “there is a 5% chance something will go wrong in a given pregnancy. So you tell your patients they are allowed to worry 5% of the time about a bad outcome, and then they need to get on with their lives and do what needs doing.”
So… Sounds like you’ve got the right balance!
Eyy! Thank you, fluoxetine!
HUGE props to you for doing what you need to stay healthy. Babies can withdraw off of caffeine, or a whole host of other things. And as a foster mom who currently has a 10 month old who was born with some Serious Withdrawal Issues, he is absolutely perfect now. Babies are so resilient, and being able to provide love and attachment and those kinds of things is so much more beneficial than “never ingested anything remotely harmful in any way.”
this is all so beautifully written, but i especially love that last segment about control. (it hits pretty close to home, also, so that may be part of it. control is such a tricky thing.)
Thank you, and best of luck.
You cannot be a good parent if you’re not holding it together as a person. Taking care of yourself is the responsible thing to do.
YES. Happy mom = happy baby. It’s like when you’re on an airplane; you have to make sure your own oxygen mask is on first so you can help them.
This is so resonant for me and, I’m sure, many others. I’m 28 and starting to think about kids, but I’m on an SSRI, and while my psychiatrist assured me I could switch to something safer, the idea of changing a 13-year-old medication routine is daunting. Thank you for speaking up about this.
“I told myself that it would be less risky to take something during pregnancy than to grow a fetus steeped in cortisol and adrenaline.”
What a great point.
I really appreciate the nuanced discussion here – something seldom found on this topic. Personally, I get so enraged when I hear about women being guilted for staying on these life-saving meds during pregnancy – when there are no conclusive medical reasons not to, and our bodies and emotions are already being put through the wringer. I’m on my third pregnancy, and with the blessing of medical professionals have stayed on anti-anxiety/depression meds for all three – first two it was Zoloft, this time around it’s Wellbutrin. There have been no adverse effects on the kids. I can’t even imagine what an (increased) mess I’d be if I was fighting my own brain chemistry in addition to dealing with the normal horrors of pregnancy.
It’s so good to hear from people who didn’t have any adverse effects. I’m on lexapro and couldn’t imagine going off, even if I did live in a lovely island vacation world. My doctor also essentially said that depression/ panic attacks are worse for a pregnant mother and developing fetus than some inconclusive results, so I’m glad to have her support. Thanks for sharing your experience!
I got the cortisol and adrenaline cocktail (my mother had extreme at-that-stage untreated anxiety and depression), and ended up being given sedatives as an infant to chill me out. I’d also lay good money on it contributing to my mental health issues.
So yeah – staying on your meds is definitely the better option as far as I’m concerned.
I’ve talked about this on Twitter, but I’ll repeat it here: I stayed on my anxiety meds when I was pregnant, and I have no regrets at all about it. My pregnancy was uncomfortable and high-risk (I have a history of blood clots, so I had to give myself shots of blood thinners twice a day for nine months. Good times.) I went into my first meeting with my OBGYN armed with the studies that said anxious/depressed mothers have colicky babies, the ones saying anxiety prevents bonding, and my family history of PPD–totally ready to fight. Then my OBGYN was like, “Sounds like you’ve thought this through. We’ll just monitor you,” and I nearly hugged her.
I’ll also say that I think being an anxious person and spending years of developing coping strategies to help with the anxiety (because I also did CBT before going on meds) was actually really helpful when I had a newborn! Everyone warned me that the first 3 months would be horrifying, but I really didn’t think they were that bad at all. I mean, I went through 4 years of college with no sleep and constant panic. Taking care of an infant under those conditions is a breeze in comparison! I also knew how to recognize anxiety as it started to spiral and could say to my support network, “I’m freaking out right now. Help talk me down.”
This is a great point about how the Life Skills that you have to learn when you have chronic mental illness truly come in handy in all sorts of other Life Areas. I had a similar experience with sleep deprivation with a newborn, and my wife was just “how.. are you Doing this and still functioning?”
This makes me feel somehow way better about having kids someday.
Do you have any links to the studies you mentioned about anxious/depressed mothers having colicky babies? Would love to investigate. Thanks
I’m not lyetteann, but I read a study recently that found that babies whose mothers were depressed had an increased stress response at 3 months (via an epigenetic mechanism). Exposure to SRIs didn’t have the same effect. It’s available here as a pdf.
Thank you!
YES to all this. I recently tried tapering off the SNRI I’ve been happily on for ten years after my gynecologist suggested I try switching to a different anti-depressant that is “safer” (I use quotation marks because there is no hard data saying that the med I’m on is safe or unsafe) since I’m planning on trying to conceive soon. My psychiatrist started by reducing my dose from 60 to 50 mg, and within a week, I was feeling symptoms of depression again for the first time in years. When I went back to see her, she said that in her professional opinion, I needed to go back on the full dose and stay there. So I did, and I told my gyn that I wasn’t interested in discussing it anymore.
I have always prided myself on being a good self-advocate, and it has worried me how much I have anguished over this being a “selfish” decision. And someone tried to comfort me by telling me that I’ll be a better mother for having my neurochemistry sorted out, and while that’s most likely true, it misses the point. I don’t want to continue taking my anti-depressant to be a better mother; I want to keep taking it to be a happier person. And that should be enough. But it feels like it might not be?
I continue to think about this a lot, and it’s great to read something so thoughtful about the issue. I wish you (and all of us) peace.
While there are risks to the fetus/baby from anti-depressants, there are also risks to the fetus/baby when Mom is severely depressed or anxious. It’s a risk-benefit calculation and the risk of Mom being sick might be higher than the risk of a medication side effect. Pregnancy is stressful mentally and physically and so is having a baby. If medication is an important tool for an expectant mother to be able to take care of herself and her baby, then that tool should be used.
I’ve cared for babies born to Moms on antidepressants and the vast majority are totally fine. They sometimes need to be monitored more closely in the first 24-48h but they pretty much do well after that.
This is a decision to be made between you and your doctor regarding the safest plan for your baby AND for you. If anyone else gives you shit about that, they can go to hell.
I’m happy to read this.
I don’t know if I want children. Part of the reason is that I’ve never been really sure about it is my depression and basically if I didn’t continue on my meds, I don’t think I’d survive a pregnancy.
Granted, I’m single and not a huge fan of infants, but I mean, at least it won’t kill me.
Thanks for writing this piece, and I wish you the best.
While I won’t be having kids, my sister has always wanted a family. However, since discovering her mental illnesses and going on Citalopram, she has sadly wondered to me on several occasions if it will work out. I think she’ll find this reassuring.
Thank you so, so very much for sharing this. I’ve been a pregnant depressed person (no meds) and I have taken care of lots of pregnant people with various mental illnesses, many of whom are shamed into discontinuing their meds while pregnant (most especially by psych providers! Who don’t know nearly as much about fetuses and newborns as I do!) and I’m always so relieved when someone decides to stay on her meds.
Your last paragraph is perfect.
With my first, I spent my pregnancy hating myself, my decisions, and my life. I look back now and I clearly see that I was dealing with antepartum depression, but I just thought it was me failing as a pregnant woman– I didn’t want to go running or see my friends or do kegels, I wanted to sleep all day and sit in the dark and cry. Six months post-partum, my GP put me on Zoloft, because it was okay while I nursed. HOLY SHIT. Coming out of 15 months of APD/PPD made it so clear to me what had happened to me and it made me furious that my midwives and doctors hadn’t noticed it when I talked about how I felt. My GP had been seeing me for three years and finally told me that I didn’t seem like myself, had I considered SSRIs?
When I decided to get pregnant again, I didn’t hesitate. Anyone who wanted to criticize a decision I made with my doctor could fuck right off. That little white pill kept me functioning when I was physically miserable, because I knew that being pregnant wouldn’t last forever. My OBs were supportive and happy to prescribe me zofran for nausea, and those two prescriptions kept me able to work and parent and partner through nine months of weekly ultrasounds, constant nausea, my pelvis attempting to separate like Pangea, and peeing myself weekly. I’ve been on Zoloft for almost five years and I have no plans on leaving it.
I’m so so sorry you had to go through that, and so happy and relieved for you – and your family – that you found the thing that works for you.
High fiving you with my Zoloft scrip in hand. I, after taking a break from my SSRI for reasons that escape me now, went back on it about 7 months into my first pregnancy, because I was having a panic attack and couldn’t see clearly or talk coherently to my midwife through the tears. That was five years and three kids ago, and that little blue pill has seen me through it all. I am a better parent AND a better person for it.
Wonderful piece. I have a congenital autoimmune disease as well as mild depression. I take maintenance medication for both. When I got pregnant, I would no more have gone off the medication for the latter than I would have for the former. No one would have asked me if I thought I was making the right choice by continuing to take the meds for my physical disease, but somehow medicine for anxiety and depression is seem as “optional.” (I stayed on both meds for both my pregnancies, and both kiddos are perfect.)
This makes me so happy to read: “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.”
I feel like it should be handed out on a card to every woman when they turn 18.
Thanks so much for this article. It is frustrating there is so little conclusive evidence out there not only about SSRIs, but also about depression and anxiety during and after pregnancy in those with a history of depression and anxiety.
I just got through my first Seattle winter off my meds (under my doctor’s supervision) in preparation for trying for a baby. I wanted to see what I was like, baseline, with out meds. It is hard, and I am definitely white knuckling it. So maybe that isn’t the best choice for me, maybe it is. I’m still figuring it out and that is ok. I try to tell myself that a lot, “It is ok! Everything is ok!” I figure I’m getting in practice for the day when we do have a child, and they need to hear that too.
Just yesterday I was complaining about how much our culture sucks about talking about the times when the best interests of the mother’s health aren’t necessarily the same as the best interest for the baby/ future baby, and then here you are doing an absolutely wonderful job- so, thanks!
I was consciously contemplating the uncertainty of my future, which is both a symptom of and cause for anxiety.
This is fantastic.
I’m on Celexa too, along with a few others. (Vyvanse FTW!) I can’t imagine going off it.
I have been thinking about this exact thing, so much, lately. Thank you for writing this.
I don’t think the fear of potential effects from anxiety meds should be of a greater concern than any fearing any other thing you might be handing to a baby. Whether that’s a family history of cancer, (I don’t know many people who DON’T have that) or a greater risk of a genetic disease or bringing a child into a pretty fucked up world. Hell, many of those concerns are why I’m pretty firmly leaning toward adopting any and all future children. A former employer was discussing the consumption of alcohol during pregnancy with her doctor, and he said that (while yes, there are risks, and certainly it should be in extreme moderation) if a woman was in the habit of having a beer after work on Friday or a glass of wine on a monthly date with her spouse, and the idea of NOT being able to do that was seriously stressing her out, that he’d be more concerned with her stress levels than with the alcohol consumption. YMMV, but, I think it’s safe to say that if your ability to be able to get through the pregnancy is a greater concern and a higher risk than the possibility of potential complications for the child, the meds are probably better for the baby than trying to go without. I wish you luck whatever you decide. This was a well-written and important piece. Thank you for your courage in sharing it.
When my wife and I went to a fertility clinic after some unsuccessful attempts under guidance of her gynocologist — and, as bad as going off antidepressants for pregnancy is, going off antidepressants and then taking Clomid is worse — and she asked the kindly wise old nearly-retired fertility doctor whether he thought she should be taking the antidepressants or not. His reaction was basically, “Of course you should be on your antidepressants; you need to be emotionally resilient and stable for this!”
So, yeah.
I recently started taking Celexa and it’s been incredible the difference it’s made. It’s like a light switch has been turned on in my head. I plan on having children sometime in the future and I hadn’t even thought about having to stop taking it. Thank you for all of this information!
Thank you so much for posting this. 2 years on Lexapro and a recent addition of Wellbutrin have made an unbelievable difference to my life — before, I genuinely thought that being a sleepless, exhausted, miserable, anxious person was just my personality. I’m 27 and getting towards this discussion — should I learn to live without? If a future baby was born with defects, would I blame myself forever because of my “selfish” decision. The article and comments here are helping me realizing I wouldn’t be the first or the only to choose a guarantee of personal wellbeing over a tiny, vague risk to an unborn child.
Thank you for this, and thanks to commenters too–as someone considering pregnancy while on an SSRI for an anxiety disorder, these are considerations I’ve mulled over for years. It’s good to know there are other folks in this metaphorical boat, especially folks who are also looking towards the ‘stay on it dear god I need to be in good working order for this process’ side of things.
This makes me feel somehow way better about having kids someday.
This is fantastic.
I was recently reunited with the child that I fathered at 18 while in an abusive relationship that I had to leave (my ex gave up the baby for adoption, which is something for which I still admire her). My daughter and I are now super-close. She has my General Anxiety Disorder, at least as bad as I have it, which is pretty bad. I felt responsible and blamed myself for her disorder, to some degree. But it helps to remember that there is no ideal or neutral set of conditions under which a human being comes to exist. Thanks for the reminder!
This is fantastic.
I was recently reunited with the child that I fathered at 18 while in an abusive relationship that I had to leave (my ex gave up the baby for adoption, which is something for which I still admire her). My daughter and I are now super-close. She has my General Anxiety Disorder, at least as bad as I have it, which is pretty bad. I felt responsible and blamed myself for her disorder, to some degree. But it helps to remember that there is no ideal or neutral set of conditions under which a human being comes to exist. Thanks for the reminder!
Your article makes a good point about never gaining 100 percent control over anxiety. The drugs work to end much of your anxiety but you may still experience some of it. If you can gain some control over your anxiety, you might find no need for anti-depressants.
So thrilled to hear compassionate discussion about this issue at last. I stayed on meds while pregnant and while, to be honest, I still occasionally feel anxious about it (but what don’t I occasionally feel anxious about?), I can’t imagine how difficult it would have been to go without them. With meds, I could actually enjoy pregnancy and more importantly, I was able to chill enough to enjoy having an infant. My child is now a healthy, happy preschooler. Mothers need to be able to experience calm and joy in order for kids to thrive–that’s something that is never mentioned in these discussions, which usually discuss women’s mental health as if it’s a luxury, not a necessity.