Fearing postpartum depression, a woman with a history of mental illness made a controversial choice.

By Ashley Womble
October 04, 2018
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I’ve wanted to become a mother for most of my adult life and have dreaded pregnancy almost as long. It wasn’t the rapid weight gain or morning sickness I feared, but postpartum depression. If it could happen to Gwyneth Paltrow and Serena Williams, it could definitely happen to me.

As someone with a history of depression, my risk is significantly higher than the 10% of women who will develop postpartum depression. Not only does it ruin the joyous early weeks of motherhood, but numerous studies point out that it can negatively impact the health of the whole family for years.

RELATED: 12 Types of Depression, and What You Need to Know About Each

But the selective serotonin reuptake inhibitors (SSRI) antidepressants that psychiatrists have been doling out since the 1990s are not recommended during pregnancy. My antidepressant, Lexapro, has a C ranking by the Federal Drug Administration, which means that although there are potential benefits, not enough research has been done to determine if the drugs are safe during pregnancy. Pregnant women give up everything from aspirin to gel manicures if there is even the slightest hint that it could damage the child. I had always planned to wean myself off of antidepressants before I even started to try for a baby.

The closer I got to baby-making time, the more terrified I became of giving up my medication. I imagined myself slogging through nine months with a baby in my belly and the monster of depression on my back, halting the happiness and emotional stability I have enjoyed for the better part of a decade. I knew I could not be the kind of mother I wanted to be if that overwhelming sadness returned.

The risks of SSRIs during pregnancy

I saw a reproductive psychiatrist who confirmed that given my history, it was more likely than not that I would become depressed either during my pregnancy or in the postpartum stage. My best defense against postpartum depression would be to stay on antidepressants while trying to get pregnant, throughout my pregnancy, and even while I was breastfeeding. Yes, there are certainly risks to taking an SSRI, but depression would harm my baby more.

RELATED: 7 New Moms Get Real About How They Learned to Love Their Postpartum Bodies

It is obvious that a woman who is depressed might not take excellent care of herself or even binge drink and smoke during pregnancy, but the health threats go deeper than poor prenatal care. Untreated depression during pregnancy can cause preeclampsia and miscarriage for the mother and low birth weight or cognitive development issues for the child. It’s also the leading cause of postpartum depression, which creates lasting harmful effects on children and increases the likelihood of depression for the mother’s partner.

I did not want my issues to hurt my husband and baby. Before I could let myself swallow a pill as an expectant mother, I decided to dig a little deeper to access the risks of taking medication for myself.

One of the scariest reports, published in JAMA, connected SSRI use during pregnancy to an increase in autism. Although these findings were widely reported in the media, the study was discredited by researchers more quietly for having weak controls. Studies consistently show that a mother’s antidepressant use can lead to pre-term birth, and lower Apgar scores, which are also linked to untreated depression. I was also warned by my obstetrician that my baby may be a little “stoned” at birth, which didn’t seem like a terrible way to come into the world, considering the mode of entry.

If I didn’t get depressed during my pregnancy, I would be less likely to become depressed in the postpartum period. I wished there was another way—but it was evident to me that effects of untreated depression outweighed the unknown risks of treating it. Medication works better when combined with therapy, so I sought out a therapist with experience in treating postpartum depression.

Ashley Womble

An unexpected struggle to conceive

Getting pregnant was much harder than I anticipated, and as a woman over 35, I didn’t think it would be easy. As pregnancy announcements came rolling in from every corner— a half dozen of my closest friends, my neighbor, most of the Kardashians, and even my fertility specialist— I worried that motherhood would not happen for me. It got to the point that each time I found out someone was expecting, I cried, and they were not tears of happiness.

RELATED: 8 Unexpected Ways Your Body Might Change After You Have a Baby

Then I did get pregnant, and just as quickly, I wasn’t. Having a miscarriage could have broken me, especially since my previous depressive episodes were triggered by loss. There were days afterward when I didn’t relish the idea of getting out of bed, but what I remember most about my miscarriage was that it signaled that I could actually get pregnant. Unlike almost every other loss I had experienced, I was not transfixed on the pain I felt.

When I became pregnant for the second time, the pregnancy progressed, but there were unexpected bumps along the way. I developed migraines and placenta previa, which can result in bed rest (another quick way to get depressed) and a cesarean section at 36 weeks. I don’t know if the SSRIs caused this—until more research is done it is impossible. I do know that my mental health was stable in spite of it.

Taking good care of baby—and myself

Thankfully, by the time my daughter arrived, a week late, with an Apgar score of nine, and not at all “stoned,” my complications were resolved. A few days after I brought my beautiful, healthy baby home, the stable ground beneath me suddenly felt rocky. I didn’t feel in control of my emotions. The self-care strategies I usually embrace— exercise, long baths, and a good night’s sleep— were either restricted or impractical. I felt like a failure when my tiny daughter lost slightly more weight than expected, which led to seeing a lactation consultant and extra visits to the pediatrician’s office.

I upped my therapy sessions to twice each week, possible only because I see my therapist via video, which I highly recommend to new mothers. We discussed the chasm between my worst fears and realities. For example, I felt sure that if my daughter rolled off the couch she would break all of her bones and instantly die. She helped me monitor the “normal” feelings known as the baby blues, such as moodiness and exhaustion, and the more dangerous symptoms of depression like hopelessness and anxiety. Six weeks after the birth of my daughter, my therapist and I rejoiced that I had shown no symptoms of postpartum depression.

If I can make it through fertility challenges, a miscarriage, a difficult pregnancy, and the postpartum stage without an episode of depression, there is hope for everyone. It reaffirmed my belief that with treatment and support, mental illness does not have to negatively impact your life.

Ashley Womble is the author of Everything Is Going to Be OK: A Real Talk Guide for Living Well With Mental Illness.

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