Help: Depression, Motherhood & Upside-Down-Me

When I saw the exoression on my face and dark circles under my eyes in this self-portrait of us, I was totally shocked.

When I saw the expression on my face and dark circles under my eyes in this self-portrait of us, I was totally shocked.

I am writing this well after my bedtime, because I don’t want to go to bed. I don’t want to go to bed, because if I go to bed, then tomorrow will get here faster. I know that this is untrue, and that being exhausted tomorrow will not make the day any better. But I have been staying awake to put off Tomorrow since I was a little girl.

What happens tomorrow? I meet with my psychiatrist. I am terrified. Not of her–she’s such a lovely person and so good at her job that my midwife started handing out the doctor’s card to local moms/moms-to-be who need help after speaking to her just once or twice. I am terrified of what she might say, and of what she might not say. It’s been a month since I saw her last, but it feels like six. Two weeks ago (again, feels like six) I told you about my anxiety attack after locking myself and my son out of our apartment. That blog entry is proof that I recognized what was happening and opened up my Anxiety Tool Kit to start dealing with those feelings right away. But they multiplied. I talked through it, but I kept crying. I felt foggy. I didn’t realize how terrified I felt about leaving the house until my therapist challenged me to leave with my son, walk out the front door of the apartment building, turn right around and open the two doors between us and home. I still haven’t done it. I can’t even do it with Nathan inside the apartment, ready to buzz us in. Since the point of the whole exercise is to prove to myself, to that doubting voice, that I can remember my keys, it’s unlikely that I would forget them. I can’t imagine it going wrong. I can imagine doing it. But I haven’t done it.

It took me awhile to realize how terrified I felt of going outside in general, because we were snowed in. As you may have heard, the East Coast, from New York to Boston (and us in between) got a lot of snow. I grew up in Minnesota, so a blizzard is not a scary event, and I can deal with snow. I know better than to drive during a blizzard, but I was not exactly panicked about the weather. In fact, I was thrilled. Thirty inches of snow fell in as many hours. It took days and days for a plow to get to our driveway. There are still major streets here that become one lane due to massive mountains of snow left behind by the plows. My husband, Nathan, couldn’t leave the house to do his grad school work; he usually leaves for a few hours every morning to work at Starbucks or the library.

Here’s the chronology: on Wednesday night, I locked us out. On Thursday, I had a therapy session about that over the phone because I felt too panicked to leave the house to go to therapy. On Friday, a blizzard dropped nearly three feet of snow on our heads. On Saturday, Sunday and Monday, the streets were too blocked to drived anywhere. But on Tuesday, he didn’t go in to school. He probably stayed home in part because of the snow; he had no idea how things looked up north on campus, and our car is notoriously bad in even a few inches of snow. He also stayed home because the thought of him leaving brought me to tears.

In under a week, I spiraled from Thriving all the way down to Crying At Random and shrieking “Take him!” whenever our baby fussed. I suddenly felt like a complete and utter failure whenever he wouldn’t be soothed by nursing or bouncing. I stopped sleeping at reasonable hours. I’d be awake at 3:00, 4:00, 5:30, hours after Walt had fallen asleep, playing games on my phone (and often crying). But this is where it gets weird, for me, because I didn’t feel my heart racing or recognize any anxious thoughts on a loop. I just felt… numb. Or sad. Once, I woke him up so that he could talk me out of self-harm; my urge that night was minor, in the scheme of such things and compared to what I felt in the past. But I have only ever felt those urges when I have also felt trapped and hopeless.

I felt depressed, obviously. But was this depression? Was this postpartum depression?

Obviously, the snow made going to therapy impossible, so I talked to my therapist over the phone. I told her about the crying (mine and my reaction to the baby’s), the fog, the feeling numb. I told her how surprised I was that the change had happened so quickly. I told her about my sleep and losing track of time.

I actually saw her today. Things are a little better, because I’ve been taking Benadryl to get to sleep. Yes, we co-sleep, and taking “something” to sleep isn’t safe for bed-sharing. But Walter is sleeping in his co-sleeper, now, if he must, so it’s safe for me to take something like Benadryl that makes me extra sleepy for a few hours. The sun is out, and I’ve gone outside to appointments (chiropractic! fun!) and even twice just to prove that I could (just not with Walter in tow). I’ve gone out for lunch and shopping with my mother-in-law. But I still feel all wrong.

There was a lovely moment today, with our gorgeous little family all snuggled up for a nap, when my husband told me that he was blissfully happy. The three of us, cuddling, was the best thing he could possibly wish for. He had never been happy like this before Us. I started to cry, because I saw but did not feel that joy. I knew that I should. I knew that I loved my family. I knew that a month ago, I would have felt the same rush of joy he was describing. But I cried today, because I could not feel the joy I had earned.

I’m crying now, as I type this. I’m doing everything I’m supposed to do, and I am not in any danger. I thank God that I have no intrusive thoughts about my son. Most of my smiles have been because of my Walt. He loves to smile up at me during breaks from nursing, and I get a special smile he saves just for me. I have fantasized about being far away, alone in a quiet hotel, because he is fussy almost every night around sunset, sometimes for over an hour, and hearing his cry hurts my heart. It hurt my heart a month ago, too, but I had perspective, then. Now, if I can’t comfort him, I can easily loose all perspective and start picturing a teenager who will hate me for every mistake I have made and will make. I have even wondered, at my lowest, how long it would take before my family realized that I was just weighing them down and left.

Part of me wants to hear my psychiatrist respond to this information with the words “Postpartum Depression.” I want those words as proof that it’s not my fault; a voice in my head has always told me that I am “faking it.” If I just tried a little harder… But do I need the diagnosis? Is it even possible to tell, yet? This could be a relapse of depression–Major Depressive Disorder is already in my history. My major depressive episode had prolonged and extreme triggers, and this just feels chemical. I feel like I got hit by a truck, or by a magic spell that erased my mental-illness-fighting powers. My therapist agreed today that, had I locked us out a month ago, I would have bounced back by now. She has a social work degree and does not diagnose things like PPD.

Something unfamiliar is happening. Suddenly, there’s a kind of distance between me and my own life. Underneath all the chatter in my head about diagnoses and justifications is one desire: find help. I just want to know that it’s going to be ok. I want to know that there is a path back. I want the mood swings to stop–I am scaring myself by feeling so full of rage and sadness that my face actually flushes hot and red. I don’t want to dissolve into tears every time my son cries. A month ago, I was pitching ideas to other blogs and excited about attending a conference, BlissDom, after winning a ticket in a contest. Tonight, I can hardly remember where this post started or where I wanted it to go. Hours go by without my noticing, or I feel like hours have passed after just one. My world is upside-down. I will do anything to make it right again.

Surprising PPD Study Offers Hope to Pakistani Mothers

My famed Google Alert on mental illness during pregnancy turned up something that actually brightened my day, today. But it’s something that gets sad before it gets happy, so bear with me.

According to an article in Pakistan Today about postpartum depression, women in some regions of Pakistan have a rate of postpartum emotional complications (anxiety and depression) around 24%, which sounds like a lot, until you learn that this is actually the lowest estimate and that, particularly in rural Pakistan, an estimated 56% of women suffer from anxiety and/or depression during pregnancy and/or in the three years that follow the birth of a child. Now, I suggest that you go and read the actual article, because my heart swells at the accurate, compassionate reporting about the prevalence of postpartum emotional complications, particularly in the developing world, and the impact of mental health issues on children in the home. It really is very well-written.

Now for the good news: someone, clearly a genius, after reading that psychotherapeutic approaches help women in high-income countries, decided to train local woman just a little bit to counsel their peers. And it worked. I am now going to include a long quote because, as I said, accurate reporting about the benefits of inter-personal therapy just makes me oh so very happy:

A randomised controlled study conducted in a poor rural community in Pakistan has shown that integration of cognitive behaviour therapy (CBT) into routine work of community health workers more than halved the rate of depression in prenatally depressed women compared with those receiving routine care only. In addition to symptomatic relief, the intervention group had less disability, better overall social functioning and the benefit persisted after one year. It has been reported that patients treated with either pharmacotherapy or cognitive therapy showed similar results. No published findings to date suggest that antidepressant medication reduces future risk of depressive episodes after discontinuation, whereas cognitive therapy has been shown to provide protection against relapse and possible recurrence.

Did you get that? They added just a little training in CBT to the “routine work of community health workers” and it halved the rate of PPD. Cut that monster of an illness in half! And these smart people even thought to check back in a year–yes, these women were still benefiting from that therapy. Note: antidepressants alone don’t show signs of helping in the long run, but cognitive therapy? Oh yeah. That lasts long after the SSRI is gone.

And that, ladies and gentlemen, has made my day. Way to go, Pakistan Today. Who knew that you’d do better than 98% of American newspapers when it comes to doing mental health and women the justice they deserve? (I say that simply because we all know Pakistan has a history of not treating its women particularly well, and I love me some examples of trends like that thwarted.)

Un-Pregnant

“You need to be un-pregnant.” –L (Therapist)

“I do actually understand that I’m not pregnant.” –Me

“I know that. You’re not bonkers! You’re not psychotic. But you’re trying to control everything about this pregnancy before it even happens. No more books. No more researching car seats. You will have plenty of time to do that when there is an actual baby to prepare for.” –L

She wasn’t being mean or even harsh. She was pointing out that obsessing about a future pregnancy makes it awfully hard to live in the moment. You know what’s a really good way to get yourself really anxious? Thinking about the future all the time. You know what therapists have always told me to do to calm myself down? Find a way to focus on the present. Focus on the taste of a cup of tea. The air in my lungs during a walk. Obsessive thoughts about the future lead only to an overwhelming helpless feeling. After all, I cannot predict, let alone control all possible outcomes.

Often, I feel better about something as I gather more information about it. Case in point: my decision to stay on my medication. I read, talked, listened, read some more and eventually decided that taking the medicine posed few risks and offered many benefits. Done and done. It’s not easy. It’s not simple. But the more I learn, the better I feel.

So why has talking and reading about pregnancy made me more anxious? Should I be less anxious? Shouldn’t reading books about birth choices make me feel confident about giving birth? If I were truly anxious about the physical changes pregnancy might bring, learning about pregnancy might help me relax. I’m not scared of all that, though. I have a healthy fear of the real dangers pregnancy can pose. But I’m not anxious about it.

I am anxious about being a bad mother. I am afraid that I will choose my own well-being over my family’s. Because here’s the thing: I already have. I will take medication through pregnancy, through breastfeeding, because I don’t want to feel out-of-control anxiety and depression. I’m glad that taking meds poses relatively low risks to our hypothetical baby compared to the risks of having an anxious and depressed mother, but I’d be lying if I said that I’m taking them to keep my family safe. I want to feel good. I take them to feel not just ok, not just slightly better than suicidal; I want to feel good. I don’t think that’s selfish and have no guilt about it. Call me names, and I still won’t feel badly about it. So why am I anxious?

I’m afraid that it’s going to be a slippery slope. I’m afraid because when I was small, my own mother made some choices that hurt me; she put herself first because she had to. And you know what? It still hurts. Will I do that to my child? These are rhetorical questions. I know that I will be a good mom, and no matter how many times people tell me that I will be a good mom, I’m still afraid. The fear is not rational. It’s a shadow that lurks in darkest corners of my mind and feeds on “What if?”

I used to fear abandonment. I am now afraid that I will abandon.

No amount of reading is going to change that. No amount of talking will fix it. Until there is an actual child to worry about mothering, I can only do one thing to beat back the shadow: stop feeding it hypothetical failures. What if I find myself so depressed that I need to leave my baby and go to a hospital? Then that will happen. And we’ll all survive. But I have done everything that I can do. I will not sit and wait for disaster.

I am going to think of the next five or so months as the best and longest “babymoon” in history. We always intended to wait until March of next year. Until then, I am going to enjoy the heck out of my family as it is. I will avoid books on pregnancy, birth and parenting. I will be sewing and knitting baby stuff, because it gives me something to do with my hands and my therapist sanctioned these activities. I will sleep late, stay up late, enjoy a quiet house, watch too much TV, play video games, read books, leave the house in five minutes flat, spontaneously go to the movies and wear impractical shoes while going on dates with my husband. And other activities parents tell me they now perceive as luxuries.

This Mothering Thing is Going to Happen?! Anxiety Spike!

Honeymoon! Me and my gorgeous husband at Hemingway's house in Key West. My husband is right about lots of things, often, but he made a particularly astute observation about this month’s big spike in my anxiety level: it has something to do with my intense focus on all this baby stuff. Case in point? I recently received an email from Amazon notifying me that I had ordered two pregnancy books I do not remember deciding to buy. Yes, I looked at them, and I remember that. But I thought I had left it for later… What’s going on? Well, it’s something I have mentioned this in the past, but it’s worth repeating.

Anxiety does a really tricky thing I call the DO IT NOW! list. You see, when we are extremely anxious, we lose the ability to order tasks according to their importance. Reading a blog post about the awesomeness of the Diva Cup? Just as important as eating lunch. Which is just as important as remembering to go to therapy. Which is just as important as answering my phone. (I’ll let you guess which ONE of those things got done.) When every single task I could possibly do takes on “URGENT!” status, I totally shut down. Wouldn’t you?

Usually, I can identify the trigger and work through the anxiety in time to, you know, get up the next morning. This time, I don’t know how to deal with the trigger. I’m supposed to somehow stop thinking so hard about becoming a mother? This is a big one. I need some help. And I missed therapy–twice! But I can do some of this work between now and tomorrow’s (double) makeup therapy session.

First, let’s rephrase the goal. I’m not supposed to stop thinking so hard about becoming a mother. I’m supposed to surrender. Obsessing today will not make me a better mom tomorrow. Or next year. To a child who does not yet exist. Practicing surrender seems like a darn good idea, too, because I am told that moms have to do a lot of it in order to stay sane. At some point, I’m going to do something truly and utterly horrible like buy my child a toy gun or a Barbie doll, and I’m going to have a nervous breakdown unless I can believe that he or she will turn out ok!

I understand, now, why some women get really excited when they find out that they’re pregnant and then feel very depressed about actually being a mom shortly thereafter. I was on a high after our appointment with Dr. P, when I finally became comfortable with planning a medicated pregnancy. I have crashed back to earth.

So. I called my psychiatrist like a responsible patient. I’m taking 2 mg of Klonopin every day again. Up from 1.5 mg. Doctor’s orders. I still don’t feel right. I’m taking a break from subbing at the child care center, which means I’m only working two days a week. And they’re not even full days. And I’m still exhausted and sleeping a lot.

But I want to say a little more about why my husband’s observation was just so incredibly helpful. I told him that I was scared that this road was leading to depression because I didn’t know why I was having so many anxiety attacks. And he didn’t lie, he told me that the prospect of me having a depressive episode after we have a child scares him. It’s a scary idea. But when he gently pointed out that this month, the anxiety has a cause, that I am fighting it, but that I am giving in to these obsessive thoughts about motherhood, I forgave myself. I believed, with him, that I’m doing my best.

I’m really glad that I don’t have to do this parenting thing by myself, and I’m really, really glad that Nathan is the one doing it with me.

The Adoption Question

Twice in twenty-four hours, people I love asked, “Why not just adopt?” Now that I’ve outlined the risks of taking medication while pregnant, it’s natural to wonder: why take those risks, when there are so many babies who need homes? I understand the question. It’s a valid question. My answer is, essentially, that adoption seems, to me, to be an undertaking more complex and difficult even than having a child who is biologically ours. I also don’t think we could afford it. But to be honest, I want to be pregnant with a ferocity I do not even understand. I need to have a baby. I don’t want to adopt right now for that reason. I do have a fierce desire to be a foster parent and to adopt a foster child, eventually. Right now, it doesn’t feel right. More importantly, I think of adoption as a whole different decision, not a simpler alternative to having a medicated pregnancy, birth, etc. I wanted to make sure that I was really exploring this issue, though, so I called in an expert.

Carrie Goldman writes the blog Portrait of an Adoption, creates amazing artwork and raises three beautiful girls, one of whom is adopted. I’ve been reading her blog for awhile, and as soon as you go take a look, you’ll see why. Her girls are hilarious, and I have definitely cried over more than one post. I was a little nervous about writing to her, but she seems like such a nice person. I’m really glad that I did! Here’s what she said:

“Before anything else, I want to reassure you that I know many many women who have been pregnant, given birth and even nursed while taking antidepressants and anti-anxiety meds.  Obviously, it is ideal not to be taking any meds during pregnancy, but the health of the mother often determines the health of the baby, and if you are doing to suffer from depression and anxiety without your medicine, it is probably in your best interest to stay on your meds during pregnancy,  Of course, I am not a doctor; I am only repeating what I’ve heard from numerous people!  But I know a LOT of healthy babies and kids who were born to medicated moms, including my daughter Katie, whose birthmother took antidepressants, and Katie is a big, healthy girl.  She does have amblyopia, but that is totally unrelated to antidepressants during pregnancy!

As far as the idea of “just adopt,” there is no such thing.  Adoption almost always involves money, time, disappointment and uncertainty.  The cheapest adoptions are foster-care adoptions, but there is a higher risk of foster children having significant mental health problems, so if your whole goal is to minimize the risk of health problems in your child, you might as well get pregnant and take your chances.

Ultimately, there are no guarantees.  Whether you adopt or give birth, you never know what you are going to get.  You can try to minimize risk, and after a certain point, it depends on good or bad luck.  Some people give birth to healthy kids and adopt kids with problems.  Some people give birth to kids with problems and adopt healthy kids.  But it is your decision, and your life, and no one should tell you how to live it.  Chances are, you will probably give birth to or adopt a kid that will be okay.  Remember, no one is perfect, and this includes our children.  I have three little girls and none of them is perfect.  Cleo, my new baby, has a hole in her heart and isn’t growing properly.  My first baby, Matthew, died of a kidney disease.  This is how life works.  Try no to let others judge you or make you feel defensive.  Once you make a decision, it is the right one for you.

All the best,

Carrie”

How nice is she to reassure me with her own experience with medication and pregnancy/babies? She also confirms what I had started to suspect, myself: “Adoption almost always involves money, time, disappointment and uncertainty.” To me, that translates as a mental health danger zone. But where she really gets me is when she says so eloquently what I was feeling about this all along, “You can try to minimize risk, and after a certain point, it depends on good or bad luck.” That’s parenting, right? Or so I hear. I hope to find out soon.

I know that I don’t need to explain myself. I wanted to write this post because adoption is awesome and important. All I have to say is “Nathan, I want a baby!” And all he has to say is, “Me too.” But I write this blog and let everyone else in on this decision making process. I even invite your comments about it all, and you might be a total stranger! So here are my thoughts on adoption.

Planning A Medicated Pregnancy: Dr. P

Nathan and I went to Manhattan last Thursday to meet Dr. P; my psychiatrist had referred me to Dr. P for her expertise in perinatal mental health (translation: medication and mental health during pregnancy and the postpartum period). We talked about my history, my symptoms, the triggers for those symptoms; I explained that because transitions are the worst trigger for my anxiety and out-of-control anxiety triggers depression, I do not see a way through pregnancy and childbirth (the biggest transition ever) without medication. She asked which medications I take. I told her. She asked Nathan how he felt about me taking medication during pregnancy (100% in favor).

Dr. P: In an ideal world, when would you start trying to conceive?

Me: January.

Dr. P: This January?

Me: Yep.

Dr. P: Two months! Wow, that’s… a little soon. I’m not saying wait a year, but definitely more than two months…

Me: You said “ideal.”

Then came the science. In sum, the good news is this: the drugs that have worked best for me, Effexor XR and Klonopin, are prescribed often, have been taken by many pregnant women and many of these pregnancies and the children born have been tracked by doctors. The bad news is that because it’s not ethical to run “randomized controlled studies” (proper drug trials) on pregnant ladies. You see, we don’t actually know that pregnant women will harm a fetus by taking your average prescription medication, but we’d have to risk a whole lot of harm in order to find out. Animal trials are useful because they let us test out chemicals in highly controlled environments. So how do we know anything about pregnant women and drugs? Researchers get women who are already pregnant and already taking a drug like Klonopin to take tests and document as many details as possible about their pregnancies and the health of their children. An example of one problem with gathering information this way: recently, the New York Times published an article about a study linking antidepressant use to increased rates of Autism. Dr. P mentioned this study and said that because all it shows is a possible correlation (link, connection) and doesn’t tell us anything about causation, there’s no way of knowing if that link to autism is because of the medication or because of depression. Catch that? If you take antidepressants while pregnant, you might put your child at a higher risk for autism. But there’s also a pretty good chance that if you don’t take your meds and you become depressed, only then is there a higher risk that your child will be autistic. There’s definitely a correlation between age and autism, so you also have to factor in all the women in that study who are, oh, no one knows, maybe over 35? Oh, and Effexor is similar to Zoloft, but not exactly the same, so there’s really no way of knowing whether that study does, in fact, apply to me. But don’t worry, the risk is still small. (Feel better? Me neither.)

So here’s what Dr. P told us to think about: what if we are in fact the couple who has the child with, say, autism? If you are that family, the fact that the odds are tiny tend to matter, well, not at all. Will we be able to cope with the knowledge that my medication may have contributed to that child’s illness? or birth defect? Yes, and I’ll tell you why: no one will ever know whether my medication did anything specific except make a significant contribution to my own mental well-being.

I know, I was surprised, too. But check this out:

[quote]Based on experimental animal studies, venlafaxine [Effexor] … [is] not anticipated to increase the risk of congenital abnormalities. A study published in abstract has suggested an increase in some malformations based on small numbers of exposed individuals. Transient and usually mild neonatal complications have been reported for venlafaxine and other serotonergic antidepressants. –Reprotox database of potential teratogens [/quote]

Translation: The drug doesn’t cause birth defects in rat or rabbit babies. As for human beings, one study (for real, just one–the National Birth Defects Prevention Study, 2010) found some (very few) cases of cleft palate, limb defects, gastroschisis and heart defects.

And this is about Klonopin, the benzodiazepine that I thought was too dangerous to take during pregnancy:

“Based on experimental animal studies and human pregnancy experience, clonazepam [Klonopin] therapy is not anticipated to increase the risk of congenital malformations. The risk of mild transient neonatal complications may be increased when this drug is used in combination with selective serotonin reuptake inhibitors. –Reprotox database of potential teratogens”

Translation: We don’t see any birth defects when Klonopin is the only medication used. In combination with an SSRI (I take an SNRI, but they’re very similar), it might cause problems for babies just after they’re born. The “complications” are mild because they mostly include feeling mild withdrawal after birth. There have been babies born with birth defects to mothers who took Klonopin during the first trimester (when “physical abnormalities” occur). It’s not clear that Klonopin exposure caused those birth defects. Here’s an example: one study in Hungary looked at 22,865 babies exposed to one of five benzodiazepines, including Klonopin, in the first trimester and found 57 “affected” infants. Out of 38,151 babies not exposed, 75 were “affected.” Reprotox says that “These data … showed no increased teratogenic risk associated with benzodiazepine exposures.” And so on.

I have another appointment with Dr. P in two weeks to discuss “a timeline” and plan when exactly it’s a good idea to start trying to conceive. In the meantime, I am no longer taking BuSpar, because my psychiatrist and I think it was actually making me feel worse, and I’m about to start a prenatal vitamin regimen.  Oh, and Nathan and I are disgustingly mushy about this whole baby possibility. Our conversation over brunch at Alice’s Teacup after the appointment was too ridiculous to repeat!

So there’s no way to know for sure, but it seems like combining Effexor XR (generic) and Klonopin (also generic) will be safer than my other options. That’s the plan. It might change, but it’s a thoughtful plan. And yes, I do have a headache.

Here We Go! Rachel, Part II

In an earlier post, I introduced Rachel. Here’s the rest of her interview:

The happiest nursery!

Can you tell us a little bit about your background? 

i have had severe depression and anxiety since i was born. i remember laying in my crib and being terrified. i remember going to watch my bother, who was 2 years younger than me, take naps because i thought something bad would happen to him. i was always convinced someone around me that i loved was going to die, that a tornado would come during school and kill my parents. if it looked like it may be a tornado day i would fake sick to stay home from school (i grew up in the suburbs of detroit, michigan so the weather could get crazy). i was always creative and very social and somehow managed to keep my worries and depression well hidden.
i had 2 friends that knew of my deepest fears. one was my friend david, who suffered from the same things as me and the other was my friend casey, who was carefree as could be. the 3 of us were super close. in 8th grade casey got a rare case of leukemia. she went home from school on a friday and died exactly 7 weeks later. the disease literally ravaged her. david and i were devastated and i think it just made our fears of losing people that much worse, that much more real. things for both of us went downhill from there.
in high school i began to really think i had cancer ALL THE TIME. i swore i could feel lumps on my ribs, and my mother and i spent many days and nights in the ER only to find out i was fine every time. the strangest part for me, looking back, is that i was incredibly social. i had a huge group of girl and guy friends. i was outgoing, played sports, did well in school. i don’t know how i managed all of that while being such a mess internally?!?!
anyway, things got really bad my junior year of high school and i started reading “Ordinary People” by judith guest ALL the time. i stopped going to class, which was not okay, considering i was in a private school.
i started realizing what depression was and i let it completely take over. i think most of my peers were pretty shocked. i just stopped caring about trying to hide it anymore. by the end of my junior year i had transferred back to my original public high school, where i still had maintained all of my friendships because we had been going to school together since kindergarten and the private school i was in always was social with all the public schools in the area. it was a totally easy transition but my depression was still wicked bad. i began my senior year and within a month i was diagnosed with severe depression and anxiety and put on Prozac. it helped. a lot of people didn’t like the idea of it. my boyfriend of nearly 4 years, my dad etc. but i didn’t care. i was a mess! the Prozac stopped working after i began to take the generic version, about 2 years later, and had to switch to effexor. i learned VERY quickly that it’s just NOT worth it to EVER take generic of your main anti-depresant. i know the costs are extremely high but your sanity is worth EVERY PENNY and way too often do the generics just fizzle out. 


You and I share some anti-anxiety medications in common. Have your anxieties changed since you found out you were pregnant? If yes, how?

not really. i was so sick that i couldn’t focus on anything else but getting through the days. it was HORRIBLY taxing on my body. i think it kept my mind off worrying about anything because i just wanted to get through the sickness.

Did you know immediately that you would have to stay on the meds, or did you think about going off of them? 

my psychiatrist initially suggested i stopped taking everything immediately since the 1st trimester was the most crucial for their development. he also mentioned that i would probably have a seizure from coming off them which would result in losing the babies. it really seemed like lose-lose situation. i was NOT happy with him. but i gave it a week and talked it over with my husband and we decided i was not going to stop my meds. we went to see the OBGYN a few weeks later for my sonigram and his initial reaction was “i hope you aren’t still taking any of your meds now” to which we replied i was. he was NOT pleased about it and said he was going to call my psychiatrist immediately and get back to us. this again was disconcerting but a week later he called us and said after talking to my psychiatrist they both agreed i should stay on my meds and do my best to wean off my xanax and klonopin but that i probably should just stay on them until the end. the plan right now is to wean me off them during my last 10 days of pregnancy so the babies aren’t addicted to them. that’s a slippery slope because with twins the likelihood of my going into labor early is significantly higher so figuring out when the last 10 days will be is pretty unlikely. also, from MANY previous experiences, i think weaning off meds in 10 days will be extremely traumatic for my body. the worst case scenario is i don’t wean off them and the babies will be given drops for a few days after they are born by a neonatologist to help wean them off.

[I am completely appalled by these doctors. First of all, they should not be allowed to recommend that Rachel put her own health at risk without first looking at the specifics of her meds. Just stopping medication like this is miserably painful–it’s painful if I forget to take my meds for just one day–not to mention whatever happens psychologically! Second, the OBGYN sounds completely patronizing and obnoxious, not least because he doesn’t know what he’s talking about. Finally, I cannot believe it took him a week to call back. It took my doctor two minutes to print out stuff from a doctor’s database of teratogens about the risks of taking Klonopin and Effexor while pregnant.]

Has your body’s absorption of or reaction to the meds changed with pregnancy? 

honestly, i think my body is leveling out more, which i had always read could be the case with women who struggle with my disease. it tends to swing one way or the other and i definitely think my body is going to be able to handle being on less meds after my pregnancy. there seems to be a balancing of hormones taking place. before i got pregnant that was one of the scariest things and reasons why i didn’t want to chance getting pregnant. what if things got worse? that was always in the back of my head.

Who was in on your decision to continue with your medication? You and an OB? You, your partner, an OB, a psychiatrist, a neighbor, your friends and your siblings? Or somewhere in between?  

i think i pretty much answered this in the previous questions but since my OB and my psychiatrist weren’t going to pull me off anything it basically became a personal decision between me and my husband. once we decided i was going to continue we also decided that we were going to do our best not to worry about it or flip-flop on the decision. we felt very confident in our decision and had faith we had made the decision that was best for us and our girls

What kind of information did the professional(s) involved give you? What did you find out on your own? Was there any specific source or piece of information that you have found most helpful? 

they didn’t give us much info. it seems more of a “we don’t know so it’s better you don’t take them and we don’t want to be liable”. i’ve read wayyyyy more studies that show that women who are stressed, anxious and depressed during their pregnancies end up having lots more problems with their little ones than woman who aren’t, even if it takes meds to keep you from feeling that way. i honestly didn’t do much research after we made our choice because more than anything our faith and trust in God was what it ultimately came down to. He knew my situation, He was the one who had placed those babies inside me, so we just decided He knew what was best and there was no point in worrying.

Were there any dissenting voices you had to overrule? 

after the year i had in 2010 i don’t think ANY one that was close to our family was going to say a word about me and my meds. i was so bad, so suicidal and so panic-stricken for months that my family and friends were just trying to be as supportive as possible. we have a big family and we are very open with each other. there are lots of people in my side of the family (my dad has 7 siblings and my mom has 3) who struggle with addiction and mental illness so it’s just something that is understood.

How does your partner feel about the decision? 

fully on board  : )

Do you plan to breastfeed your babies? If you have had that conversation with a doctor, do you know if there are any risks associated with breastfeeding that are different from the risks involved in taking the meds while pregnant? 

i will NOT be breast-feeding and decided that a long time ago. quite frankly, i’m completely fine with the decision, especially because there are going to be 2 of them.

Have you started drawing on a crib or diaper bag yet? 

haha, love this question! i actually registered for 2 diaper bags at target, 1 for me and 1 for my husband, and we got them both at my shower. i think i’m gonna use a regular diaper bag in the begininng but i’m sure i will be using all sorts of vintage totes and cases for storage and running around once they are born. i really have been unable to draw throughout this entire pregnancy because of sickness or because of huge-belliness! i have gotten really into cross-stitching for the nursery because it’s light and my tummy doesn’t get in the way. i’m DEFINITELY making them train cases to store all of their baby stuff in once they are born. these will be displayed in the nursery and hopefully they will use them when they are older.

See that little bunny with the heart? That's the cross-stitch! Those button-y monograms are more craftiness.

Do you have any advice for women who are/want to be pregnant but face anxiety and/or depression?

man, that’s a tough question. i don’t feel i have exact points but rather just the sharing of my story seems to be the most helpful thing i can do. ultimately, listen to your body and do what you think is best for you. if you freak out before even attempting to cut back your meds then i would advise you don’t do it. chances are you are going to make yourself sick before the drugs have even begun to leave your system. the mind is a VERY powerful thing. just listen to your body and trust the advice of those people who know you very well and will support you. you really cannot care what others think or say, which i know is easier said than done but remember: people who don’t know you aren’t fit to give their advice. they haven’t walked a day in your shoes and they certainly don’t know the challenges and struggles you’ve faced and will face. there is no way in the world they could come close to being qualified to making decisions about your meds. i would really suggest you just be as open and honest as you possibly can and find some sort of support, even if it’s just one person. that person can make all the difference in the world.

Bed rest. Music and art to keep her company! Grow, babies, grow!


Ready or Not… Rachel, Part I

Meet Rachel! She’s a talented artist and popular Etsy seller. I happened to be on Twitter one day and saw an announcement: she was closing her Etsy shop for awhile, because pregnant with twins, Rachel’s belly was just too big to keep making, packing up and shipping upcycled vintage luggage. Here’s Rachel before she knew why she was so tired:

"me when i was 3.5 weeks pregnant and, though i was unaware, i vividly remember needing a nap that day and being EXTREMELY EXHAUSTED and all out of sorts. it's one of my favorites because i was watching my friend's little boy and wondering why on earth he was taking all of my energy?!"

Isn’t she cute? Oh, and this is what the Etsy world is missing out on:

Wouldn't you love to have this train case with Rachel's adorable birdie design? I would!

Her shop, Get Ready Set Go, is here, where you can sign up for an update when it opens again.

Rachel contacted me when she read my blog in its early(er) days, and our Twitter friendship was born. Turns out, Rachel has suffered from anxiety and depression for her whole life, too. It’s easy to see myself in her shoes. This? This makes a lot of sense to me:

[quote]i have to preface this by saying that i am by NO MEANS a doctor or claim to be one of any kind. i have however been VERY interested in my disease and therefore have done a TON of research over the years. i’ve always been really open about my struggles which has helped me to gain wisdom from others and learn more about myself. i do not drink alcohol of ANY kind, nor do i use any recreational drugs or smoke. if you do struggle with depression and/or anxiety i would highly recommend you avoid alcohol, recreational drugs and cigarettes because it’s amazing how HUGE an impact these things can effect your mental state, especially when combined with prescription medicine. there are plenty of people, doctors included, that will say a glass of wine here and there or a beer is just fine with meds but if you stop and think about it, it makes ZERO sense. alcohol is a depressant and you are taking anti-depressants. it’s simple math and if you want to stay your healthiest then why would you mix the 2? again, my opinion but i’ve seen how alcohol affects my friends who are on meds and the end results are always extremely negative[/quote]

Whenever I see my psychiatrist, he asks me how many drinks I have per month, on average. Every. Single. Time. Even one beer gives me a migraine the next day, so a glass of something sparkly on a really special occasion is about as much as I allow myself these days. I was at my worst when I smoked cigarettes and drank, in college, and even though things were miserable for very separate reasons, I knew that I was making things worse. So I’d just like to add this to what Rachel says: if you’re anxious and depressed, and you find yourself smoking and drinking, then you have reached the point where you don’t want to take good care of yourself, anymore. It’s sabotage. It’s self-destruction. You are telling yourself and the world that you don’t care very much about your own well-being. Warning! Get help. You probably don’t need to check yourself into a hospital, but you could probably use some therapy. Keeping in mind, of course, that I am not a doctor, either. Just a fan of common sense.

Ok, here’s part I of my email interview with Rachel:

[hr]

How did you feel about the possibility that you might be pregnant, when it first occurred to you? Did those feelings change when it became a reality? 

my pregnancy was a complete accident. one slip up in 8 years of marriage and it happened to be when i was ovulating and wham! pregnant. i was NOT happy about it. i came around surprisingly quick though. i knew it was God’s plan and it wasn’t like i was in a bad relationship. my husband and i have an awesome relationship that has just gotten better over the years. we got married young, 21 & 22, and we’ve spent 8 years of it being just “us” so we were ready to focus on something other than ourselves. in terms of how i was going to deal with my meds was definitely disconcerting because i had just spent 2010 being so depressed that we thought i might have to have electro-shock-therapy treatments. we had finally found a perfect balance of meds about 4 months prior to my getting pregnant and things were finally going so well for me mentally so getting pregnant threw a wrench in everything.

How many weeks were you when you found out for sure? 

about 4 weeks.

How far along are you in your pregnancy? How is it going so far, on a scale from radiant to miserable? 

i’m almost 30 weeks. now, keep in mind i’m having twins so i’ve had double the amount of the HCG hormone running through my body from the very beginning and it was brutal on my body, physically. i had morning sickness 24/7 for the first 16 weeks and had to get IV’S 3-4 times a week because i was so dehydrated and couldn’t keep anything down. now, surprisingly, i was not miserably depressed during this time but just miserable physically. and looking back, i think i was throwing up a lot of my meds, another thing people don’t think about when they get the flu or food poisoning. *when you are throwing up a lot you are generally losing your meds because they are not fully into your bloodstream, even if you took them hours ago.

(*just something to think about that regular psychiatrists will rarely EVER mention or give a second thought to. even when you try to bring things like this up to them they will generally shake their heads and say, “no, that’s not true and the likelihood of that happening are slim to none.” most all of them are sooooo against hearing new ideas and not having all of the answers bothers them. that is another thing i had to get used to. doctors will always act like you are super sensitive or strange when weaning off a med or having a strange reaction to a med. they make you feel like you are the ONLY one who has ever mentioned strange side-effects. DON’T LISTEN TO THEM. YOU ARE NOT ALONE and PLENTY of people have a VERY difficult time with meds and what may seem like small changes in doses to a doctor can GREATLY affect your precise body chemistry. don’t let ANY doctor tell you otherwise!)

[hr]

Strong lady, right? I know! I want to highlight two things, especially for anyone who has wondered why I don’t just let “nature” decide when we have a baby (no one has outright said this, but people who don’t know us well have winked at it): pregnancy is hard and being on medication for anxiety & depression is hard. They key to surviving both pregnancy and psychiatry with your sense of self intact is, it seems to me, a willingness to stand up for yourself. “Hey! This doesn’t feel right!” Scream it until the doctors listen to you. Reading Rachel’s responses, it really struck me how many times she mentions how her body felt at a given moment–it’s that kind of knowledge and confidence in that knowledge that makes her an effective advocate for her own health care and mental health care.

At 20 weeks!

Why Psychiatrists Avoid Giving Straight Answers

Because people with mental illness are notoriously unstable. I still feel disappointed after yesterday’s therapy session, when we checked in about next week’s appointment with Dr. P, perinatal mental health expert. As soon as L (my therapist) asked me, “What do you think the appointment will be like?”

Obviously, it’s going to be a First Session. I’m going to tell Dr. P my life story, at least whatever parts of it are relevant; she’s going to write a lot of stuff down. She may talk to Nathan. She’ll say “Nice to meet you” and we’ll set up a time to meet again. This is now completely obvious to me, because this is how a First Session always goes. Until L asked me to picture it, though, I somehow expected something much more exciting.

I thought that I would go to this appointment, explain that I want to have a baby, that my husband is on board, tell her what my meds are and hear what they should be. I thought that I would get answers. “Switch to this medication.” “Stay on that medication.” “You’ll probably be ready to start trying early next year.” THAT is what I wanted. I am not going to get it.

The anxiety attack I had this morning seems to have centered around not getting answers and a fear that the uncertainty will go on indefinitely. And what if it ends with a “no”? Well, it won’t. Because psychiatrists bend over backwards to avoid telling patients “no.” You never know how someone is going to react, especially if she has a history of anxiety attacks and depressive episodes. Psychiatrists tell you about risks and benefits surrounding the various choices a patient can make. But not until they know a whole lot about you–not if they’re any good and especially not if we’re talking about taking medication during pregnancy.

That is why Dr. P will ask me lots of questions, probably ask Nathan and Dr. C (regular psychiatrist) lots of questions, wait, ask me some more questions later, to see how I do over time, ask Dr. C how he thinks I’ve done over time, probably talk to L, wait, and ask me some more questions. Finally, L will tell me what my options are, explain the risks and benefits, and leave the choice up to me. And I do not know how long that will take. I hate not knowing. I hate waiting.

But parents need patience, right? I should learn patience? Right?

Go Team!

Traditional shrimp curry as prepared in Benagl...

If you haven't tried shrimp curry, you are missing out. And yes, I thank God and Nathan daily for my husband's culinary skills, which include Indian food that is better than takeout.

I have “met” with Jan The Amazing Nutritionist twice now, and after both Skype video chats, the flood of hope and relief I have felt has brought tears to my eyes. These emotions come after I begin to absorb the wealth of new information each conversation affords. While a visit to a doctor, even a good doctor, finds me struggling to get a word in, visiting with Jan means answering questions about every aspect of my life, not just about her area of specialization. I have lost count of how many darn times rushed to stop a doctor with a hand on the door handle, saying “Wait! I think this other piece matters!” only to see Doc turn around, sit down again, and reconsider a medication or other piece of advice. Even the neurologist I raved about had no idea which questions to ask. The visit went well because she listened to me, but I have had to learn to make them stop and listen to my speeches about how migraines are connected to anxiety which is connected to you name it. Jan asks me questions and then tells me why she’s asking. Best example? She asked a bunch of questions about Frova, my new migraine medication. I figured she just wanted to know what else I was putting in my body in addition to the foods I reported in my food diary entries.

I felt discouraged this morning, when I woke up with pain all through the right side of my upper body, from my shoulder blades to my eyeball and realized I was going to have to take Frova if I wanted to make it to babysit this afternoon. Then came the beta blocker. Then, I forgot to take my anti-anxiety meds until 11:30 am, and only remembered because I suddenly thought “Why in the hell do I feel so jumpy?” So I added a Xanax to the mix, to make sure that I’d get dressed and leave in time to make it to my 1:00 pm gig at the big house down the block. A baby just felt so far away as I swallowed that handful of blue, red and gray pills, all with warnings on their bottles against consumption during pregnancy.

But then, I read this in an email from Jan:

“Frova is a serotonin receptor agonist. It mimics serotonin production. This is the feel good, calming neurotransmitter. Tryptophan is the precursor to serotonin.
 Have a look at the foods high in tryptophan..  shrimp is #1!!!!!
That link revealed this list of “events” that indicate a need for foods high in tryptophan:
  • Depression
  • Anxiety
  • Irritability
  • Impatience
  • Impulsiveness
  • Inability to concentrate
  • Weight gain or unexplained weight loss
  • Slow growth in children
  • Overeating and/or carbohydrate cravings
  • Poor dream recall
  • Insomnia
Yes, Yes, Yes, Yes, No, Yes, No, No, Yes?, No, No. That’s fully HALF of things I most definitely need help with. And FOOD can help! Because the chemicals in my brain are also in food… which makes total and complete sense. “Hey!” I thought, “I eat lots of shrimp! Shrimp is great!” (Nathan makes the best sauce you’ve ever tasted.) But we had just talked about how I’m not eating enough of any of the animal proteins in eggs, cheese, grass-fed beef, organic chicken and other obvious foods. I am eating more shrimp. Connection? Who cares! Let’s pile on the shrimp and see what happens!

Some of these are on the high-in-mercury or over-fished categories, but lots are in the Wonderland-style "Eat Me!" category even for pregnant ladies. (PS Jan says "shrimp is #1!!!" in her email because it was high on our co-created list of foods to eat more of on a budget.)

Here’s what just makes me insane: not one of the many, many doctors I have asked about migraines and triptans has ever explained to me what they actually do. I have asked. They have been vague. Discouraged and already having taken twice as long as I’m “supposed” to take in the doctor’s office, I give up. Time and again, I give up trying to get doctors to explain to me what exactly these chemicals are doing. I have mutely accepted “help with the pain” and “help keep blood vessels open,” too exhausted to repeat “But HOW?!” I’m smart. I’m well-educated. I even understand a good amount of medical jargon. Hit me. I can take it. But they refuse. The notable exception is my neurologist, but I see him four times a year, and we usually have a whole lot else to talk about. I am now encouraged to email him to ask more questions, though, because he’s just such a nice guy and so good at explaining stuff.
My therapist is right (shocker!)–I feel less anxious when I learn more. The more information I have, the more empowered I feel and the less anxiety I experience. Right now, I am pretty excited about that huge bag of frozen shrimp Nathan found on sale. (I never get sick of it.) As Jan pointed out, preparing for pregnancy by eating more and more often. She tells me that I’m already eating lots of the foods she recommends during pregnancy. And, one of my favorite quotes from her is this one: “You need tons of this stuff when you’re building a human fetus, but you need them to rebuild your own cells, too!”
Maybe the Xanax has kicked in. Maybe I’m excited about my ability to do more every day to help me fill my brain with the happy chemicals the pills are currently helping me produce/use effectively. Information is power.