Despite Doctors' Concerns, Many Pregnant Women Demand Anti-Depression Meds
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Like most new parents, Lynne McIntyre wasn't getting much sleep. In fact, she wasn't sleeping at all. Nor was she eating or getting dressed or doing much of anything. Her level of anxiety was through the roof.
"One night I considered jumping off the top of my apartment building while my husband and baby slept," she tells ParentDish in an e-mail.
The next morning, she asked her husband for help.
The 39-year-old Washington D.C. mom began taking the antidepressant drug Zoloft when her first son was 6 months old and, because she didn't want to experience such debilitating despondency again, she started up again two days before her second child was born. Although she weaned off the drug between her two pregnancies, she says she "didn't quite feel right" after trying to taper off the second time. She continues to take Zoloft today.
Most of us have heard of post-partum depression, a serious condition that affects 5 to 25 percent of women, but pre-partum depression, known in the medical field as antenatal depression, is just as serious and common and affects 10 to 20 percent of all pregnant women.
The existing data on the effects of taking antidepressants while pregnant is inconclusive at best, which makes it tough for women suffering from pre-partum depression to make a decision on whether or not to take them. But, for some, it's a decision that must be made.
For many, the difficulty in making a choice to take medication while pregnant is about more than the unknown effects of the drugs on the fetus. It's also about the perception of others.
"What helped me (get over the stigma) was changing how I looked at the disease," says Michelle, an Orlando-based 39-year-old single mom of three who requested last-name anonymity, in an e-mail to ParentDish. "It is nothing I can cure with the strength of my mind alone. It is the result of a chemical imbalance beyond my control. I needed to have it compared to diabetes, a condition that constant medication makes manageable, in order to not see this as a personal weakness."
What convinced Deborah, a 38-year-old Boston-based mom of three who took antidepressants for her last two pregnancies, was when her doctor told her that studies show it's worse for a mom to be depressed and carry a baby than it is to be on medication.
Other women report similar experiences.
"I was prepared to stop as soon as I learned of my pregnancy, but my doctor told me it would be more dangerous to stop than to just keep taking them," says Shell Fruscione, a 21-year-old mom of a 5-month old boy in Las Vegas who had been taking Sertraline, the generic version of Zoloft, for a year before she got pregnant. "He assured me that he personally had had many patients who took antidepressants throughout their pregnancies and had no complications whatsoever."
Not all physicians feel that way, however, and a lot of it has to do with the lack of convincing evidence about the effects of the drugs on the safety of the fetus.
"There doesn't seem to be a general consensus throughout the medical field regarding this," Fruscione says in an e-mail to ParentDish. "Most of my own research confirmed that many antidepressants are Class B drugs (which are presumed safe for pregnant women), but still I had a lot of doctors look at me like I had three heads when I listed my current medications. I wish that the medical associations would at least address the issue because in those situations I was made to feel guilty or less than worthy for 'subjecting' my unborn son to the medication even though the risks of discontinuing use greatly outweighed the risks, in my case, of continuing."
Katherine Stone, a 40-year-old Atlanta mother of two, agrees and is frustrated that many people don't realize how dangerous untreated depression can be to both the mother and the fetus.
"The absolute risk of birth defects is small but still exists," she says in an e-mail to ParentDish. "It can impact birth weight and preterm delivery, but so can depression and anxiety during pregnancy." Stone is the founder and author of "Postpartum Progress," as well as a board member of Postpartum Support International.
As of August 2009, a joint report from the American Psychiatric Association and the American Congress of Obstetricians and Gynecologists recommended that "psychiatrically stable women who prefer to stay on medication may be able to do so after consultation between their psychiatrist and ob-gyn to discuss risks and benefits." In addition, "women with severe depression (with suicide attempts, functional incapacitation or weight loss) should remain on medication."
These are simply guidelines, not rules or laws, that physicians are required to follow. And many are still reluctant to offer approval.
"My doctors initially made a big stink about me using Lexapro while pregnant," says Carrie, a mother of three in Louisville, Ky. "When I gave them my informed consent that I would continue my meds and then mentioned newborn pulmonary hypertension, they said that this was highly unlikely, and more likely (to happen) was low birth weight, which made me wonder why they were so concerned about it in the first place. I think the only reason they made such a big deal was liability."
With so many doctors unable -- or unwilling -- to give a definitive statement on whether or not to take antidepressants during pregnancy, many moms-to-be do their own research to facilitate an informed choice.
Lisa Humphries, a 36-year-old Australian mother of a 6-month-old boy, learned through her own investigation that the known risks of taking an SSRI (Selective Serotonin Reuptake Inhibitors -- mood boosters such as Zoloft, Prozac, Paxil, Celexa and Lexapro) during pregnancy "are still not 100 percent clear, however the risk of me relapsing was pretty much a certainty because I had tried many times over the past five years to come off my medication unsuccessfully."
When doctors are ambivalent about pregnant women taking these drugs, often times a mom isn't getting the help she needs.
"The way I went on Zoloft for the first time was nothing short of bizarre," Washington, D.C. mom McIntyre recalls. "I was trying to get an appointment with a psychiatrist who took my insurance. I was calling in May and being told that doctors had appointments in July. I even told one receptionist, 'I'll probably be dead by then, but thanks anyway.' "
McIntyre eventually found a doctor who gave her a prescription.
"The meds were like a miracle to me," she says. "I felt like someone opened up my head and pushed the 'restart' button. A few days after I started taking them, my husband looked at me and said, 'You're back.' "
When Boston mom Deborah heard that some studies indicate taking Zoloft and other SSRIs during pregnancy can result in a lower birth weight for the baby, she laughed.
"That's really funny," she says. "I had giants. And they were all three weeks early. At my third delivery they told me the baby was nine-five and I said, 'Oh, is that his Apgar score?' and they said, 'No, that's his weight.' I was like, 'No wonder I feel like sh*t.' "
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