Why I Stayed On Antidepressants During Pregnancy

When my daughter, Celine, was born in May, she decided to enter this world face-up. If you’re like me, you didn’t imagine this to be much of a complication; “same head, same hole,” was my first thought upon hearing of her atypical orientation. Eighteen hours of labor later, when she emerged bruised and a bit indignant, I had learned for myself just how difficult it can be to get a baby so positioned past one’s pelvic bone. Thanks to some skillful (if much protested) snipping by my OB, I narrowly avoided an emergency c-section and moments later laid eyes on my baby girl for the first time, just as the doctor exclaimed: “Wow! Her face is all fucked up right now; but don’t worry, it’ll go back to normal very quickly.”

But when asked—as I often was in the early days—if that slightly savage delivery was the hardest thing I’d ever done, my answer was an easy no. The hardest thing I’d ever done was recover from clinical depression as a teenager. That made delivering a sunny-side up baby look like a day at the beach.

I was fourteen years old when I was diagnosed with “double depression” - dysthymia (persistent, long-term depression) coupled with acute depression (which manifested in a penchant for crying for hours on end each day.) After years of trying everything suggested by experts, doctors, and my parents, Zoloft was the first thing that actually worked. After three weeks of increasing dosage, I felt the first glimmer of hope I’d felt in a long time. At six weeks, I started to feel the veil of inescapable sadness lift. Over time, as I improved and my life started to take another shape, a secondary diagnosis and consideration led my doctors to add in Ritalin.

There’s nothing like having a chemical imbalance corrected to convince you of its power in the first place, but believe me when I say that there’s no simple pill that fixes everything. Starting these medications were landmark moments in a lifelong quest to keep what Winston Churchill called “the black dog” at bay.  Happiness remains the thing I still work the hardest at in my life; something I have to choose. I still rely heavily on myriad tools to stay well: support systems, physical exercise, a gratitude practice, sleep, doctors, community service—and, of course, medication.

And while I no longer identify as a girl drowning in sadness, but rather as someone overwhelmingly recovered, life-loving, and stronger for having gone to battle, any contentment and peace I feel now is still tinged with the weariness of something hard-won, mixed with the bittersweet undertone of a fear, always, that this may pass. I don’t know if other people rest easy in their happiness. For me, happiness is accompanied by the whisper that I might have to work very hard to get back here again; that I cannot take it for granted as my resting state. So I have learned to protect my mental health, and everything that helps me sustain it, with every arrow in my quiver. That was not going to change when I got pregnant.

A lot of people have told me how brave it was to stay on my medication when I got pregnant, and also to speak about it so openly. I’m not sure that’s how it feels—it seems a whole lot braver to make the decision to get off of medication one desperately needs to pursue the dream of having children, as many of my friends who need other treatment that is not safe during pregnancy have had to do.

According to the Mayo Clinic, “Experiencing major depression during pregnancy is associated with an increased risk of premature birth, low birth weight, decreased fetal growth or other problems for the baby. Unstable depression during pregnancy also increases the risk of postpartum depression and difficulty bonding with your baby.” When I asked my psychiatrist if it was safe to stay on Zoloft and Ritalin through pregnancy, she shared some research and potential risks and side effects with me, the short version of which was “the data is spotty and problematic, but it seems mostly fine.” It was easy for both of us to come to the conclusion that given the minimal risks and my personal history, we were very comfortable proceeding with the research-approved dosage.

And yet, the overwhelming reaction to my choice—surprise, admiration of my “bravery”, and often whispered pleas for more information from women struggling in private with the same question—speaks not only to the stigma and ignorance that still exists around mental health and treatment, but also to the taboo surrounding pregnant women and mothers choosing themselves even as another soul enters the scene. It is one of those deeply frustrating realities that there has been a massively inadequate amount of money dedicated to studying women’s health, and answering so many of the infinite questions that come up during pregnancy. In the meantime, the lazy solution to so many old fashioned assumptions has been that women should compensate for a lack of science by simply putting aside not only conveniences when pregnant but by and large any modern intervention that may leave them less pure a vessel for the baby. I have seen this kind of thinking cause unnecessary guilt around everything from reproductive health to formula-feeding to caffeine consumption - and don’t even get me started on my decision to continue with my bi-monthly hair highlights.

In the end, Celine was a whole handful when she was born. As we visited with friends who had also recently become parents, and gingerly laid our respective infants down next to each other on colorful mats, Celine repeatedly struck a stark contrast thanks to what one pediatrician generously called her “powerful” and almost relentless wail. I wondered when other babies born days or weeks after her might “catch up” to all the fuss, but instead my mom group chats continued to light up with stories of younger babies sleeping through the night, breastfeeding lovingly, and just generally making life more wonderful, not more challenging, for their besotted parents. Even I—formerly so confident in my decision—began to wonder if I had, in fact, done—or taken—something to make her this way.

The truth of the matter is that for all of my clarity about what “choice” to make as I got pregnant, I held off on writing this until I was sure that she was…okay. But now I realize that she is more than okay. She is four months old and not only happy and wonderful, but also just, like, a baby. Of course she cried and struggled to sleep and breastfeeding is challenging and all of it is absolutely confounding and frustrating and becoming a parent is just so goddamn hard, especially when you add recovering from physical birth into the mix. There are a million ways I could have messed her up (I ate sushi? I used the microwave?), or completely had nothing to do with who and how she is, and no one will ever know.

But what I never wondered, even when I did worry, is if I would have made a different decision if I could go back and do it all over again. I am grateful that I had every tool available to me to meet the challenges of each of those early days with a baby who needed me to show up with extra strength, resilience, and patience. Rather than focusing on the ways in which I might have messed her up, I realized that I could focus on knowing that I helped her get to the happy, healthy baby she is today. In what feels literally superhuman when you’re first doing it, I was able to show up over and over again to feed her, to soothe her, to love her, and to take care of her. All of this because I loved and took care of myself first. And for that, I have no guilt.