Taking Antidepressants During Pregnancy and Nursing

Coming to terms with taking care of myself

A month after my first baby was born I began thinking about death. My husband had recently lost his job, breastfeeding was extremely difficult, and we had just moved. And somehow these very real stresses found their way into fantasy. I became convinced that car rides with my baby or flights with my husband would end in accidents. Family trips became a trigger for panic, and I was soon living with a daily fear of the imminent death of the two people I loved most in the world. When my son was 7 months old, I picked up the phone to call for help.

I had found descriptions of my symptoms online, but every article said they signaled postpartum depression. I didn’t feel depressed, but something from Psych 101 in college kept coming back to me. My professor described the “fight or flight” response by asking us to imagine how our bodies would feel and how our mind would respond if we were walking through the forest and suddenly came face-to-face with a tiger. That was how I was feeling every day, and it was exhausting. I spent much of my time in bed with my baby, and I realized that I was not going to be able to make these feelings go away by my will alone.

Putting a plan in place
I met with a few different psychologists before finding someone who instilled courage and optimism in me, and then I began therapy along with my own self-improvement project. I increased my cardiovascular exercise, began eating more fruits and vegetables, prayed and meditated, worked on getting enough sleep, wrote in my journal, took B vitamins and mineral supplements, and focused on thinking rational thoughts. All these changes helped but were not enough.

My therapist recommended talking to my doctor about taking the antidepressant Zoloft to help rebalance the chemicals in my brain and alleviate my anxiety. I was nursing, so I was apprehensive. Evidence had just come out that Paxil, another antidepressant, might cause birth defects, and I worried that the medication would pass to my baby through my breast milk and harm him.

I spoke with my OB, my midwife, my family doctor, my aunt who is a nurse midwife, and others. The resounding message I heard from them was that even though there could be unknown risks to taking Zoloft while breastfeeding, I had to get better in order to take care of my baby. It was apparent I needed the help of medication to do it, so I took their advice.

Medication made the difference
The results were amazing: I became the mother I had imagined I would be. I was able to take my attention off the anxiety and turn it to my baby and husband. I had the energy to be silly and fun, to bond with my baby, and to revive my relationship with my husband – all of which had taken a backseat to the vigilant tasks of fear and worry. Eventually I stopped therapy but continued the lifestyle changes.

Over the next two years, I tried a few times to wean off the medication, but the debilitating anxiety flooded back and each time I decided to return to the medication. When I discovered I was pregnant with my second baby, I weaned off Zoloft again. But the racing heart, heavy chest and exhaustion set in as the worries became unmanageable on my own.

So I weighed my options. I knew that some of the drug would pass to the baby through my placenta but so would my stress hormones. Which was worse? I wasn’t sure, but I knew that I could not take care of myself and my older son when I was consumed by constant irrational thoughts. I decided to go back on Zoloft and continued taking it through breastfeeding.

Coming to terms with my choice
It was not an easy decision. I felt guilty taking medication that might affect my baby. I blamed myself for not being able to handle things on my own, and I sometimes second-guessed my choice. For example, my younger son’s ears don’t look exactly alike. I asked several pediatricians if this could have been an effect of the medication, but they all called it a normal anomaly.

He is also an incredibly happy child, which made my husband wonder if my mood-boosting drug had the same effect on the baby. Again, my pediatrician was reassuring. She said she knew plenty of mothers who took anxiety and depression medications while pregnant and nursing whose children were not so happily disposed.

Now that my son is 8, transitions are becoming difficult for him, and he worries about events before they happen. I often ask myself: “Is this normal 8-year-old behavior? Is it a genetic trait from my side? Is it because I tried to stay off Zoloft during my first trimester and my stress hormones passed to him? Or is it the result of the medication?”

And even as I ask these questions, I do know that I made the right choice. I was very sick and I needed to treat myself in order to take the best possible care of my children, whether it was while I was growing them or nursing them. When the worries creep in, I try to focus on the many positive traits I have passed on to my children.

And it’s still important to take care of myself as I am raising them. As I’ve reflected over the past decade on my kind, well-mannered, and (dare I say) gifted children, the overwhelming feeling I have is gratitude that I took care of myself so that I could learn to enjoy the journey of motherhood.