Monday, February 7, 2011

Not Just Another Anti-Depressant. Not Just Another Pregnancy.

There is a fine line between being informed and knowing too much.

I work in media/public relations, specifically in pediatric health care. Public relations and sick kids either work wonders together, or are completely conflicting. Nothing makes the headlines more than "1-year old lives over all odds: doctors call her miracle child". Actually, something always does: bad stories. Stories about tiny babies born with awful congenital disorders, toddlers dying in the ER from shaken baby syndrome, little kids with brain cancer, mothers who die on the delivery table only to have their baby die a day later. 

There is a lot of wonderful things going on with child health care and research. But for all the press releases I send out on new discoveries for cutting-edge treatments or new preventative approaches to an illness, I get 100 news stories on how our kids are the unhealthiest they ever have been, or how many kids are not getting what they need. For all the heart-warming stories about how communities pull together to raise money for a family who can't afford medical treatments, there are 100 more about how families fall apart in times of turmoil... because there is little you can do when your child is sick with something a mother's kiss won't heal.

I like my job in the sense that I need to read a lot about maternal and child health. I like being in the middle of touchy topics like vaccines and ADHD and breastfeeding and stem cell debates and women over 40 getting pregnant. I like having access (without having to search for it) to numerous sides of each equation. I like knowing the benefits and consequences to something.

Or do I?

Generally... and I really do mean generally... when it comes to depression and pregnancy, taking anti-depressants isn't the most optimal choice, but if the benefits of treatment outweigh the risks, some doctors will suggest staying on meds throughout the pregnancy. And some are vehemently against it.

I have read enough to know that the risk to the fetus of taking an anti-depressant is quite low. Note my emphasis on the singular. Here's where I lose myself. I'm not on an anti-depressant, I'm on a cocktail of head meds. I have come off two over the past year or so - with a lot of complications - but I still take a few more. I don't have the kind of depression that a low dose of Prozac is going to take care of. My depression is - or should I say was (?) - extremely abnormal. Like shock-treatment, isolation-for-10-days, been on every head med I know about kind of depression. Like the kind where people are not sure what to tell you when you say you want to die, because they can tell how much pain you're in. Like the kind of depression that I can honestly say I didn't believe for a second I'd live past age 21.

Now, I'm better. I've been stable for many years, but it took even more years than that to find a balance of meds that worked (coupled with therapy) and I'm terrified to fuck with that. My shrink does truly believe that the benefits of me keeping most meds the same WAY outweighs the risk of changing/coming off them all. But I don't want to add even a 0.00012% risk to a fetus.

In the grand scheme of medical research, there is very little data on pregnancy and head meds in the first place (really, who wants to be in THAT study). There is absolutely no data on the combination of meds that I take and pregnancy, that I can find. All I have is information on the individual Rxs... and that info isn't confidence-building on the best of days.

If a pregnant woman is being treated with anti-depressants, it can be associated with low birth-weight, developmental problems, heart defects, cleft palate, to name a few. And the flip side? If a pregnant woman with depression remain untreated, it can be associated with low birth-weight, developmental problems, premature birth (causing heart problems and many other health problems). And, as numerous people have pointed out, every child is at risk of anything... regardless of their prenatal pasts.

I want to go into the pregnancy informed, and I want to feel confident in the choices I end up making. I obviously want to do what's best for everyone involved (baby, me, partner). I want to stay healthy, and I want my baby to be healthy. 

I know myself well enough to know that coming off my meds is life-threatening. I also know myself enough to know that I will read every single one of those awful articles that tell mothers that if they don't do everything naturally - from not eating sugar to refusing an epidural - that they are bad mothers. I will read every study I can get my hands on and will freak out about the 0.00012% chance that my baby will end up with a cleft palate and think I'm awful for taking that risk.

I will do everything I can to be informed... I just fucking wish sometimes that I was a straight girl who could get knocked up and could figure this shit out as I go. But no, I have to plan every step.

Tomorrow, I will try to find a positive headline to start my media report. Those ones really do make you realize that regardless of what happens, there are people who support and love you. Something everyone deserves - whether you're 1 month old, or a hundred.

4 comments:

  1. Can you use your eggs and use a surrogate to carry thus it is biologically yours and you can still take meds once your eggs are retrieved? With so many surrogacy here and in India it is a real option. The good thing is you can return to all your meds after 3 months of pregnancy I would assume. This is an amazing journey you are on and I have confidence you will make great choices.

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  2. Hang in there, lady. This definitely is a thought inducing post! You make many good points and I agree with you that it is difficult to consider TTC when you know more than the average person about a variety of topics. You have overcome so much and are finally at a point where things are heading in the direction that you have been dreaming of...you and D will find a way to make this work :)

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  3. That's such a hard decision. I tend to think that whatever is best for the mom is best for the baby--that putting yourself in harm's way to avoid the possibilities of risk to the baby isn't worth it. But I think that it's going to be a personal decision that you work out with your doctors. Can you look at each individual med that you're on and compare results to see what issues they cause? I know that doesn't address issues of them interacting, but it might give you a ball-park idea of what you're looking at?

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  4. Oh my god, do I know some of the struggle you're experiencing. :( My wife carried our first baby, and the plan is for me to carry the second. Last year, after being diagnosed with Bipolar I following a really scary mania, I was told by pretty much everyone that meds were my only option.

    But here's the thing, every cell in my body knew that wasn't right. (For me. I know what I'm about to say doesn't apply to everyone.) I'd read way too much about the chronic damaged cause by long-term psych meds, and I approach everything naturally - I didn't want this to be any different.

    But the biggest motivation was knowing that I would be pregnant in the next year or two. I read study after study, and made myself crazy (or more crazy!) over it.

    Fortunately, just as I was about to give in and go on meds (because I'd already put my wife through hell, and I was so desperate to not lose her), I found a therapist who recommended Empower Plus (http://www.truehope.com/default.aspx). I've been on it for 9 months now, and not only have I not had a single episode of mania or depression ever since, I feel like myself again for the first time in years.

    Not that everything is perfect. It's not. I've had my struggles to remain balanced and stable. But a lot of that can be chalked up to being the stay-at-home mom of a toddler...as my therapist has said more than once, being a parent leaves even the most stable people at their wits end sometimes! It is one tough job. But oh my god is it worth it. :)

    I also use other supports, such as daily morning meditation, yoga, adequate sleep, mindfulness, a high quality DHA (fish oil) supplement, etc. to keep myself balanced. But Empower is my foundation.

    All this to say, there are non-med options. Granted, I'm speaking from a bipolar standpoint, but Empower is also used to treat major depression, with great success. They have support people who walk you (and your therapist or doctor) through weaning off any current meds and getting on Empower successfully. I know it's not an easy path, but I've talked to more than one person who is so glad they did just that.

    And here's the kicker - when I asked the Empower folks if I could be on it while pregnant, instead of listing the risks (as so many psychiatrists had done for me when discussing psych meds), they talked about how some pregnant women go on Empower just because it is so HEALTHY for the baby. That's right. Not only can I stay on Empower while pregnant, my dose will actually go up slightly to help my body and brain with the added stress of pregnancy. And it will take the place of a prenatal vitamin.

    Ah. Okay. I'm sorry to go on and on. But on the off chance you hadn't heard of it, and on the further off chance that it's something you would want to consider, I had to share my two cents (or twenty cents).

    Good luck. Take care. I'll be here, following along, and cheering you every step of the way (no matter what you do or don't do with meds - that is such a very personal decision!!). Your strength is giving me renewed courage for the next step on my own journey.

    Thanks for sharing and for reaching out. :)

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