It started with plumbing. And no, I’m not using a cute term for my genitourinary anatomy. I mean actual plumbing. When I was pregnant with my second child, I became obsessed with the idea that our house had leaking pipes everywhere. I was absolutely convinced that I would wake up one morning and find our home sinking into the earth, a result of those leaking pipes bursting and ripping the house from its foundation. (My knowledge of engineering and home construction is admittedly poor; I have no idea if burst pipes really do this.) To calm my fevered brain, I began checking pipes under the sinks for leaks. I checked our first-floor ceilings for water stains. I checked the floor around our toilets, convinced there was water seeping from the caulking. I could not leave the house in the morning or go to sleep at night until I “made my rounds” and assured myself that the house was leak-free. My older daughter, who was two years-old at the time, certainly suffered the consequences of my hypervigilance; when I should have been enjoying her, I was checking, checking, and checking again. I still met all her necessary physical needs, but her emotional needs were definitely shoved aside because I could not stop checking. The need to check was simply irresistible.
I also involved others in my pipe-leak obsession. I called our plumber and scheduled appointments with him – and I truly do not exaggerate – about once a week during my second trimester. On one particularly humiliating day, I somehow pulled the toilet out of the floor in our half-bathroom. I was checking for water around the toilet and, when I couldn’t find any, I decided there must be water leaking into the sub-floor that I couldn’t yet see. So I began pulling the toilet and I pulled and I pulled until there was a crack in the caulk and – voila! – the toilet and floor were separate entities. (Turns out, there was no water in the sub-floor. Nope. The only thing that definitely was there was a very mystified, rather frightened plumber.)
Until that day, I had done a fairly impressive job hiding all these behaviors from my husband because I was so embarrassed by my actions. However, it’s hard to hide a plumber, a free-standing toilet that should not be free-standing, and ripped flooring. (My husband came home from work early that day. And yeah, he noticed that something was amiss.) That was the day my husband sat me down and told me that it was time to a) restart my anti-depressant medication, b) see a therapist, or c) do both a and b.
I have taken a selective serotonin reuptake inhibitor (SSRI) for depression for about a decade. For both my pregnancies, I weaned myself off the SSRI as soon as my husband and I began trying to conceive. With my first pregnancy, I eventually resumed a low dose of the SSRI in the third trimester because my obstetrician felt my depression was affecting my physical health. (The main concern was that I was losing weight.) My first daughter was born full-term with a perfect Apgar score and is now a healthy, happy six year-old.
Before my second pregnancy, my only formal (i.e., professionally given) mental health diagnosis was that of depression. Once I began seeing a psychologist for talk therapy (after the Great Toilet Caper), I was given a second diagnosis: Obsessive Compulsive Disorder (OCD). That wonderful psychologist, with her spot-on diagnosis, gave me the great (and often underestimated) gift of clarity. My past behaviors and anxieties made so much sense now. When I was in medical school, I spent hours engaging in lengthy decontamination processes when I got home from the hospital. At all points in my academic career, I wasted scads of time re-checking notes I had taken from textbooks, convinced I had missed something or copied something incorrectly. The first home I owned as an adult was a tribute to my as-yet-undiagnosed OCD; all the lamp shades had to be precisely parallel to the tables beneath them and I could not go to bed until they were perfect (and they never were, so I was always exhausted). In short, I wasted mountains of compulsive energy on molehills of obsessions.
Until my second pregnancy, I had never sought therapy (nor had it ever been professionally recommended). Therapy was enlightening, soothing, and helpful; however, because my physical health was (once again) sub-optimal (weight loss, mainly), both my psychologist and my obstetrician advised me to restart my SSRI at the lowest dose in the third trimester.
Did the SSRI help me in my third trimesters? Absolutely. I began sleeping well (“well” being a relative term in pregnancy, of course). My appetite returned and I gained the appropriate amount of weight. The intrusive obsessions were still there (and still are there, to this day) but I was able to control my response to them with positive self-talk instead of time-wasting, energy-zapping, mood-killing compulsions.
So, what’s the story with my second daughter? Has her health been affected by my choice to use an SSRI in the third trimester? The short answer? I’m not sure. And that scares the hell out of me. My younger daughter was born full-term with a perfect Apgar score. She met all the usual physical and mental developmental milestones for the first two years of her life. She is almost four year-old now and I have concerns about her emotional and social development. She is emotionally labile. She acts like a one year-old most of the time. She has no interest in learning skills of which she is physically capable (riding in a “big kid” swing, riding a tricycle, using the toilet, playing with other children). She is extremely withdrawn around others her own age. Maybe this is a phase. Maybe it’s not. (And yes, before you ask, she is meeting with a behavioral specialist later this month for a developmental assessment.) Is she autistic? Does she have Asperger’s? Does she have an unspecified developmental delay? And, if she does have any of the above, could I have prevented it by not taking an SSRI during pregnancy?
Last month, The New York Times published an article reviewing the latest research on SSRIs during pregnancy. The findings reported there are disturbing, to say the least. According to some newer studies, prenatal exposure to SSRIs increases the risk of developmental delays and autism. One study found that boys with autism were about three times more likely to have been exposed to SSRIs int he womb than were boys without Autism. Other research suggests that SSRI use in pregnancy is associated with reduced language skills in children by age 3.
What does this mean for pregnant women with depression (or OCD, which is also treated with SSRIs)? There is no simple answer. Yes, the latest research seems to make it obvious that SSRIs should not be taken during pregnancy. However, as Dr. Roy Perlis, a Harvard professor of psychiatry explains, “the severity of the depression or anxiety (for some women) can make it very hard for them to take care of a child (pre- or post-birth), and is such that their life is at risk if they’re not treated (with medication).” According to Dr. Perlis, it is imperative to understand that women with mental illness are more likely to have children with developmental disorders independent of their SSRI use.
What does this mean for me? Personally, if I could go back in time, I would not have taken SSRIs in either pregnancy. The newest research is compelling. Every time I look at my younger daughter struggle to try something age-appropriate, I wonder…is it because of the SSRI? Every time she cries like an infant for no discernible reason, I wonder…is this because of the SSRI? Every time she frantically clutches to me when a child approaches her, I wonder…is this because of the SSRI? I wonder every day…is this all my fault?
I wish I had realized the importance of therapy long before my first pregnancy. Perhaps long-term therapy would have allowed me to temporarily conquer my demons during pregnancy, or to at least control them enough to preserve my physical health. Perhaps. I can’t possibly know what would have happened in an SSRI-free pregnancy because I didn’t choose that path. I only have the path I’m traveling now. It’s a path that includes my daily SSRI, because without that medication, my obsessions and compulsions take control. It’s a path filled with my daughters, whom I love limitlessly. It’s a path that leaves behind regret for past decisions. It’s a path that must focus entirely on the present and future, because it’s a path for my family’s and my health and happiness.
This blog was originally published on October 17, 2014 on the Women’s Health Foundation Community Blog.
(Photo credit: www.mentalhealthnews.org)