Decision
The Friday before last, I reached 26 weeks in my pregnancy. Third trimester has now begun. This milestone brought with it (quite promptly, I have to say) a sudden, marked increase in uncomfortable Braxton-Hicks contractions, which kind of freaked me out until I talked to the midwife on call that Sunday night, and she reassured me. I've also been getting winded much more easily lately, and sometimes my heart rate goes up above 100 for no apparent reason. And with my big belly, I'm having a harder and harder time slipping, say, between the IV pole and the privacy curtain, or past the other nurse in the med room to get to the automated dispensing computer.
The kid is moving around in there a lot, which I guess is kind of fun, if distracting, and last Sunday Cassie actually got a chance to feel it with her hand. So that was cool. But mostly I'm getting irritated with and tired of this whole pregnancy thing, a feeling I try hard to suppress, since with any luck, I'll be suffering through it for another 3 months. (You hear me, little one? I may kvetch and moan, but you are forbidden to pay any attention. You have to stay in there at least until mid-February, okay?) Novelty and fascination got me through most of my first pregnancy, and besides, I kind of didn't mind waiting, what with anxiety about being a parent and worries about labor and delivery. This time around, though, the crankiness and impatience are setting in way earlier.
The other thing that's different about third trimester this time is that I'm now on Prozac. So I have to make a decision. Some studies have shown neurological symptoms in newborns of moms taking SSRIs during the last months of pregnancy--mostly hypertonia (being too tight, as opposed to being too floppy) and difficulty initiating breastfeeding, as I recall (but don't quote me--it's been a while since I read about it). For a long time, I pretty much assumed that I would stop taking the drug as soon as Week 27 rolled around. I was feeling really pretty solid, emotionally, and thought I might not even relapse if I went off. And anyway, I figured, I've gotten along with untreated depression for a lot of my life, so what's a couple months, in the scheme of things? We're talking about the health of my baby, here. My shrink did seem a little leery, and made jokes about coming to the delivery room with a Prozac IV drip to start as soon as the kid was out. But basically I felt good about the decision.
It so happened, though, that during the week of hospital and nursing orientation for new hires at OFH, I noticed a posted notice while waiting for an elevator. **Pregnant? Depressed? Taking Antidepressants? Do you have questions about depression and antidepressants in pregnancy?** Um, why, yes, I do! Please tell me more, yellow xeroxed sheet of paper! The obliging piece of paper explained that OFH researchers were conducting an observational study of pregnant women with a history of depression. So I used the campus phone on the opposite wall to call the number, and got set up with an appointment for an initial intake visit.
So basically, a research assistant does the initial interview, asking a bunch of the kinds of questions you would expect, about history of depressive episodes and history of treatment and stuff. And then you get to talk to one of the MD study investigators, who does a bit more interviewing, and then you get to ask anything you want. So I laid out what I was aware of, and how I'd made my decision thus far, and asked what she thought. And she was great--nonjudgmental, thorough, thoughtful, and able to pick up on the fact that I had a certain relevant knowledge base already, so she didn't talk down to me at all. And what she said was this: there were two studies published looking directly at this question of the effects on babies of their mothers having been on antidepressants during pregnancy. Both had small N's (she couldn't remember exactly, but on the order of 20 subjects each), and in neither of them were the observers blinded to the exposure status of the babies. (Jeez. Way to go with the study design, people.) She said that, yes, they did find some evidence of some neurological effects on the newborns of mothers who took SSRIs during their 3rd trimester, but it was also notable that they did not control for the severity of the mother's depression, which may itself have an effect. Furthermore, all the effects noted were within the first 48 hours of life. They didn't see anything longer lasting than that. Finally, she pointed out, other studies have shown a many-fold increase in the risk of postpartum depression in women who go off their antidepressants for even a few weeks, as compared with those who stay on.
So basically, my understanding is that even if the effects observed in those studies are absolutely real, and even if you could say with 100% confidence that everyone would have them, you're weighing two days of neonatal neurological symptoms versus a greatly increased risk for maternal postpartum depression. Another thing to consider, the psychiatrist lady said, was that I was on fluoxetine, which has a very long half-life and may well not have the same kind of withdrawal pattern seen with shorter-acting SSRIs. Besides which, I was on a relatively low dose (20 mg), which I should also take into account.
And so I'm staying on my lovely little white ovals. My reasoning now is that I have duties not only to my newborn during the first two days of life, but also to Cassie, and to the baby over the course of its babyhood, and to my patients when I go back to work, and to my marriage, and to myself. A high risk of depression undermines my ability to be fully there for all of the above. And for Cassie, particularly, this is going to be kind of a dicey moment. It's not even the risk of Mama being depressed for a while any old time--this is the period when she gets her blissful only-child life irretrievably altered through no fault of her own. I just need to try to be there for her as much as I possibly can, given the circumstances. The squally, poopy, absorbing, exhausting, distracting, ever-present circumstances.
I feel even more solid about the decision as a few times in the last couple weeks, I've felt for a few hours or a day the front edge of a depression. It ebbs away again, and I'm fine, but newly sobered by what exactly depression means. The gray, heavy kind, and even worse, the sickly yellow-brown miasma kind that taints everything it touches and makes it seem that there is nothing sound or bright or wholesome in the world. Feh. Good riddance.
The kid is moving around in there a lot, which I guess is kind of fun, if distracting, and last Sunday Cassie actually got a chance to feel it with her hand. So that was cool. But mostly I'm getting irritated with and tired of this whole pregnancy thing, a feeling I try hard to suppress, since with any luck, I'll be suffering through it for another 3 months. (You hear me, little one? I may kvetch and moan, but you are forbidden to pay any attention. You have to stay in there at least until mid-February, okay?) Novelty and fascination got me through most of my first pregnancy, and besides, I kind of didn't mind waiting, what with anxiety about being a parent and worries about labor and delivery. This time around, though, the crankiness and impatience are setting in way earlier.
The other thing that's different about third trimester this time is that I'm now on Prozac. So I have to make a decision. Some studies have shown neurological symptoms in newborns of moms taking SSRIs during the last months of pregnancy--mostly hypertonia (being too tight, as opposed to being too floppy) and difficulty initiating breastfeeding, as I recall (but don't quote me--it's been a while since I read about it). For a long time, I pretty much assumed that I would stop taking the drug as soon as Week 27 rolled around. I was feeling really pretty solid, emotionally, and thought I might not even relapse if I went off. And anyway, I figured, I've gotten along with untreated depression for a lot of my life, so what's a couple months, in the scheme of things? We're talking about the health of my baby, here. My shrink did seem a little leery, and made jokes about coming to the delivery room with a Prozac IV drip to start as soon as the kid was out. But basically I felt good about the decision.
It so happened, though, that during the week of hospital and nursing orientation for new hires at OFH, I noticed a posted notice while waiting for an elevator. **Pregnant? Depressed? Taking Antidepressants? Do you have questions about depression and antidepressants in pregnancy?** Um, why, yes, I do! Please tell me more, yellow xeroxed sheet of paper! The obliging piece of paper explained that OFH researchers were conducting an observational study of pregnant women with a history of depression. So I used the campus phone on the opposite wall to call the number, and got set up with an appointment for an initial intake visit.
So basically, a research assistant does the initial interview, asking a bunch of the kinds of questions you would expect, about history of depressive episodes and history of treatment and stuff. And then you get to talk to one of the MD study investigators, who does a bit more interviewing, and then you get to ask anything you want. So I laid out what I was aware of, and how I'd made my decision thus far, and asked what she thought. And she was great--nonjudgmental, thorough, thoughtful, and able to pick up on the fact that I had a certain relevant knowledge base already, so she didn't talk down to me at all. And what she said was this: there were two studies published looking directly at this question of the effects on babies of their mothers having been on antidepressants during pregnancy. Both had small N's (she couldn't remember exactly, but on the order of 20 subjects each), and in neither of them were the observers blinded to the exposure status of the babies. (Jeez. Way to go with the study design, people.) She said that, yes, they did find some evidence of some neurological effects on the newborns of mothers who took SSRIs during their 3rd trimester, but it was also notable that they did not control for the severity of the mother's depression, which may itself have an effect. Furthermore, all the effects noted were within the first 48 hours of life. They didn't see anything longer lasting than that. Finally, she pointed out, other studies have shown a many-fold increase in the risk of postpartum depression in women who go off their antidepressants for even a few weeks, as compared with those who stay on.
So basically, my understanding is that even if the effects observed in those studies are absolutely real, and even if you could say with 100% confidence that everyone would have them, you're weighing two days of neonatal neurological symptoms versus a greatly increased risk for maternal postpartum depression. Another thing to consider, the psychiatrist lady said, was that I was on fluoxetine, which has a very long half-life and may well not have the same kind of withdrawal pattern seen with shorter-acting SSRIs. Besides which, I was on a relatively low dose (20 mg), which I should also take into account.
And so I'm staying on my lovely little white ovals. My reasoning now is that I have duties not only to my newborn during the first two days of life, but also to Cassie, and to the baby over the course of its babyhood, and to my patients when I go back to work, and to my marriage, and to myself. A high risk of depression undermines my ability to be fully there for all of the above. And for Cassie, particularly, this is going to be kind of a dicey moment. It's not even the risk of Mama being depressed for a while any old time--this is the period when she gets her blissful only-child life irretrievably altered through no fault of her own. I just need to try to be there for her as much as I possibly can, given the circumstances. The squally, poopy, absorbing, exhausting, distracting, ever-present circumstances.
I feel even more solid about the decision as a few times in the last couple weeks, I've felt for a few hours or a day the front edge of a depression. It ebbs away again, and I'm fine, but newly sobered by what exactly depression means. The gray, heavy kind, and even worse, the sickly yellow-brown miasma kind that taints everything it touches and makes it seem that there is nothing sound or bright or wholesome in the world. Feh. Good riddance.
posted by Rosie Bonner at 4:11 PM
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