06 October 2009

Hesistatingly offered free unsolitcited advice!

When it comes to clinical depression, I am a lifer. Because I have had more than three episodes of major depression, the likelihood of me slipping into this state again is too strong to risk going without medication. So Depression is a Dilemma for Women in Pregnancy, in today's Science Times, caught my attention.

I cannot live without antidepressants, pregnant or not. I suffered crushing postpartum episodes after the birth of my first two children, because I stupidly, and against my doctor's advice, tapered my medication back to a minimal dose during these pregnancies. Because I was feeling great throughout the pregnancies, I didn't want to expose my developing babies to more medication than was necessary. The result was what my psychiatrist called double-depression; ie, someone with a predisposition toward depression + postpartum hormonal surges = initial elation followed by an ENORMOUS crash.

When I was pregnant with Sacha, in consultation with my doctors, we decided to keep my medicine at my therapeutic dose. In my third trimester my psychiatrist considered lowering the dosage during the last few weeks of the pregnancy and immediately increasing it back to my therapeutic level upon giving birth, because there were some slight risks to the baby. Ultimately, we decided that the risks to the baby were small, and not serious enough, compared with the possibility of another postpartum episode, to warrant tapering down my medication.

In part because of this decision, Sacha ended up spending sixteen days in the NICU. He was a pokey nurser, but we brought him home from the hospital, unconcerned, two days after he was born, as I'd breast fed two children and was confident we'd get the hang of it. When he was seen by our pediatrician for his first newborn well visit, Sacha had lost almost 10% of his birth weight, and we were instructed to keep an eye on him for any changes in behavior, and return the next day for a weight check.

That evening, we did indeed see changes in his behavior. He was sleeping an alarming amount, even for a newborn, had no suck, refused a bottle, and kept falling asleep at my breast when I attempted to nurse him. When we were reduced to pumping breast milk and administering it via syringe, we called the doctor, who instructed us to take his temperature and call him back. Thus began twenty minutes of shaking down the thermometer, and repeatedly attempting, and failing, to get a reading.

When our doctor called to see why we hadn't called him back I replied, "The thermometer is not working." In our postpartum haze, it had not occurred to us it was our baby, not the the thermometer, that was not working properly.  

And thus began a rush to the hospital, where he was ultimately diagnosed with neonatal serotonin syndrome, and reflux.

I don't know if it was because I was on a higher dose of medication during the third pregnancy, or because Sacha was  particularly sensitive to the SSRI's, but in effect, the medication had a sedating affect on him, and when he was born, he did not understand that he was no longer in utero and had to begin to take on life-sustaining functions for himself. As we joked at the time, he was born depressed, just like his mother!

And yet, despite what was unquestionably a harrowing ordeal, I do not regret my decision to take antidepressants during my pregnancy, because it was absolutely essential for my health. I was already a mother of two, and my experience of being raised by two depressed parents had given me painful proof that a child's well being is intimately tied to their parent's physical and mental health. As my wise therapist once said, a broken arm heals more quickly than emotional scars. 

Through the initially terrifying days, when we had NO IDEA what was wrong with our child, and whether he was he going to be okay — although it was stressful, I was able to function because for the first time ever after giving birth, I was not depressed. This is meant I was able to cope with a crisis, and be available and present for my family. While I was scared, and worried, and did my fair share of crying in those early hospital days, I did not blame myself up for having hurt my baby. I understood that in the face of all available information, and in consultation with my doctors and husband, we made what we thought was the best possible decision, and were now dealing with the consequences. And that is the difference between a depressed mother, and a healthy one. 

I've no idea if it would have made any difference, but in hindsight, I do wish I had lowered my dosage during those last few weeks of my pregnancy and increased it upon giving birth. I regret we had to go through what we did, but not my decision.

And as this blog can attest, Sacha is a now a healthy, ball-busting, 3-1/2 year old.

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