My Recovery Story – Part II

Shadows from the umbrella danced on my legs while I hid in plain sight. I watched the world go on from my lounge chair by the pool, wishing I could melt into the seething white cement without anyone noticing. I didn’t check my watch; I had no interest in knowing how long I had been there. Playful shrieks floated up from the pool while a woman walked by with her newborn. The tiny baby nestled in her arms as she watched her other children launch into cannonballs from the side of the pool.

She beamed.
I silently wept.

My mind buzzed with relentless agitation and raged against the unfairness. I would never know that kind of joy. All I could do was park myself within arm’s reach of humanity, cry, and wait for Nortriptyline to quietly breathe life back into my ravaged brain. This was my second time fighting Major Depression.

Four months prior, I was stable—stable to the point that my doctor, husband, and I decided I could try weaning off my antidepressant. It had been four years since I was first diagnosed and went into remission, and I had worked hard to maintain my wellness. Quite honestly, I had worked hard to even like myself again. Now, we dreamed of moving on and starting a family. My goal was to accomplish this without Nortriptyline, and I hoped I was healed to the point I wouldn’t have to take it again.

I weaned very gradually over four months, relapsed at the end, and had to go back on my medication—for good. The suffering was real: extreme side effects from starting the medicine again, depression itself, and thinking I would never become a mom. And so, I spent many hours sitting next to that neighborhood pool with the warm sunshine wrapping itself around me. It was the closest thing I had to hope.

My recovery was won in small steps over time. I made the commitment to take Nortriptyline every day and keep regular appointments with my psychiatrist and psychologist. I let go of the idea that it wasn’t natural to take daily medication to be myself, and instead appreciated it for the freedom it gave me to be my best self.

I confronted my fears about taking an antidepressant during pregnancy, passing on depression, and being a good mother. This involved finding the best mental health care in our region and seeking a consultation from a maternal-fetal health expert. In my case, there were very few risks. It would not be considered a high-risk pregnancy. Truly believing I was fit to be a mom took longer, but therapy helped me separate the facts from my fears. On my good days, I would visualize myself in the hospital delivery room with my husband, holding our newborn for the very first time. On the challenging days, I would carefully tuck that dream in the back of my mind. I placed it out of sight so I wouldn’t dwell on what I didn’t have, knowing that I could easily summon it when I was ready to move forward again.

I realized that I would be a better mom for having battled depression. The simple acts of getting out of bed each morning and giving a good morning kiss to my newest love would not be taken for granted. I’d have more compassion for everything from stubbed toes to moody streaks and broken hearts. Depression has given me patience, which would certainly come in handy while pacifying tantrums and waiting for those tiny fingers to pick up every last Cheerio. I’ve undoubtedly gained the humility to ask for help at the first sign of needing it. I figured if I had the stamina and determination to survive being secretly unwell, I could be a tremendously capable mom when feeling well with full support.

Was I ready to become a mom despite depression? The final answer came to me on a wintry Saturday morning run in 2015. My footprints blazed the trail in the pristine snow, and ice glistened on the bare tree branches overhead. Playful shrieks floated up from a nearby hill where families had gathered to sled. Parents chatted on the hilltop while their bundled children flew down the slope with excitement.

They beamed.
So did I.

I knew that I was ready to share the beauty of life with our children—as perfectly imperfect as life may be.

~Sixteen months later~

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My Recovery Story – Part I

One of the most powerful moments in my life was when my antidepressant first started working. I was sitting next to a first-grade student I was tutoring, trying to figure out my next teaching move and waiting for depression to taunt me as usual- “You can’t help him. You’re incompetent. You’re worthless. Why are you even here?” But instead of hearing depression’s voice, I heard my own for the first time in years. “You can do this. You can figure this out. You’re right where you should be and you’re going to be okay.”

I was 26 years old when major depression overpowered me for the first time. It had been pushing me around for years, but now, I felt weakened to the point that I couldn’t push back.  I had been in therapy for a year, but I could barely get myself out of bed in the morning and had to blow-dry my hair hunched over our bathroom rug because I felt so sick to my stomach. I cried relentlessly the moment I came home from work each day—the barrage of negative thoughts had to be released. I constantly beat myself up, felt terrified of being judged, and could no longer focus on improving. It kept getting worse. As much as medication scared me, it was now a risk I was willing to take.

The first psychiatrist I saw prescribed me Zoloft and recommended slowly building up to a therapeutic dose. Within a few days, it became clear that even a small amount of Zoloft made me much worse. I couldn’t eat or sleep and cycled through feelings of stability and extreme agitation every 12 hours. The doctor told me to stop taking the medicine immediately and that he no longer felt that antidepressants were right for me. “You should try things other than medication,” he said, as I stared at him in disbelief. I had finally taken the leap to help myself and lost every shard of wellbeing in the process.  I didn’t think I could go on. Fortunately, over the course of the next six weeks my husband helped me switch doctors, try a different class of antidepressants (tricyclics), and start cognitive behavioral therapy twice a week until I began feeling better. It saved my life.

One of the most important realizations I made in therapy after this episode was that feelings aren’t facts. After letting depression run unchecked for 10 years, I felt my distorted thoughts were true—that I was inherently a miserable, unlovable, unintelligent, incapable person. Therapy helped me learn that what I thought were personality traits were actually symptoms of depression and social anxiety. Over time, the combination of medication and therapy changed my self-talk and allowed me to approach my thoughts more mindfully.

In the face of mental illness, I have earned my Master’s degree, specialized in early literacy, and challenged myself to keep improving in my career. I have adjusted to moves from Virginia to North Carolina and Pennsylvania with my husband of 10 years, and focused on building friendships—old and new. I’ve finished 3 marathons and I’m signed up for my 18th half marathon. I am immensely grateful I had the chance to plan a healthy pregnancy and deliver a healthy baby girl in April 2016. My illness is something I actively manage each day; it’s a marathon fraught with peaks and valleys. But I consider my recovery journey to be one of my greatest unsung achievements in life. I have braved major depression, social anxiety, and severe reactions to antidepressants, one step at a time. Hills inevitably loom in the distance, but I know I will rise to meet them.

Stride On,
S

10 Steps I Took to Plan a Healthy Pregnancy While Taking An Antidepressant

10-steps-picFor us, the benefits of staying on my medication throughout a pregnancy far outweighed the risks. Knowing that still didn’t make our decision to have children an easy one. Medicine and statistics are one thing, but real voices are another. I needed to know that someone had walked in my shoes and made it to the other side. If taking an antidepressant during your childbearing years is a non-negotiable for you, you are not alone. I encourage you to work with a team of doctors who can evaluate your individual case, advise you about the risks and benefits, and determine the best treatment options for you and your baby before you become pregnant. Here are some steps that helped us along the way.

1. Recruiting A Team
I already had a psychologist and a psychiatrist, but we wanted as much information as possible about the safety of my antidepressant during pregnancy, so we searched for preconception counseling. We discovered that there are centers dedicated to the collaboration of psychiatry and obstetrics for women, such as The Penn Center for Women’s Behavioral Wellness in Philadelphia (PCWBW). We spent a lot of time driving to appointments in the city, but felt strongly that it was worth it for the highest standard of care. A psychiatrist consulted with us about my history, the safety of Nortriptyline, the doses that were optimal, and ultimately whether pregnancy was a safe option for me and a potential baby. Through PCWBW, we also connected with a maternal-fetal health specialist. He specializes in managing high-risk pregnancies (although ours was not considered high risk) and provided us with very reassuring information over the course of an hour. We learned that the risk of birth defects in our case was statistically the same as the risk for the general population, and that the drug was not considered a teratogen. He described studies related to my antidepressant and some very encouraging results: very low, if any, risk of Persistent Pulmonary Hypertension of the Newborn (PPHN), heart defects, or withdrawal symptoms for the baby following delivery. Bottom line, I was advised to use the dose of my antidepressant that kept my symptoms under control during conception and pregnancy. “Go get pregnant!” he said. We felt the weight of the decision start lifting from our shoulders.

2. Reading Research
We trusted our doctors, but wanted to do our due diligence and be as informed as possible. The PCWBW recommended information from the Massachusetts General Hospital Women’s Mental Health website, as they are a leader in the field of reproductive psychiatry. I admit that my husband had to help me proceed with caution. It was easy to fall into the “black hole” of information and overthink every possible aspect of depression, antidepressants, and pregnancy. Whenever I came across less than encouraging information in the general news, I questioned our decision to try for a pregnancy despite all of the professional advice we received. So read up, but at the end of the day, listen to your doctors who know your individual case.

3. Optimizing Medication
For a while, I was experiencing symptoms of depression even though I was taking my medicine and participating in regular Cognitive Behavioral Therapy. I delayed discussing this with my psychiatrist because I didn’t like the idea of taking a higher dose during a potential pregnancy. This certainly didn’t do me any favors, and actually went against the advice of our maternal-fetal specialist: take the dose that keeps you well. It’s important to be honest with your doctors throughout this process. Once I decided to speak up, I started feeling better and found the dose that kept me consistently well.

4. Going Off Hormonal Birth Control
Birth control such as the pill can sometimes affect your mood and feelings of stability. Personally, once I went off the pill, I noticed times during my cycle when my mood dipped significantly. It was easy to confuse these fluctuations with a relapse of depression. We found that it was helpful to use a mood chart to keep track of my symptoms and see how they related to my cycle. It reminded me that these episodes were short-lived, could be controlled, and weren’t total setbacks in our goal of becoming parents.

5. Living a Clean Lifestyle
I felt strongly that if I was going to expose our baby to Nortriptyline in utero, I wanted to decrease my exposures to other potentially harmful chemicals as much as possible. I drank filtered water, ate real food (avoiding artificial colors, flavors, preservatives, etc.), and avoided artificial sweeteners, caffeine, and alcohol. I bought organic fruits and vegetables, especially those on the Environmental Working Group’s “dirty dozen” list. I took a food-based prenatal vitamin and a DHA supplement for two years prior to becoming pregnant. I washed more clothing instead of using dry cleaning, chose mineral-based sunscreens, and asked my husband to hold off on using lawn fertilizers, weed killers, or bug spray. Things will never be perfect, but I did the best I could to protect our future baby from unnecessary exposures.

6. Exercising Most Days
Running is part of who I am. It has often been my escape and my time to reflect and process life. It has always welcomed me back with open arms after taking a back seat to flares of depression. Therefore, I made it a priority before, during, and after pregnancy. I ran 5 days a week following a half-marathon training plan, and lifted weights in a Les Mills Body Pump class 2-3 times each week. I switched to an elliptical machine at 33 weeks pregnant, but was still working out a day before I went into labor. The good news is, most fitness activities you do consistently before pregnancy can be done during pregnancy, with modifications along the way and careful attention to hydration and nutrition. I believe my fitness routine helped me have a healthy pregnancy and delivery, both physically and mentally.

7. Separating Facts From Fear
At one point in our journey, I was keeping appointments with my doctors and going through the motions, but inside I still wasn’t ready to try getting pregnant. I’m not a risk-taker, and my fear of medication causing harm was crushing. My psychiatrist asked me to target these feelings in talk therapy to fully differentiate my fears from the facts of our situation. The facts were overwhelmingly encouraging. With my psychologist’s guidance, I decided that I can’t make decisions based on fear alone. That’s not how we live life. Make your decision, don’t look back, and trust that you will be able to work through any challenges. “A ship in harbor is safe, but that is not what ships are built for.”—J. A. Shedd.

8. Getting Inspired
I found comfort, inspiration, and immeasurable hope in blogs such as Bipolar Mom Life, This Is My Brave, and Postpartum Progress. You are not alone. Having a family while managing mental illness is possible, as is being a remarkable, loving parent.

9. Knowing Your Body
Once our decision was made, I realized that getting pregnant is sometimes not as easy as you’d think. The book Taking Charge of Your Fertility (Weschler, 2015) was very helpful. I learned how to chart my basal body temperature and get in tune with signs of fertility. That being said, don’t let it get regimented. Go out and just have fun—things have a way of falling right into place when you least expect it!

10. Staying The Course
Be consistent with your wellness plan, and a healthy pregnancy is well within reach. Even if your journey is long like ours, it will be worth the wait on that special day when you meet your newest love, feeling confident that you gave her the best possible start in life.

Stride On,
S