For 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.