When I was seven months pregnant with my daughter, my first child, I was diagnosed with an anxiety disorder. "What this means," my doctor told me -- correctly, as it turned out -- "is that it is very likely that you'll experience some degree of post-partum depression or anxiety. You might think of this, actually, as partum anxiety." I joked to my husband later that this was definitive proof that I was an overachiever. "I have post-natal depression before I've even had the baby. I win!"
He didn't think this was funny. "Are you going to take the medication she (my doctor) prescribed?"
"No." I had no intention of taking the antidepressants. My doctor had insisted that they were safe, that there was little to no risk in taking the antidepressants she'd prescribed while pregnant. But as I said: I'm an overachiever. I over-function in doing anything, and that includes pregnancy. There was no way that I was taking any medication that I didn't know was 100 percent safe.
Well, as it turns out, I might have been right. According to a study that was released this week -- I saw the story in Jezebel -- taking antidepressants during pregnancy can cause miscarriage. As Jezebel reports: "The study by researchers from two Canadian universities found a 68% increased risk of miscarriage among women who took antidepressants. The risk was greatest for those who took paroxetine (Paxil) or venlafaxine (Effexor), and those who took higher doses of the drugs or a combination thereof also saw increased risk."
This is not, of course, the whole story. Determining the causes of miscarriage (as anyone who has had or been at risk of having a miscarriage can tell you) is a notoriously thorny business. And, as Jezebel notes, there's the confounding factor of the risks inherent to depression itself: Some studies have indicated (Jezebel cites this story) that depression itself can increase a woman's risk of miscarrying, in which case there might be some evidence to suggest that it's the core condition and not the treatment of that condition that creates the problem. This is a critically importance difference: If it's the depression that increases risk of miscarriage, then avoiding treatment only increases that risk.
If I had know these things during my first pregnancy, or my second, I'm pretty sure that my head would have exploded (which is also not good for a healthy pregnancy).
And herein lays the problem for women who struggle with depression: We are, it seems, damned if we do and damned if we don't. My doctor's concern, when I expressed my reluctance to take the medications she prescribed, was that my anxiety and depression would worsen and that this would -- duh -- be bad for me and for my baby. Which was a legitimate concern: The Times story that Jezebel cites notes that "studies have shown that pregnant women who are depressed are more likely to have premature births and low birth weight babies. Their infants are also at increased risk of irritability, sleep problems and high blood levels of the stress hormone cortisol, compared with babies born to mothers without depression."
So where does that leave us? What would I do if I found myself pregnant again? (For the record, this won't happen: The depression was just so severe the second time around -- and the physical damage so extensive -- that my husband and I decided that it would be folly to go through it again. SNIP.) Would I take the meds, to forestall the depression that has such terrible effects -- or would fear of miscarriage or harm to my baby dissuade me, as it did in my first and second pregnancies? Would the anxieties provoked by these studies and reports make things worse?
Sadly, the only one of those questions that I can answer is the last. And that answer is YES.
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