Not Just the Pregnancy Blues
Entry 1: Why isn’t anyone talking about prenatal depression?
Photograph by Tatiana Gladskikh/iStockphoto.
Two months after the nadir of my prenatal depression, my husband can finally joke that he knew things were dire when I started envying Mad Men’s Betty Draper Francis. While Betty was pregnant, I explained to him at the time, no one expected her to do anything but lie around all day in bed in her shortie nightgowns. I was nine weeks pregnant then, and so irrationally anxious about how I was going to manage the insertion of a much-wanted baby into my already busy working life that I hadn’t slept for three days, and cried pretty much continuously. My morning sickness was so unrelenting that I was barely keeping any food down, and when I took the short walk from our bed to the kitchen, my body would shake.
In my saner moments, I told myself: You will not be the first working woman to have a baby. You have a supportive husband and a good marriage and a boatload of other sundry privileges. You will be fine. But those reasonable thoughts were drowned out by a bleak combination of terror and regret. I had just started a new, demanding job, and every morning at 7 when I pulled my MacBook onto my lap, sinking deeper into bed, I felt so unlike myself, so incompetent, that I wished I wasn’t pregnant. I never considered abortion for a second, but I longed for some alternate universe where I could claw out of my sad self, leaving the broken shell behind to grow the baby while I resumed being a person again.
It was at this point that I started to accept that going off antidepressants to conceive was possibly not the best choice I had ever made. Back in November, when I had tapered off my 100mg of Wellbutrin under the watchful care of both a psychologist whom I saw weekly and the medicating psychiatrist I saw quarterly, I thought I was making a healthy, informed decision. The psychiatrist told me that if I wanted to stay on meds while pregnant, Wellbutrin or Prozac would be safe options. I figured the safest of all would be to go off meds entirely. I knew I was at risk for postpartum depression—even Brooke Shields had it!—so I would consider going back on if I crashed after giving birth. But I wanted my body to be drug-free for pregnancy.
Neither the psychologist nor the psychiatrist mentioned prenatal depression. In fact, I had never heard the term before I started plunging into a clinical melancholy so deep that my Google history from that period is a darkly hilarious trail of cries for help. I entered many permutations of the terms “pregnancy depression” and “pregnancy can’t stop crying” and discovered that prenatal depression is just as common as postpartum depression—it affects between 10 and 15 percent of women.
Despite these stats, prenatal depression is still relatively under the radar, and many obstetricians are not well-trained in its complexities. Until very recently, doctors didn’t even know a woman could get depressed during pregnancy: They thought antenatal hormones protected against it. And women who have prenatal depression don't want to talk about it. You're supposed to glow while pregnant, not spiral into darkness.
Women with a history of depression—i.e., someone like me, who has had two serious bouts of clinical depression in her adult life—are even more prone to prenatal depression than the general population. Some studies show that women who go off antidepressants before conceiving have a nearly 70 percent chance of relapse during pregnancy.
I had been off meds for four months by the time I conceived, and I hadn’t relapsed, so I thought I was in the clear. But the pregnancy hormones walloped me in a way I hadn’t expected. In her memoir Love Works Like This, the journalist and psychologist Lauren Slater talks about her bout with prenatal depression, and writes that a specialist once told her that there’s a correlation between women who react badly to the birth control pill and women who become depressed during pregnancy. It makes sense: During your first trimester, the doctor tells Slater, you are getting the progesterone equivalent of 400 birth control pills a day. By the time you give birth, you are ingesting the equivalent of 1,000 pills a day. I always hated the pill—I tried several different kinds and they always made me excessively moody—so had I known about the correlation, my misery might have been less of a shock, or even preventable.
In retrospect, I started rapidly declining around Week 6 of my pregnancy. I began to have obsessive fear about the future. How would we ever afford to stay in New York City? Where would our child go to school? I didn't just consider these questions—I fixated, and then fixated some more. After seeing a listing for a Web job at Outside magazine, I suggested to my husband we move to Santa Fe, N.M., despite the fact that we had never been to Santa Fe, did not know a single soul in New Mexico and there were no jobs for him there. “Santa Fe?” he asked, thoroughly confused, a tinge of worry in his voice. “I guess we can look into it.”
Compounding the obsessive thoughts was an overwhelming sense of guilt. We had wanted and planned for this child. I was supposed to be thrilled, cooing at strange babies in the street and gleefully learning how to knit tiny hats. This should have been something that brought my husband and me closer together. Instead, I was scared and sick and sloppy, and my husband was increasingly terrified.
Around this time, my psychologist brought up the possibility of my going back on antidepressants, but before those three shaky, sleepless days during Week 9, I was resistant. I'm not sure why. I have worked in women’s media for five years, and really thought I was inured to all the “natural” pregnancy hype. I don’t want to have a baby in a bathtub or eat my own placenta. I fully intend to get an epidural. But even though I knew lots of women who had healthy babies while on Prozac and Zoloft, and I knew that many, many studies showed only a minuscule chance of those drugs affecting my fetus, I didn’t want to go back on. I suppose on some primal level I wanted to be pure while pregnant. If anything went wrong with the baby, I would always wonder if my being on antidepressants was to blame. This was not a science-based decision. But when it comes to pregnancy, particularly your first pregnancy, it’s tough to ignore your emotional brain.
Over the next three weeks, I tried every other possible, non-drug remedy for depression and anxiety: I continued talk therapy, I tried acupuncture, I listened to relaxation tapes, I reached out to friends and family. That terrible, insomniac, bottomed-out weekend I attempted to get a massage, and got so agitated halfway through that I started having a panic attack. I mumbled an apology to the soothing, soft-voiced masseuse; threw on my clothes; and bolted out the door sobbing, the sounds of a Brazilian rain forest receding as I ran.
That afternoon I called a friend with three children, trying through hysterical tears to explain how unmoored I felt. I was still laboring under the delusion that my freakout might be on the spectrum of normal reaction to pregnancy hormones. She listened to my halting breaths and barely coherent fears and told me, not unkindly, “You are out of your fucking mind.”
Her words made me realize that no, this was not a typical reaction. I got off the phone and, after another night of not sleeping and wishing I was Betty Draper Francis, I called my medicating psychiatrist, who consulted with my new obstetrician and put me on Prozac immediately. I had been on Prozac before and it had always worked within a week, so even as skin-crawlingly unhappy as I was, I could detect a small glimmer of relief.
What made it easier to go back on was knowing what could happen if I stayed so miserable. There are studies that show that the stress of untreated severe depression and anxiety can be just as bad for the fetus as the very, very small risks of much-tested drugs like Prozac. And untreated depression doesn’t just affect the fetus and the mother—it also affects the rest of the family. If a mother is so depressed it hurts her marriage, or she’s unable to care for her other children, the collective damage is something to consider. I had read some of these studies before I was pregnant but still clung to the idea that I could get better without pills. By the time I went back on the meds, it was clear to me and to my doctors that staying off was potentially more harmful than going back on.
In the scheme of things, I was extremely lucky. I had access to good medical care, insurance, a loving spouse and extended family, and I had an option for medication that I knew worked. And it did. Within 10 days of my starting on Prozac, I slept through the night. Soon after, the endless cycle of negative thoughts lightened up a bit.
Things weren’t perfect. I was still throwing up several times a day. I ended up leaving my job because I was having trouble dealing with the combination of work stress and health stress. But when my second trimester rolled around, the nausea finally stopped, and I could start to feel excited about our healthy, growing baby, instead of just guilty for not being able to be excited.
Though I entered my pregnancy never having heard the term prenatal depression, scientists are studying it. In the second part of this series, I will explore the current research. But I also want to hear from you: I have created a survey for women who have experienced depression during their pregnancies, and for their loved ones. The survey is here: https://www.surveymonkey.com/s/prenataldepression, and all responses are anonymous. Next week, I will write up what I’ve learned from you. Also, if you’d like to tell me more about your story, please email me at firstname.lastname@example.org. All of those emails will also be kept anonymous unless you explicitly give Slate permission to publish your essay about your experience with prenatal depression. One of the most distressing parts of the dark days was how alone I felt. I didn’t know any women who were going through what I was, and save for a few, mostly British, message boards, did not even find kindred spirits online who could help me feel less isolated. I hope that this series and the accompanying survey can help other women find some solace.