Getting pregnant wasn’t a race against time, it was a race against mind.
Content warning: discussion of suicidal ideation
Throughout my teens I was adamant I didn’t want children. I thought they were annoying, sticky money pits who had no business being near me. I was a sad and corny teen. Now, I’m 30. I’m still sad, but I’m not broke, and I have a husband. My feelings on the child situation have changed. I’m more open to it now. I think it was a combination of seeing other people with kids and, as I’ve gotten older, having more love to give — or something. I didn’t have the most stable childhood (or adulthood, for that matter), but I’m now in a position where I could give a kid a good and not-at-all toxic upbringing. I’m not desperate to have a baby — not that there’s anything wrong with that — but I’d love to try.
I traipsed off to therapy, excited to discuss starting a family. I’d only talked about it with my husband, and my therapist would be the only other person who’d know. Lucky her! I readied myself for all her joy and delight. I’d seen it before with my friends. They’d start with a goofy grin on their face and say something like, “We’ve stopped using birth control.” This would be followed by gasps and tiny squeals of glee: “You’re trying for a baby! We’re so happy for you!”
With the same goofy grin that I’d seen from my friends, I proudly announced to my therapist that I wanted to start a family. She smiled, looked me dead in the eye, and said, “If you want to have a baby, you need to tell me around three months before you start trying.”
Ah, just how I dreamed it would be!
I have bipolar II, which means I experience frequent episodes of severe depression with a smattering of hypomania. Therefore, I need a longer lead-time to process and plan for the mental and physical changes that occur during pregnancy. I’d heard of postpartum depression, and I’d heard of people developing depression during pregnancy, but I haven’t heard anything about what happens when you’re already depressed and want to have a baby. But with that one decision — to try for a baby — my depression shifted to pre-prenatal depression.
The prevalence of mental illness cannot be overstated. One in six Americans suffer from a mental illness, millions of whom are depressed — and according to an analysis carried out by a clinical psychologist at Oxford University, women are 40% more likely than men to develop mental health conditions.
With the one decision to try for a baby, my depression shifted to pre-prenatal depression.
So it seemed odd that there’s not more out there about getting pregnant while depressed. The few stories I found scared the shit out of me. (One article was ominously titled, “Scary News For People Who Get Pregnant While Depressed.”) And, unfortunately, there’s no clear list of guidelines for depressed women who want to become moms.
As Bay Area psychiatrist Jill Armbrust explained to me, the plans for treating a person with depression who wants to get pregnant are the same as those for anyone who’s becoming depressed. “The difference being there would be more focus on and care put on the side effects of various medications.” This takes a lot of time and careful planning. “One usually starts with about six months of psychotherapy if you have that kind of luxury,” Armbrust advised.
The guidelines that do exist center on medication, of which I take a range to keep my mind intact, namely lithium, Latuda, trazodone, lorazepam, and clonazepam. I’d be a whole lot worse without them, and — with absolutely the intention of sounding dramatic — I may even be dead.
But it turns out these pills don’t mix well with pregnancy. My therapist advised weaning off the meds completely. My first thought was simply, “No.” I didn’t want to think about who I would be without medication. I tried to kill myself without medication. My brain flooded with questions: How could I create a new life when I’ve wanted to end my own? Will I turn into a monster? Should people like me even have children?
I found myself asking that last question a lot. Given my history of depression and suicide, was it safe or even fair for me to have kids? I wondered if there were any circumstances where therapists advised people against getting pregnant.
There are, though, as Armbrust explained, “It’s tremendously variable because of the stigma that even some practitioners carry.” While there’s no absolute answer to this, Armbrust suggests the only two reasons she’d advise against pregnancy: when the woman had unstable psychosis or an untreated substance abuse problem. She went on to say that she believes women with schizophrenia, bipolar, and depression — like me — are all candidates to be very good mothers.
I am fortunate enough to have a therapist, and (thanks to my husband) health insurance. Having a baby while depressed was going to be hard but not impossible.
So we began.
My therapist said we would start by lowering the doses of my lithium, trazodone, and Latuda. However, I had to stop taking lorazepam or clonazepam, since both have been recognized by the U.S. Food and Drug Administration as drugs with “positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans.” The U.S. agency calls these Category D drugs, with Category A being the safest for pregnant women and X being a total no-go. But since I didn’t take lorazepam or clonazepam every day, I didn’t think that would be too bad.
The one I was worried about most was lithium. Lithium was the one that tied the room together. At the time of talking to my therapist, lithium was category C, the third of the five categories, so I could potentially keep taking it at low doses even if I did become pregnant.
My therapist assured me we’d get through it together and that she’d be monitoring me closely. She suggested I see an OBGYN and see what they thought. About a month later I was booked to see a nurse practitioner where I had a pap smear and a ton of questions. It isn’t common practice for an OBGYN to screen for depression at this stage, though Armbrust says this would be hugely beneficial, given that postpartum depression is so common. But when it comes to pre-prenatal depression, “It’s still considered stigmatized in a separate area of expertise.” Most of the time you have to volunteer the information yourself.
Given my history of depression and suicide, was it safe or even fair for me to have kids?
I told the nurse about my psychiatric history, and that I was trying for a baby. Before I could ask her any questions, she stopped me: “Do not start trying until you are completely off your medication.”
“Even lithium?” I spluttered. She furrowed her brow, left the room to check. Three minutes later she came back. “Even lithium.”
My therapist was confused. “Even lithium?” she asked me. I nodded, and when she opened her laptop to check, she nodded, too. “It’s changed to a category D” — just like lorazepam or clonazepam.
This was the first of many conflicting pieces of information I would come across in my mentally ill quest to become pregnant. Distressed that no one had a clear-cut answer, I turned to the one place I knew would be even worse, though it seemed to be also the place where my doctors were getting their information: the internet.
LUV 2 B ONLINE
Here in the murky depths of online pregnancy forums is where I found other people with mental illnesses who were as equally as confused as me. Though there were still no clear answers, it was strangely comforting. Up until now, I’d been speaking to medical professionals who discussed coming off medication as though it were a procedure. However, in the forums I found people who were talking about it in terms to which I could relate. These were people who lived with schizophrenia, bipolar, PTSD, and depression. There were those who felt guilty about continuing to take medication and those who were OK with it. There were some who’d stopped taking their medication, had a bad episode, and had to go back on. And there were those who stayed off meds for their whole pregnancy but went back on after the baby was born. One thing was for sure, nobody had the “right” answer because the “right” answer is whatever works for you.
These conversations turned from medication to general feelings. Women talked about how they felt ashamed of feeling depressed when they should be happy and grateful that they managed to get pregnant in the first place. They talked about how they wrestled with their emotions on the inside and the judgment cast upon them from the outside. The judgment on the outside being other moms in the forum telling them they’re bad mothers for taking medication. It happens all the time and is not exclusive to pregnant mothers with a mental illness. If you’ve ever been on a parenting or pregnancy forum, you’ll know that, while they can offer solace and support, they’re also diabolical whirlpools of toxicity designed to drag you down into a complex sewer system of self-righteousness and unconstructive criticism.
“So why even go on them?!” I hear you cry. Great question — but avoiding them is easier said than done, especially when forums are one of the only places I could go to read about other pregnant peoples’ struggle with mental illness (and I’m a sucker for shame). Even though pregnancy forums are bustling hellscapes, they’re (ironically) the only places some us can go to discuss “taboo” subjects such as mental illness.
It’s Not You, It’s Me
I decided the “right” answer for me was to come off all my medication before trying for a baby, including the lower-risk ones. After three months of careful planning and monitoring, I was entirely med-free for the first time in five years, when I’d tried to commit suicide. The few other times since then when I came off certain medications because I convinced myself I didn’t need to be on them, I experienced particularly bad depressive and hypomanic episodes, at one point landing myself back in the hospital.
Before, I didn’t tell anyone when I went off medication and decided to go cold turkey, which isn’t ideal. This time, it felt different. I had my therapist monitoring me closely. Still, being off meds contained all the terror of a manic episode without the mania, like walking a tightrope over the Grand Canyon with no safety net.
For the first time in five years, I started to feel — but not in a good way. I’d become so accustomed to my moods being regulated; it was like I had two bouncers standing in front of my mind, letting thoughts and feelings come in at a steady pace. Now the bouncers were gone, and everyone started to rush into the club and fuck shit up. I was overwhelmed and began to isolate myself. I talked to my husband, my therapist, a couple of friends, and a whole bunch of strangers on the internet. I retreated into the pregnancy forums where I could be among women who were going through the same thing as me. Out of everyone, the forums is where I felt the most comfortable. I didn’t feel like I was burdening people with my “issues,” I didn’t feel like I was boring anyone with my constant questions, but most importantly, I didn’t feel alone. I’d tried talking to other people, but with all these unsupervised feelings, it was hard not to get upset or angry.
When it comes to your pregnancy, everyone you meet is an expert on you and your body. You tell people you’re trying, and immediately they’re all, “You’ve got plenty of time,” or “Relax, it can take up to a year.” As with everything in life, if I want your opinion, I’ll ask for it, but please know I’ll never ask because I never want it. I knew getting pregnant could take a while. Sometimes it happens instantly, other times it can take years. Either way, the wait can be excruciating. And when you’re flying solo without your antipsychotic medication, the wait becomes dangerous.
Every day I’d wake up and wonder if today were the day I’d lose it. I hoped I wouldn’t have to be hospitalized again. I begged my mind not to have an episode. For me, getting pregnant wasn’t a race against time, it was a race against mind.
After only a couple of months, I felt unstable. I started to feel sad. Not depressed, just sad. I assumed this was part of my unregulated moods, but the sadness lingered. Before long, I felt myself sliding into dangerous territory. The sorrow had morphed into depression, and without any medication to block it, the depression began to pick up speed. I still wanted to have a baby, I just didn’t know if I would be around to have it. I talked with my therapist, and we decided to give it one more month before I went back on the meds. One more month would make it three months total of being off meds, and whether I became pregnant or not, I felt proud I’d made it this far. Those three months were both terrifying and challenging, but nothing prepared me for what happened next. I got pregnant.
Even without a mental illness, pregnancy can mess with your head. There’s the hormones, nausea, and the ever-changing body, which can be hard to process for anyone. But here I was, with no control over my body or mind. Everything started happening so quickly. I felt as though I was losing myself. I was happy and grateful we’d managed to get pregnant in a relatively short amount of time, but I was also depressed and disconnected. I remember staring blankly at the eight-week ultrasound. I knew I should be feeling something, but it just wasn’t happening. It was like I was experiencing phantom feelings. I’d already disassociated from the pregnancy, a pregnancy I wanted and planned. I started to experience a familiar numbness, the same numbness that enveloped me for the first 20 years of my life. I couldn’t even feel shame anymore.
Just like pregnancy, everybody experiences mental illness differently. And while I am fortunate enough to have a therapist, health insurance, and an OBGYN, the only person who was going to come up with the “right” answer was me. I’m now four months along and still off medication. Things aren’t perfect. (Is any pregnancy?) I still struggle with depression, and managing without meds does not mean I’m “cured.” I will always have bipolar, and anxiety, and PTSD, but there are things I can do to lessen the mental strain while I’m pregnant.
Just like pregnancy, everybody experiences mental illness differently.
I continue to work hard at therapy. I try to eat healthily and exercise as much as I can. And I’m starting to increase my social support system beyond the confines of the internet, which has been daunting, but it’s helping a lot. And although I feel good now, I don’t take for granted that it could all change.
I want to be clear: Nothing can or will replace my medication. Even now, going back on medication is still an option, and once the baby is born, the plan is to start taking them again. The most important thing is my health. If I’m not healthy, then there was no way this baby could be either. I considered starting back on a low dosage of lithium, but I before I made that decision, I wanted to work on my mental health one last time. Again, I do not judge anyone who continues or goes back to their medication. If that’s what’s best for them, then that’s the right decision.
These are just things that help me personally, but who knows, it all may change. I’m taking it one day at a time. That’s the way it is with depression. There’s no cure; there’s just what works for you, for now.