Recently Pfizer has been the target of lawsuits from parents claiming that Zoloft caused birth defects. Not long ago, the Globe did a piece examining the (small but scary) links between anti-depressants and autism. It’s a subject close to my heart and even closer to my brain. Since 2006, I’ve taken Zoloft to control my anxiety. In 2009, I stopped taking it to get pregnant. I had to decide which was more important: My own mental health, or the potential safety of my unborn baby.
For me, Zoloft was a wonder drug. But I also knew that it carried fetal risks. My decision wasn’t simple, even though many well-meaning acquaintances sometimes acted as if it were as logical as giving up wine or unpasteurized cheese. I mean, it wasn’t as if I had a life-threatening illness that might resurface, right? I just had anxiety problems! (One woman actually said to me, dumbfounded, “It’s not as if you have cancer!”) But as anyone who’s dealt with depression and anxiety will attest, mental health issues can be as insidious as any cancer or physical disease.
The other night, over dinner at Tryst, a friend who’s also on Zoloft (and contemplating pregnancy) asked me how I decided to abandon my pills for nine months. I told her I’d blog about it. Maybe my experience can help her; maybe it can help you. Not to sound all “Law & Order”—but this is my story.
It was September. Perched on my gynecologist’s examining table, it could’ve been school picture day. I’d shaved my legs to perfection. Worn makeup. Blow-dried my hair. I’d even dressed up (I’d forgotten about that whole “paper gown” thing). I wanted to look the part of a responsible potential mother—because the reason I sat there in the first place made me feel, completely and utterly, that I wasn’t.
I wanted to know if I could take Zoloft and Valium—two drugs that had controlled my anxiety and panic disorder for years—if pregnant. I’d read about the fetal health risks (persistent pulmonary hypertension, low birth weight, failure to thrive, a terrifying condition called anencephaly, in which baby is born without a forehead). Meanwhile, I felt fantastic on medication. How could I conceive a child and forgo something that brought me more peace of mind than a baby ever might?
Brian, trying to be kind and very ready for a family, told me he’d back me regardless. (Totally supportive, yet thoroughly unhelpful.) I also made the mistake of sharing my worries with older relatives, who in their “day” considered Tylenol verboten. Basically, I needed someone to tell me what to do.
The appointment went well. He gave me a clean bill of health and I joked that my flabby stomach made me look pregnant already. He was rummaging in his drawer for folic acid samples when I sheepishly addressed his back.
“I, um, have panic disorder—I get horrible panic attacks—and I really feel like I don’t want to be on any sort of pill while pregnant but I also know a happy mother means a happy baby, and I’d hate to get panic attacks and not be on my medicine, but really I’m completely OK and I’m sure it’ll be fine whatever you tell me to do, I’ll do it, because obviously the baby’s health would be my top priority!” The more I blabbered, the more I sounded like I was asking for a bathroom pass.
“Oh?” He turned around, hands full of vitamin packets. “Do you take anything now?”
“Zoloft!” I chirped. “And Valium! But like I said, I have no problem going off of them and …”
He fixed me with a benign gaze and said the words that would haunt me for months:
“I can’t tell you what to do. There are risks, of course, though Zoloft is one of the safer drugs to take while pregnant. We have to weigh whose health is more precarious—yours or the baby’s. But, ultimately, it’s about what feels right to you.”
The bottom line: To protect my baby—a baby who didn’t even exist yet—I’d have to consider abandoning the very drugs that protected me.
I knew what life was like off drugs, and it was hard. For years, I’d suffered nagging, anxiety-producing fantasies. On bad days, I’d obsess over cancer or imagine myself nibbling cat food in a homeless shelter. I flirted with medications throughout college and my twenties, but until Zoloft, none worked. Some made me irritable. Others made me exhausted. Almost all made me feel like a sleepwalking tub of goo.
Untreated, I adopted rigid behaviors to cope with my fears—behaviors that propelled and shamed me. I checked my bank balance multiple times per day to convince myself I had money. (Never enough, of course, but I was a writer, after all.) Once, I begged a surgeon to operate on a “cancerous tumor” and demanded an emergency biopsy. (It was a swollen gland.) I often envisioned myself booted from my fancy magazine job and hurled into homelessness. Then, just to show my brain who was really in control, I’d regale my friends with tales of my latest doctors’ visit or bargain-hunting expedition. That Kara! She’s so funny! And we’d all laugh and drink some martinis.
That’s just it: On the surface, I looked so together. I landed plum writing gigs and got good jobs, lived with a great guy, had plenty of friends. But I ferried from dinners out to drinks with friends to late-night sessions online, telegraphing my neuroses to the Internet with searches like “signs of latent cancer” and “twenty-something ideal 401k balance.”
Then, on my Hawaiian honeymoon in 2006, all that checking, stewing, compensating, and obsessing caught up with me. Abandoned in paradise, it was just my brain and me. We weren’t a happy couple. Every fear I’d ever had—and joked about—became chokingly legitimate. Panic attacks were my fears made physical. And so I froze, literally froze, on the Delta Airlines runway, leaving the honeymooner behind me to crash into my back. Brian begged me, somewhere between aisles G and H, to keep walking. Once we arrived, I refused to leave my suite because I was petrified to navigate the world, let alone the buffet line. My margarita was poisoned. My lungs weren’t working. Somehow Brian got me home and dragged me to a psychiatrist, who insisted I take medication immediately or accept confinement to a hospital for intravenous treatment. At this point, I hadn’t slept in days, had lost major weight, and resembled Amy Winehouse’s gargoyle sister. I took the drugs.
And thank God. On Zoloft, I felt productive and centered. And carrying Valium, a fast-acting sedative, assured me that I could control my physical symptoms if I ever did feel an attack coming on. Thanks to medications, time I’d wasted Googling obscure diseases was actually spent living. I wrote articles about anxiety and even went on the “Today” show to discuss panic disorder. I stopped analyzing my checking account. I deleted my WebMD bookmark. Being on Zoloft was like moving heavy furniture to the edges of my brain, cool and clean. There was so much room to function! Brian graduated from business school and embarked on a new career. I landed a gig editing a women’s magazine, Lola, for the Globe—my dream job.
Now, four years after that hideous honeymoon, life was happy. And for Brian, life would be even happier with children. He wanted them badly. I always did, too—someday, of course, after I bought a house and lost some weight and got a raise and enjoyed a few more sushi rolls and late nights. I wasn’t a woman who longed to trot through the park rigged up to a Baby Bjorn. I fantasized about my first book, not about my child’s first words. And when I seriously considered the idea—and I did, often—I feared that managing my own brain had been challenging enough. The idea of governing a child’s life seemed unthinkable.
And so, the night of my unfulfilling gynecologist appointment, I sobbed on our bed as Brian stood slump-shouldered in the doorway. “What if I don’t want kids?” I wailed. “There’s too much uncertainty. What if you lose your job? What if I lose my job? What if bad things happen and I can’t deal because I’m not on my drugs?”
“I’m going to be very unhappy without children,” Brian sighed. “But you need to be happy, too.” Then, ever the peacemaker, he abandoned me in the dark to watch SportsCenter. It was easy for Brian to want kids. He’d never picked through a Hawaiian buffet looking for an arsenic-free wedge of cantaloupe.
The next morning, we decided I’d make a pilgrimage to my psychiatrist, a guy I mainly saw for prescription refills. That’s how secure I felt on Zoloft: I didn’t even go to therapy anymore. The following week, when I visited him—a grim noodle of a man, vaguely paternalistic—I mentioned staying on Zoloft while pregnant as if I were suggesting a tryst on his desk. Knowing the risks, the notion sounded foreign, naughty. He peered at me over tarnished wire-rims: “Not if you were my wife.” Then he handed me a stack of paper. Studies, he warned, about the potential consequences of Zoloft and other selective seratonin reuptake inhibitors during pregnancy. Fatal hypertension. Anencephaly. Low birthweight.
Those risks again. And that did it. For someone who once spent hours palpating imaginary lymph nodes, it seemed insulting to my past to court health problems. And it seemed downright unthinkable to let fear govern my future. I’d had a major breakdown and ended up on the Today show, for God’s sake! I spoke to groups all the time about anxiety and urged people to take control of their lives. And now I was going to cower? I was better than that, tougher.
Or so I hoped. The following Monday, I stopped taking meds—slowly at first, because the withdrawal symptoms are brutal if you go cold turkey (and even if you don’t), ranging from tremors to intense dizziness. But within weeks, I’d swallowed the chalky remains of my pills. I kept the empty bottle (with two refills) in my cabinet. Sometimes, when reaching for the toothpaste, I’d stare at it—the way you might stare at a photo of a long-gone boyfriend who made you happy, then slowly stopped returning your calls until one day the phone just stopped ringing.
Emotionally, I was going through a breakup. Physically, I felt fine. For a few weeks, I walked around gingerly, like I’d been issued a glass set of lungs. I’d pause in doorways and breathe deeply. Then breathe again. Really? I was living? Giving up my safety net for a hypothetical baby began to feel like a science project. Would I lose more weight today? Would my heart beat erratically? Would people notice? I didn’t tell anyone what I’d done—it was a little game I played with myself, like wearing an audacious bra underneath a prim Ann Taylor cardigan.
I got pregnant right away. For a few weeks, I was delighted. No—smug. Even if my mind didn’t always click, my body did. Then, in February, at what I thought was a routine ultrasound, my gynecologist settled onto his stool and smiled benignly once again. “Now, don’t get alarmed,” he began. Who, me?
“What’s wrong?” I sputtered. After all the doubts about having a baby, I felt fiercely protective, possessive in a way that I used to reserve for parking spaces.
“Your son’s left kidney is dilated,” he explained. “It might be nothing, but we’re going to monitor it. We might set you up with a perinatologist if it doesn’t resolve…”
All I’d absorbed was that my baby could be sick. I felt sickeningly guilty. I’d doubted even wanting him, so committed was I to my own well-being. Irrationally, I thought I was getting my comeuppance. I put on my cute Motherhood Maternity trench coat and power-waddled to the car with Brian in the cruel February chill. Our car was sprayed with sludge. I hoisted myself in, slammed the door. Gritty gravel lined the floor. My thin coat was splattered with gray snow. Everything felt dirty, rough, wrong. I just wanted to take a Valium.
The kidney issue was like having Alka-Seltzer deployed in my brain. Thoughts—pointless, irrational thoughts—fizzled and burned up my mind. I obsessed, the way I used to obsess about rare cancers and welfare motels. Why didn’t we have a bigger house? Grown-ups with kids had big houses. Could we afford formula? What if we had no house and no formula and lived on the street with a hungry baby? My mind scurried down every avenue possible to avoid confronting the actual problem: What if something was wrong with our son?
I worked hard to talk myself down, and Brian worked even harder. Without drugs, I had to get up and go to work. Eat. Sleep. Function. In 2006, nobody depended on me. Now I had a very visible, five-months-pregnant stomach reminding me that my worries were, to some extent, secondary. I forced myself to compartmentalize for the baby’s sake. Because each time I wanted to cry, I imagined him crying with me. Each time my heart raced, I imagined his little heart racing, too.
So when the doctor told me two weeks later that his kidney problem hadn’t resolved and that he’d need a follow-up ultrasound at birth, I tentatively accepted the open-endedness. It was uncomfortable and useful. For so long, I thought that being a successful mother—or grown-up, really—meant clear-cut perfection. I craved that pristine ideal: Glossy career, dreamy life, ready to welcome a child as if I were ordering him from Babies R Us. If Zoloft couldn’t cure me, perfection would! But pregnancy handed me a hard lesson: True peace of mind comes from embracing uncertainty, simply putting one foot in front of the other and living. What else could I do? Life had insisted that I sit still with myself, like reconnecting with a long-ago friend and making tentative conversation: How are you? Who are you? I was strong.
And as it turned out, I had more time to get to know myself than I ever imagined. Our son wouldn’t come out. June stretched into July, languid and hot, with no signs of labor. I jumped up and down, I drank hot sauce, I guzzled loose-leaf tea. Finally, my gynecologist looked at my bread-loaf ankles and suggested we induce. Eighteen hours of unproductive labor later, Andrew was extracted via a painless emergency c-section.
At 17 months, he’s still in the 97th percentile for size, has more hair than Fabio, and guzzles his diluted fruit juice like a trucker. And when I watch him snoozing peacefully in his crib—milk-stained lips pursed, butt in the air, both kidneys perfectly developed after all—I’m confident that I made the safest decision for him.
As for me, my story doesn’t have a clean ending. Occasionally my heart pulsates for no reason and I wait for the inevitable dizziness, the telltale, panicky shortness of breath. Once in a while, I’ll wake up with a pit in my stomach, resentful that I can’t hide in bed because a tiny human is counting on me to function. Lying there, I seize up: “Is this the day my anxiety returns for good? Can’t I zip myself into a sweat suit and hide forever?” Then I get up, unpeel some Gerber purees, and go about my business—silently wondering if my luck’s running out and if I’ll soon be stewing in my psychiatrist’s office, this time with a baby yowling in the background.
After having Andrew, I went right back on a low dose of Zoloft so that I didn't slip into my 2006 self—and so far, it’s working. It also meant that I couldn't breast feed. Despite its health benefits (and trust me, I read all about them!), my sanity was more important to me. I figured that Andrew would do quite well with Enfamil and a happy mother.
And looking back, all these months later, I’m actually grateful for these frightening, rewarding nine months. That time forced me to embrace the imperfect and court the unknown. Through the unknown, I came to know myself. And when I take a deep breath and look at Andrew, I know something else, too. If I could handle pregnancy without pills, I can definitely handle another frightening, rewarding journey—parenthood.
So, yes, I think that I made the right decision. The uncertainty of exposing him to the effects of drugs simply wasn’t worth it, especially for someone who spent the better part of her life fretting about illness. To put myself at risk was one thing; to put Andrew at risk was another. But I also know what life is like without medication: At times, it’s unbearable. Just like in parenting, there’s no "right" or "wrong" answer. There’s only instinct, and sometimes instinct is more powerful than statistics.
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