Depression meds?

chloe97 · February 2016

At dinner tonight with H, it occurred to me that the sadness, insomnia, trouble concentrating, and obsessive thoughts about TTC probably all point to me suffering some sort of depression/chemical imbalance. I'm not suicidal, but I've had a few days of depression since my MC. It's not unusual for me to be having a normal day and end up obsessing to my H about how we're never gonna have a baby a few times a week.

For 10 years, I took a low dose of an SSRI that I started because I was having terrible anxiety in grad school. About 2 years ago, I weaned off the meds because I knew I would be getting engaged and TTC and I felt like the benefits would not outweigh the risks of exposure to my infant in utero. I had no problems after weaning off the drugs and I think I would've had no issues not being on the meds throughout pregnancy if I hadn't miscarried. But I did and here I am.

I really am am grappling with whether I should explore this option again or if I should just continue with therapy and try to better about meditating and forcing myself to be more social and spend less time worrying about TTC.

Im just wondering if anyone else is in this boat and want to talk about their thought process about whether to be on or off SSRIs.

Pompomlove · February 2016

How long ago was your loss? Hormones are a B. It's taken me 3 months really to feel normal again. I have been on anti depressants in the past and had several days of "I need to go on meds again". I think the fog has started to clear.... For the time being.

I'm not making any recommendations but I feel glad I let myself have "grief" and not "depression". Maybe have a chat to a doctor anyway and see what they think. My H suggested counseling a couple of times too.

chloe97 · February 2016

Thanks @pompomlove maybe it is grief still. It seems like a long time to be so upset. I'm at 2.5 months right now. I'm not sure how to feel better. I'm just so deathly scared of not conceiving this month and I wish there was something I could take to make these horrible feelings go away.

BornReady · February 2016

I'm sorry you are having a hard time. I have been having a similar thought for myself. My anxiety has always been high, my entire life.It has been well managed for a long time, but this miscarriage has not helped matters. I've also been wondering if it's time to reevaluate meds, which I have not been on in years. For me it's difficulty sleeping/waking up everyday at like 4 AM wide awake and OCD behaviors. I'm still thinking it might be grief/hormones, but I'm open to seeing someone for a med eval if this keeps up.

My sister lost her first child when he was a week old due to a hospital accident. She went on to have 3 more children and was on zoloft during all of those pregnancies. Her anxiety/depression being pregnant and the postpartum period was too much for her to be untreated.

Good luck whatever you choose and definitely get feedback from your counselor, they are usually very good at helping discern a chemical depression that would benefit from meds and typical grief reaction symptoms that will be better treated by counseling.

NamelessAria · February 2016

I would say after only 2.5 months it could still be grief. I don't know how severe the grief/depression is for you though. But I know I still have days/nights where I cry. I still have some hard TTC days. I still can't really see a pregnant lady or newborn without emotional pain. And I had my MC back at the beginning of November, so about 4 months ago.

I lost my grandpa (we were always very close) 2 months before my MC back in September and I still have days where someone says something that reminds me of how much I hate the idea that I'll never see my grandpa again, and it makes me cry. I'm actually tearing up a little writing this just thinking about all the moments in life I thought I'd be able to share with him and now I can't. Like having him around for holidays or having him there when I finally get to show my take-home baby to my family. (Because surely someday at the end of this dark TTC tunnel there is a take-home baby). Or just the little things like being able to call him and ask for advice on how to make the tomatoes in my garden stop dying since he was always such an amazingly talented gardener. It's just hard, sometimes, with loss. There is no "appropriate" amount of time to grieve similar to how there is no "appropriate" manner in which to grieve. It is what it is for you. Some people grieve for a couple of days or a week and then they're good. They have closure and they're ready to move past it. Other people need months, or years. And some people never really completely move past it. It will always be something that makes me a little sad sometimes when they think about it. And that's OK.

Some form of counseling or therapy may be helpful for you. This is especially true if you're starting to think that your grief has become/is becoming pathological. If you feel like you're becoming depressed, for example. Only you know how you feel and if what you're going through seems "normal" for you or something more. If you think that your loss has made you depressed don't be afraid to seek treatment. Some people only really need to have depression treated through counseling and other non-drug interventions. Other people will need drugs. Of the people that need drugs some of them only need to take a SSRI or other drug for a brief period of time. Just long enough to get them "over the hump" so to speak. Maybe a few months. There are plenty of women who take SSRIs and other psych. meds throughout their pregnancy and have healthy pregnancies and a healthy baby. And you really never know if you'll even conceive between now and when you no longer need medication, if you decide to go that route. So basically, you have to do what is right for you. And then if/when you become pregnant you can make the decision about what is right for you while pregnant. But it's perfectly fine to cross that bridge when you get there and not worry about it now.

mylittleversailles · February 2016

I'm sorry that anyone has to feel this way. I literally just stopped bleeding yesterday and I'm only 2 weeks out (3 since we found out at our ultrasound) but I am closely monitoring this and my progress as I'm very prone to anxiety and only recently got over a severe bout of depression related to my best friend's passing (and a deep trauma surrounding the circumstances; happy to talk about it privately). I have some really bad hours of the day, my anxiety is out of control and I am experiencing some intense self-hatred, but I understand right now I need to ride it out because hormones, etc.

Grief works itself out, in its own violent way, in its own sweet time.

I think patience with yourself is necessary at all points in life, especially now. However, asking for help, in whatever way you know how is always the right thing. Medicine can save us on so many levels and when it comes to mental health, it can get us to a place where we can seek the next level of treatment to learn other methods of coping and new strategies to getting ourselves, hearts and minds back into shape or, as mentioned above, it can simply get you over that seemingly endless hump. Whatever your choice, this random stranger on the internet understands and supports you.

MamaCoffin · February 2016

Grief knows no time line. I found out there was no heartbeat on November 12th. I abandoned just about everything until a couple of weeks ago. Fortunately DH is amazing and works from home and was able to pick up some of my slack.... But there were weeks I couldn't even pull myself off of the couch. I felt like I was drowning. I honestly couldn't see EVER getting back to life and feeling good.

I still have days but looking back over the last few months I'm amazed at how much better I'm doing. Day by day.

Please, if you're concerned talk to your Dr. But don't think for a minute that something is wrong and you are somehow grieving inappropriately. Only you can decide when you've started to heal. If it takes medication and/or therapy to start that healing process, so be it.

Hugs to you.

MamaCoffin · February 2016

Ps healthy mama means healthy baby. Get yourself healthy first!

RiverSong15 · February 2016

chloe97 said:

Thanks @pompomlove maybe it is grief still. It seems like a long time to be so upset. I'm at 2.5 months right now. I'm not sure how to feel better. I'm just so deathly scared of not conceiving this month and I wish there was something I could take to make these horrible feelings go away.

Try to remember that grief does not have a timeline. There is no right or wrong length of time to mourn a loss. I don't have much experience to share, but wanted to give you some hugs. I've had some pretty dark days myself, but no experience with meds.

jlo1019 · February 2016

I am 6-7 months pass my loss and it still haunts me. I would allow yourself this time to grieve. Women losing their children is such a heartbreak and no easy task to overcome. SSRI's can be a wonderful tool to allow yourself to heal. It maybe all you need right now to get yourself through this period. I have a friend who had a late term loss and she also had to use an antidepressant to get her through. No shame in loving yourself :-)

take care of yourself in any way necessary. Talk therapy can also be very wonderful and healing. So can meditation, positive affirmations, etc. I hope you find your own path in healing. Hugs to you.

cjs260 · February 2016

@chloe97 I am so, so sorry you're feeling this way. Like PPs have said, you know you, AND 2.5 months is a brief period of time after what we've all been through. Everyone grieves in their own time.

I have diagnosed (from childhood) OCD (in which my anxiety leads to depression), so I had decided to go off my medication when we decided to TTC. After my loss, I told my psychiatrist that I would prefer to stay unmedicated** as 1)we would be TTC again after a cycle and 2) I wanted to feel my grief. Since I have been dealing with OCD since I was 10 years old, DH and I know the warning signs to spot when my anxiety is getting dangerously high, and my psych has checked in on me biweekly since the meeting we decided to stay off meds. We both feel comfortable with this, but that is a decision that should be made by a patient and a doctor and hopefully not influenced by a stranger on the internet. Typically, if I myself think my mood is getting beyond what is normal for me, I go talk to someone, whether it's the psych or a counselor. I think counseling might be the best first step, as they are great at assessing whether someone could benefit from medication.

** Now, I have to say, that even though 90% of OBs and psychiatrists believe that SSRIs during pregnancy are decently safe and the risk of depression to the fetus may be worse than medication, I disagree. Just because the risk of birth defects are low, doesn't mean the baby won't be affected. In rodent animal models, where pups are exposed to SSRIs in critical brain development windows grow up to show a significantly higher behavioral indicators of depression and anxiety than their litter mates. SSRIs work by altering some receptors in neurons of the central nervous system and as SSRIs have been shown to have substantial transfer across the placental barrier in humans, I personally am not comfortable with taking a medication that could alter my developing fetus's serotonin uptake later in life. DISCLAIMER: I am NOT a medical doctor, but I AM a Ph.D. candidate in Anatomical Sciences and Neurobiology. I have taken classes on developmental neurobiology, and my Master's thesis focused on prenatal exposure to testosterone (and other exogenous factors).**

catiecatp · February 2016

@chloe97 - big hugs - I echo what everyone else has said, that everyone grieves differently but I'm going to pick up on a few different points - it is a bit of a book of a post - sorry I am a wordy person in real life too... Given your concern, the timeline, that you are currently seeing a therapist (I think), and your past use of SSRIs - I think it is time to talk to your therapist about maybe going on an SSRI for a short while. And if your therapist is dismissive about the idea go to your GP or psychiatrist - have someone talk about it with you. There are a few that are considered safer (my GP was telling me about them, so they exist) and you could try one of those at a low dose for awhile. It may be what you need to help break your current mood - there isn't anything wrong with grief, but if it is affecting your daily life and you want it to change then SSRIs could help. Given that you used SSRIs in the past, perhaps you have a propensity towards a chemical imbalance that was triggered by the MC.

If you do get a BFP then you can evaluate how you feel and perhaps wean off at that point. As far as I know, there isn't a strong link between antidepressants (esp. the ones considered safer) and any neonatal outcomes - and if there are, they are correlational and I can wax poetic about the issues with correlations at another time. It is again only correlational, but there are stronger correlations between maternal depression and neonatal outcomes.

In terms of right or wrong times for how long to grieve - there is no definite timeline. However, the medical profession seems to go with about 6 months for a loss. If you've had a major loss in the past 6 months you won't be diagnosed as having Major Depressive Disorder (DSM-V classification) but you may still benefit from short term antidepressants and/or therapy. Beyond 6 months, medical professionals consider it a full depressive bout - again, you may benefit from antidepressants and/or therapy.

A bit of background for my recommendations - I was on high-doses of many different types of SSRIs for years (at least 8, including at least half of the ones that are safer during pregnancy) - I never stabilized - they said it was because I was an adolescent and my body was changing - but when I was 23 I called bullsh*t and went to a naturopath. Chemical depression runs in my family - although I never had much relief from SSRIs many of my family members have. Personally, I've been successfully treating my depression better with natural supplements (5HTP, folate, and omega 3 fatty acids) - and unfortunately I'll have to be on all 3 of those when pregnant (I've tried weaning off 5HTP, it isn't pretty) and of course there is no research on supplements because pharmaceutical companies don't make money off of them (argh!)... My depression while pregnant would be incapacitating and would likely affect the health of my fetus as well as the health of my marriage. I take ones from my naturopath and she's researched the companies so at least I know I'm getting quality ones (and as a result can actually take lower doses).

chloe97 · February 2016

@catiecatp and @cjs260 Thank you for sharing your experiences. I guess that I also have a hard time believing that SSRIs are 100% safe during pregnancy. I work at a child health organization and every day all staff receives a roundup email about new research that might as well be titled "How pregnant ladies are f-ing up their unborn children this week". I can't tell you the number of times that there have been studies linking SSRIs in pregnancies, birth defects, and developmental disabilities. Because of this, I made the decision years ago to go off SSRIs before TTC. I really do honestly believe that there are some pregnant women- baby dyads that are much better off on SSRIs. There are many pregnant women who are severely depressed or are bipolar, etc who will have much healthier pregnancies on their meds. I'm just not sure that my case reaches that level and that I am willing to take that chance. I like the ideas that you all mentioned. I really need to be better about attempting to meditate and make my therapist a priority, even if that means cutting out of work early.

I am 2.5 months passed a MC. It's cold and snowy here. H was busy all weekend and I laid around ate the cookies I baked him for V-Day and binge watched all 13 episodes of a Netflix show. I know that I am going to feel down sometimes.

Thank you all for taking the time to respond. It's helpful to know that I am not alone as I go through this stuff!

fivetimesnoluck · February 2016

The advice here is remarkable, so I will only add that I have tried a variety of approaches at different points in time and currently I am avoiding Lexapro (and have been for two years) in favor of exercise, acupuncture, and occasional talk therapy. There are myriad ways to address the anxiety and depression that so many of us feel - with or without current circumstances playing a part. I would go back on it in a heartbeat if I felt the need, but I have been managing well so far and am grateful to not have another thing to worry about affecting my plans for conception.

catiecatp · February 2016

@chloe97 - I can see how regularly hearing that type of research would affect your decisions. I had a lot of guilt staying on my drug therapies but really couldn't see living without them for a full pregnancy - if I have to use a different brand (lower quality) at double the dose I'm depressed in under a week.

Have you tried a SAD lamp? I find that helps me too - and it would have zero effect on a pregnancy.

Out of curiosity, have you run across any research on the following naturopathic supplements: 5-HTP, SAMe or St. John's Wort? Or higher doses of folate? I tried a PubMed search but just came up with a study or two on St. John's Wort that were largely inconclusive. Once I get a BFP I decrease my dosage - I've gone back up after the MC to help me cope but will likely decrease again soonish, regardless of BFP or BFN.

megsbrock · February 2016

There's a lot of great advice here. I just wanted to send good thoughts your way that you will soon see yourself on the other side of the deep sadness. I encourage you to put yourself first and try whatever you think will work to help you feel better in the moment; hopefully that moment will turn into a day, then turn into a week....etc.
I have always been a people pleaser and so worried about putting others first...since dealing with the grief of two miscarriages, one of my main coping mechanisms is to put me as #1. I do think it's helping.

MamaCoffin · February 2016

megsbrock said:

There's a lot of great advice here. I just wanted to send good thoughts your way that you will soon see yourself on the other side of the deep sadness. I encourage you to put yourself first and try whatever you think will work to help you feel better in the moment; hopefully that moment will turn into a day, then turn into a week....etc.
I have always been a people pleaser and so worried about putting others first...since dealing with the grief of two miscarriages, one of my main coping mechanisms is to put me as #1. I do think it's helping.

So much this. I've been extremely selfish lately. And I'm not sorry.

chloe97 · February 2016

@catiecatp I actually have not seen any research about HTTP or St. John's wort. The problem, as I understand it, with supplements is that they aren't regulated by the FDA so not a whole lot is known about them good and bad. Have you talked to your Dr about them? H takes a whole bunch of weird things like horny goat weed and this weird Green superfood. That gives me pause, but my OB didn't seem ti think it was a problem. I only take CoQ10 and EPO, but I'm also doing the Chinese herbs that my acupuncturist prescribes. I will probably quit those totally when I get the BFP.

I also like your idea of the SAD lamp. We do live in Chicago, but it's supposed to be 60 here on Friday!!

@megsbrock and @jenmlangtake2 I like the idea of being completely selfish these days.

CoonMom · February 2016

I've been debating talking to my doctor about depression for over 6 months now. DH is strongly against me going on anti depressants. I was too at first, now I'm more open to talking about the possibility. Once I hit the 6 month mark of TTC I had a gut feeling something was "wrong" with me making it difficult to conceive. A horrible pain sent me to the ER late August and discovered my gallbladder needed out. While in surgery the dr discovered Endo and removed it. Two months later I got my BFP. Coincidence? I think not; OB didn't confirm but I still believe that's the reason. Unfortunately baby didn't stick and I loss him/her at 6 weeks. Surprisingly after a month I was ok and ready to try again. However lately I can't focus at work, I'm not sleeping well, cry all the time, etc. I'm not suicidal but I don't see the point of living right now. DH usually has to pry feelings out of me and I was so open with him tonight. I didn't mention I'm thinking of calling the doctor. He suggested therapy in November and I went but didn't feel it helped. The therapist just wanted me to relax and not help with my feelings. I don't know what to do myself.

I didn't mean to hijack your thread chloe97 I simply wanted to let you know you are not alone. I hope you figure out what works for you. * hugs*

DinosaurJumper · February 2016

My goodness, so many well-educated ladies on this board! It's been great to read all of the pp and I'm glad to know I'm not the only one with depression on this long journey of TTC and not just the blues or anticipation. I hope all you ladies are able to find your way through these dark times, whether it's medically or on your own.

catiecatp · February 2016

@chloe97 - my GP suggested SSRIs over the natural supplements but I told her that wasn't an option for me, I've been on them (I believe I have tried 7-8 of them) and the side effects are crazy (including low sex drive, not helping with TTC), the doses need to be high, and they don't work... She suggested I talk to my naturopath and a pharmacist. The naturopath looked into it too and couldn't find anything - and I never got around to talking to the pharmacist. I'm fairly certain there is a chemical issue with me given the family history and my own personal history - I don't think not treating for 9+ months is an option for me.

I hate that supplements are unregulated and largely unresearched. I get my supplements from the naturopath as a level of quality control - for example if I get 5HTTP from the natural foods store I have to double the dose and I still get depressed by the end of a week relative to the dose I have to take when I get it from the naturopath (and I don't get depressed with them).

GhanimaAtreides · February 2016

Keeping it simple: As you know, SSRIs do not have to be forever. You don't need to distinguish between what is grief and what is depression at this point in order to take them. If you feel that they will help get you through this time, there is no shame in taking them. You can decide if you want to wean off once you come across another BFP. If you decide to keep taking them through pregnancy, just know that nursing on them too is the best way to mitigate a newborn's transition to outside the womb. There are also non-SSRI antidepressants to consider that may be safer too. My doc wants me to switch from my 10mg Adderal XR to Wellbutrin (non-SSRI antidepressant) if I ever get another +HPT since it has shown to help attention span as well. I've also taken Zoloft during my 2nd pregnancy, and nursed without issues.

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