by Katie Madden, RN, BSN, IBCLC

I have taken Zoloft for about 13 years.  I first went on it in Nursing School in 2002 when I had a Major Depressive Episode. In truth, I had been unraveling since I started college in 2000, but things didn’t come to a head until my junior year.  At the time, I was a high achieving nursing student and the president of my student body.  On the outside, I looked amazing.  On the inside, alone in my Baltimore apartment, I was having panic attacks while studying; slipping into a deep depression over getting a B+ rather than an A on my test; contemplating suicide as the only escape from simple, mundane, everyday difficulties; and steeping in a vicious stew of body self-hatred.

After a lot of talk therapy, I started medication and started feeling a little better within a few weeks; it would be a few years until I got the dosage right.  I went through phases when the dose was too high and I felt numb.  At one point, I was so unstable, I even took a two-week leave of absence from work to get myself straight.  I was lucky to have been on a good dose and feeling pretty well balanced when I became pregnant with Lucy in 2005.  Then, Joe and I had to decide if I would stay on the medication during my pregnancy.

Nine years ago, we knew less about the safety of Zoloft during pregnancy and breastfeeding. Now, however, it is quite common place and trusted to be safe. Back then, there were suspicions of possible withdrawal for the baby and possible pulmonary hypertension.  Here is a public health advisory published in July 2006 about this issue. In 2011, the FDA updated their statement stating that new studies have yielded conflicting results, bringing the connection between Zoloft use in pregnancy and pulmonary hypertension into question. But in 2005, I had to balance the potential risks for Lucy and the potential risks to me. Joe and I talked with the midwives and we made the decision together that it would be safer for Lucy and me if I stayed on my medication rather than go off of it. I had a history of depression, which put me at a high risk for postpartum depression.

Lucy was born a perfect, healthy eight pounds, 14 ounces.  She was a little slow to breathe right after she was born and she didn’t cry once for the first 24 hours of her life.  She then went on to cry every day for three hours straight for the first two or three months of her life.  I remember wondering if any or all of these things were a result of me taking Zoloft during pregnancy.

Lucy was a hard baby, or I had a hard time adjusting to motherhood… or both.  She cried a lot and I became reluctant to let anyone else hold her for fear she would start crying again and I would need to spend hours consoling her.  I wore her in the wrap almost constantly and began to develop irrational fears whenever she wasn’t in the wrap.  Once, I remember walking around the mall with my mom when Lucy was maybe two or three months old.  My mom really wanted to push Lucy in a stroller. This was mom’s first grandchild and it was simply one of her dreams: to push her grandchild in a stroller around the mall.  I hesitantly peeled Lucy out of the carrier and laid her in the stroller where she was calm and quiet for a few moments.  My heart was racing and I had a panicked (irrational) feeling that someone was going to spit on her; I snatched her out of the stroller and stuffed her back into the carrier where I felt safe.

I attempted to return to work when Lucy was three or four months old and she wouldn’t take a bottle.  Out of fear or stupidity, who knows, I asked Joe if I could quit my job and out of love or stupidity, he let me. He started working overtime night shifts and I was left alone with crying Lucy. A lot. And things got worse.

My marriage started to disintegrate.  I remember thinking that I didn’t have the capacity to care about, attend to, or take care of Joe. I was barely managing to take care of myself because Lucy was so high needs and required so much attention.

I remember when Joe and I took Lucy to his family’s Christmas party.  I had a full blown panic attack in the car before we went in when Joe told me that I shouldn’t wear her in the Moby and that I should let people hold her.  I was crying and he was fed up with my obsessive overprotectiveness.  We walked into the party and he literally pried her out of my arms and sent me to the kitchen.  I am remember sitting in the kitchen in a fog. I was shaky and nauseous and I couldn’t eat. People around me were talking and it sounded like I was underwater.  I was afraid to be apart from her. Literally, my whole body was afraid.  I went into the other room to see her happily playing on the rug with her father and her uncles.  I remember exhaling just a little, then waiting anxiously for her to show signs of hunger.  At the first root, I snatched her and went upstairs to a quite room to nurse.  And I cried.

Despite all the anxiety, the depression wasn’t there.  I realized quickly after she was born that killing myself was no longer an option as a solution to every problem I had.  What was even scarier was that it wasn’t an option anymore.  I did, however, formulate a very specific plan for how I would deal with it if anything ever happened to Lucy. Now, that—I am not sure if that is pathological or not…

It took about 14 months and a divorce to get me to a place where I was okay without Lucy touching my body almost all the time.  The anxiety got better and I got tougher.  I had to. She and I were living alone and she would spend time away from me with her father.  I had to be strong.  There were a few things that got me through that time.  My amazing parents, my friends who I met at Mom’s Group at The Birth Center, the consistency and connection of breastfeeding… and Zoloft.  It scares me to think what would have happened if I weren’t medicated.

Would the stirrings of anxiety have become crippling?  Would I have been able to grow into a tough single mom?

I am glad that I will never know the answer.

Being on medication is something that I am not ashamed of.  I consider my depression a well-managed disease for which I take daily treatment.  I will tell anyone who I think needs to hear it that I take meds because I found out a long time ago that the more I said it, the less shameful it was for me.

Making the decision to stay on the medication during my pregnancy was one of the hardest decisions I ever had to make.  It is a decision that I will carry with me for the rest of my life.

A few months ago, I was at an in-service with a few neonatologists discussing care of the newborn right after birth.  In conversation, one of them mentioned that a known side effect in babies exposed to SSRIs like Zoloft during pregnancy is aphonia at birth.

They don’t cry.

My heart sunk.

The part of Lucy’s birth story that was so unique wasn’t unique at all.  It was a side effect of a drug I exposed her to.  Nine years later, this shook me.  I told Joe later that night and he shrugged.  “She didn’t have anything to cry about,” he joked. “She was on antidepressants.”

God, do I love that man… almost as much as I love Zoloft.

P.S. Yes it is the same Joe that I divorced earlier in the story. Confused? Read this.