To Medicate or not to Medicate?

In the interests of full disclosure (and as you may have guessed by my other posts) – I am absolutely a proponent of medication, be it mental health related or otherwise. You wouldn’t have thought so given my upbringing. My mom raised me to be an avid reader and skeptic of conventional wisdom. She taught me to question things and make sure that I was really doing my research. My mom was a huge advocate of holistic methods for healing, rather than just reaching for a bottle of drugs.

Mom was skeptical of all the bad press on eggs since before I could remember. When I had a sore throat, she had me gargle salt water. When my allergies or sinuses were bad, she handed me a neti pot.

Of course holistic cures aren’t always realistic when you work full time and only get four weeks of vacation (which also counts as your sick leave).

Practical reasoning led me to use a healthy combination of drugs and natural remedies where possible. I temper drug use with my attempt to keep up with research on various areas, critically looking at research methods, a body of evidence and so forth.

When I got pregnant, I found myself wading into a swamp of contradictory information. Coffee was bad – until it wasn’t. Alcohol was definitely not good, but maybe it was not bad. Deli meat was off the table because of listeria, yet the three outbreaks of listeria that occurred while I was pregnant happened in dairy products.

There was no way to be absolutely safe. People who say “but if you can’t know how it affects your baby, why would you even risk it?” drive me up the wall. Technically everything carries risk. When you’re pregnant, you sort of figure out what you’re comfortable with and what you’re not.

It’s about finding a balance. 

I took Tylenol when I got my sinus headaches, but otherwise I used steam, the neti pot and other holistic remedies rather than Sudafed. I knew women who used it, but I was uncomfortable with it, so I opted out. Unlike most women, I drank during my pregnancy. My OBGYN told me a glass of wine every so often in the second and third trimester was fine. I found that a glass of wine in the evenings helped reduce my stress levels. I was working on my Masters and had a full-time job. Given that studies vary wildly on what the effect of stress is on a fetus, maybe drinking was better for my baby because it reduced my cortisol levels.

When I started breastfeeding, I intended to try to stay as unmedicated as possible. But several factors forced my hand. I ended up going through four rounds of prednisone due to a killer postpartum rash. It was to the point where my legs were inflamed and physically hurt to touch. I had ripped long gashes in them trying to get at the horrible itching. I tried creams, lotions…every holistic option in the book. Nothing worked. Finally at my 6 week postpartum checkup, the doctor saw my legs, arms and back and referred me to a dermatologist to take care of the problem.

My dermatologist ordered me a round of prednisone (along with a battery of tests) and told me to ask my pediatrician if it was safe to take while breastfeeding.

The pediatrician informed me that releasing small amounts of steroids into my milk was perfectly safe. In fact, they treat infants with steroids for certain ailments. It’s a long practiced treatment. Everything that I read indicated a similar bent, so I proceeded and tried to pace my breastfeeding from the time of that I swallowed the pill, where possible.

Once I finally beat the rash, I was drug free until my postpartum depression escalated and got out of control. I was experiencing fatigue, hopelessness, suicidal impulses and a lack of connection with my baby.

I went on Zoloft. I used Zoloft in conjunction with breastfeeding for about three weeks until I ultimately decided to wean to get my estrogen levels back to normal.

Zoloft is one of the most widely studied drugs for pregnant and breastfeeding mothers. But several other drugs have been studied as well. Paxol is another one that typically is quoted as a safe drug for breastfeeding mothers. Studies on Zoloft suggest that while the seratonin levels in the mother are impacted by the Zoloft, the transporter mechanism to the infant leaves the infant’s seratonin levels roughly unchanged. Admittedly studying pregnant and breastfeeding women has its problems due to ethical reasons. In fact, in the quoted study, the sample sizes are very small, which makes it difficult to draw conclusions. In replicated experiments, greater amounts of Zoloft were detected. Regardless, no adverse side effects were observed. One of the studies suggests that .02% of infants were affected by an SSRI (Selective serotonin re-uptake inhibitors such as Zoloft, etc.)…but what exactly does affected mean? Not every side effect is bad.

When making decisions on medications, it’s important to look at the body of evidence rather than just one independent study. Understanding the research methodology, choices and limitations that researchers use is critical to understanding whether or not the study is valid. But more importantly, the study must be replicated to ensure that it wasn’t a fluke or a victim of poor research methods. We can see the damage that one bad study can do with the measles outbreaks due to the anti-vaccine paranoia.

I really like using sites sponsored by NIH or I find these sites to be comprehensive and provide more detail on how the study was performed so that I can assess whether or not I think it’s reasonable. There’s a tremendous amount of information on Zoloft on, for example. Sometimes I’ll take a list like this one, and then look for health organization sites to confirm my findings. Doctors often are too busy with day to day care to devote extensive time to research, so combining good research sites with a discussion with your doctor is the best bet.

When making decisions though, it’s really important to balance the pros and cons throughout your decision. For example, if you are driven to breastfeed to give your baby those benefits, than perhaps those breastfeeding benefits outweigh the risks of a modest amount of medication showing up in your blood stream.

OK, that’s good information…but is suffering through depression or anxiety harmless?

I know a lot of women though who would rather sit there in silence and painfully struggle through postpartum anxiety or depression because they are absolutely committed to giving their babies drug-free nourishment.

OK so that’s an option – but are those mothers actually making the best choice for their child? An interesting thing that I learned from a psychiatrist who specializes in perinatal mood disorders is that “suffering in silence” may have other effects that you’re not seeing.

What am I getting at? A couple of different things, actually. When we are stressed, anxious or fatigued from postpartum depression and anxiety, our bodies are having chemical responses to both create the fog of depression and then also to counteract said depression…to survive.

Moreover, a frequent symptom of postpartum depression is lack of connection and bonding. Does the lack of connection impact a child’s well-being? There are those studies that suggest that yes, it can.

The research community has been trying to determine for years if anxiety and other related symptoms of postpartum depression can impact the child of the suffering mother. Frankly it’s very possible that by opting to “power through”, you’re hurting your child’s cognitive development. The choice to not get drug treatment when it is needed may not actually be in your child’s interest. One thing that psychiatrists who specialize in perinatal mood disorders look for is impact on the affected mother’s infant. The possible side effects of not treating postpartum depression could actually be quite chilling:

Withdrawn mothers are disengaged, unresponsive, affectively flat and do little to support the infant’s activity. The infants are unable to cope or self-regulate this negative state, and develop passivity, withdrawal and self-regulatory behaviours (eg, looking away or sucking on thumb)

It may not even end there. The quoted piece goes on to suggest other impacts on the depressed mother’s child throughout development.

More to the point: we simply don’t know if choosing NOT to act can be damaging. 

As with all of these studies, you absolutely have to do your research and determine the right course of action for you and your child. I’m not saying that every mother who has depression and anxiety needs medication. Rather I’m simply offering a message of caution to the mother who doesn’t want to medicate because she believes no meds = a healthy child. The choice not to get treatment when treatment is warranted may have other unintended consequences.

Note that I’ve used and continue to use words such as “should” and “may”.

My main point here is to challenge the conventional wisdom that it’s always better to skip the drugs and suffer through. We may not know how stress, anxiety and depression affects our child, but there’s enough information there suggests we should probably factor it into our decision making. We moms find ourselves into these positions of martyrdom. Moms are held on this pedestal and sharply judged (be it real or perceived) for doing anything that could remotely be deemed selfish. But we run into this problem of extremes which can lead us to lose our way at times.IMAG1253

After all, sometimes taking care of the mother is the best way to take care of the child.

But even more importantly – after going through everything that we went through to bring our child into the world, don’t we owe it to ourselves to care for ourselves so that we can actually enjoy our child?

Postpartum World_ICON_4C_Yellow Rattle

3 thoughts on “To Medicate or not to Medicate?

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