Pregnant on Prozac, Dr. Shoshana Bennett's latest book and a must-read!!!

I'm thrilled to announce a new book, "Pregnant on Prozac" by Dr. Shoshana Bennett, nationally renowned Postpartum Depression expert and past president of Postpartum Support International.  This new ground-breaking book will be released in January, 2009, and I personally can't wait to see it on book store shelves around the country.

I've written more than one post here on the issue of taking anti-depressants while pregnant and breastfeeding, and found out quickly that not only is it extremely controversial, but there are so many unanswered questions that continue to surround this issue.  And moms, as well as experts, end up lining up on opposite sides as we try to muddle through the confusion.

Well, now, thanks to Shoshana, there's finally a book that cuts through the fog and answers integral questions such as: Does the media exaggerate risks?  What of options such as tapering the dose? Most importantly, this book empowers each woman with the knowledge to make THE BEST decision for her and her family.  "Pregnant on Prozac" is for any prospective mother who has experienced depression or anxiety as well as anyone with a friend or loved one in this situation.  It's the first guide to separate the myths from the facts, and clearly spells out not only the possible risks of anti-depressant use (whether it be Prozac, Wellbutrin, or any of the other drugs), but also the lesser-known yet serious risks to both fetus and mother from untreated depression.  In the book, Shoshana also discusses natural treatment methods, which I believe is so very helpful and important, and haven't seen elsewhere.

The only problem now is waiting till January to scoop copies of this book off the shelves to give to every obstetrician and pregnant woman I know.....

Atlanta Mom asks me about how to prevent postpartum depression

Yesterday I heard from Atlanta Mom who also blogs about her PPD experience and tries to reach out to help new moms. She asked me how I overcame PPD with my subsequent pregnancy. Even though I've written about how I prevented experiencing PPD a second time, it's been a while, so I want to share what I wrote back to her.

Here's an excerpt from my e-mail to her:

I was determined not to go through PPD again at all costs, and began researching ways to avoid it. I came upwith a list of options/resources and spent much of the pregnancy planning on what I wanted my postpartum tobe like.

One thing I did was to hire a postpartum doula. That was absolutely the best money that I've ever spent!

I also enlisted my neighbors and close friends to help -- I told them my PPD story, if I hadn't already shared it with them, and asked if they would help with different areas that they felt like they could help with (ie: preparing meals, having my two older kids over for play dates, going to the grocery store for me, etc.). I got my friends to commit to certain things, and they were so happy to help out -- they were awesome. (It's so hard to ask for help,but once you do, you find that your close friends are so relieved to know what they can do that will truly help you.)

I also hired a neighborhood teenager to come over to my house nearly every afternoon just for a couple of hours or so toplay actively with my older kids, to give them really solid attention. My husband saved up his vacation time andwas able to take a full 3 weeks off after the birth, and he was great around the house and supervising everything.

I also started on an anti-depressant within minutes after giving birth, and also had a psychologist on call in case I experienced any PPD symptoms so that I could quickly get in to see her or have a phone consultation if I needed it.

So, basically I was very focused on creating a really strong support system, not only helping me with just about everything but also helping me monitor any PPD symptoms should they arise. Happily, I never even experienced a single symptom!! It was a wonderful postpartum and I was relatively rested even after having had a C-section. The doula helped me immensely with getting the baby on a schedule while juggling my older kids. I only needed her help for the first three weeks. I stayed on the anti-depressant for about 9 months or so just to make sure I was doing okay, and then I gradually weaned off of it and did great. PPD is totally preventable. That's my big message. The big thing is overcoming the fear of going through it again, facing that fear and then preparing/educating yourself on how to avoid it. Everyone should be able to experience a happy postpartum!!

A postpartum depression interview with an extraordinary high school student

I was recently contacted by a high school student named Ashley clear across the country who asked if she could interview me for a high school project. She had chosen to write about Postpartum Depression with the hopes of educating others on how devastating and misunderstood it is. Ashley found me when she came upon this blog and I was so thrilled and honored to help her out. Below are her questions to me and my responses during the interview.


What was your initial reaction to finding out you had Postpartum Depression, how did it impact your life?

My initial reaction, as sappy as it sounds, was crying tears of joy. Receiving a diagnosis of Postpartum Depression had a major impact on my life at the time. I had spent three months suffering horribly, some of that time in and out of the hospital, with so much of my stress wrapped up in the fact that I had no idea what was wrong with me. The doctors caring for me had no idea either, so I felt completely isolated and alone. Being diagnosed was incredibly empowering because at last I could say: here’s what’s wrong with me and it’s treatable. There was a name for my agony. That knowledge literally brought up from the darkest place where I was contemplating suicide to one where I felt some hope.

What symptoms of Postpartum Depression did you have to suffer through, and if you had any, what physical changes occurred as well?

My symptoms were largely gastro-intestinal; mainly comprised of stomach pain, vomiting, diarrhea, fainting, dehydration, dizziness, major weight loss, lethargy and nausea. The nausea was far more intense than even the worst morning sickness that I’d ever experienced with any of my pregnancies. The most disturbing symptom was the extreme dizziness. The room would start spinning the moment I lifted my head from my pillow. I would have to literally crawl on the floor to make it to the bathroom. I went from being a very healthy and physically active (former marathon runner) 30-year-old woman to being completely debilitated and unable to function. Even the simplest everyday tasks, such as brushing my teeth, were impossible at times.

What impact did your Postpartum Depression have on your family and friends?

It destroyed my relationship with my parents, who did not understand depression (especially PPD) at all. During my second hospitalization for dehydration, my dad called me on the phone and told me to “get off my butt and start taking care of my babies.” I begged my parents to help me and my husband take care of our babies so that I could get out of the house for doctor’s appointments, but they refused and said it was my choice to have the babies, therefore I must deal with the consequences. When I was finally diagnosed with PPD, I needed some financial assistance in order to see a psychologist who was a PPD expert, and when I asked my parents for a loan they responded similarly. It has been nearly twelve years and I haven’t had a relationship with my parents since. I was so deeply affected by their ignorance of the reality of mood disorders and their lack of compassion that I’ve chosen to keep them out of my life. At the time, I was too ashamed about having PPD to tell any of my friends, so I didn’t share or ask for support from them. I think I feared they would react the same way my parents had.

What treatments did you go through for Postpartum Depression and if there were multiple treatments, which ones do you believe to be the most effective?

Immediately after my diagnosis, my obstetrician put me on an anti-depressant, Prozac, and it started working quickly. In only two weeks I felt nearly like my former self and I was able to take care of my babies and function well around the house. I also immediately began seeing a psychologist who specialized in PPD. Talk therapy helped enormously and I continued seeing her regularly (first once a week and then eventually once every two weeks) for about a year until I felt I was completely recovered. In addition, my psychologist recommended that I start writing in a journal, which I did, and also found very helpful. In fact, I credit that as the official start of what became my career in writing. I had never dreamed of becoming a professional writer, but after journaling and writing extensively about my PPD experience, I found that I loved writing so much that I became a freelance journalist.

In addition to talk therapy and taking Prozac, my psychologist recommended that I take a class of some sort or join a book club, etc, to have an excuse to get out of the house and do something just for me. I signed up for my first yoga class, one evening a week at the time, and that in itself made a major impact on my life. Not only was I getting out of the house by myself, I was doing a wonderfully therapeutic form of exercise that has taught me a great deal about the mind/body connection. I still do yoga regularly and my kids have done yoga since they were small.

Where there times when you would just want to give up because everything just seemed so stressful and overwhelming?

YES. There were many times when I couldn’t raise my head from my pillow and I’d think that I was so worthless that my life wasn’t worth living. I truly believe that if I had gone on much longer without a diagnosis that I wouldn’t be here today.

How do you feel when people assume that Postpartum Depression is just the “baby blues” and that “everyone goes through it, so it’s not a big deal”?

Whenever I hear or read the term “baby blues,” it makes me extremely angry. It's a load of crap. That term was created either by a man, or by a woman who never experienced a perinatal mood disorder. It’s like saying cancer is just a mild discomfort. And PPD is indeed a big deal since women have died from it since the beginning of time. They’re still dying.

Did you ever feel like people would judge you unfairly when they found out you had Postpartum Depression?

Yes, I totally felt like I would be judged since there’s still such a stigma surrounding mental disorders. The reason I began speaking out about my PPD experience is because I got so tired of hearing how women are still suffering every day, being misdiagnosed or left undiagnosed. And their children are suffering, both emotionally and cognitively. I don’t believe we’re any further along in decreasing the incidences of PPD than we were in 1996 when I had it.

Do you feel that after your recovery, you are a changed person or generally the same as you were before you knew you had Postpartum?

I am a completely different person. I feel like I’m more compassionate in general, but especially when it comes to mental disorders. I actually look at my PPD experience as a gift in a way because I’ve learned so much about my body and how to cope better with stress.

A few years after I suffered from PPD, one of my children was diagnosed with both Asperger’s Syndrome and Tourette’s Syndrome. Since I had worked so hard to educate myself on my own mental disorder, it was easier to understand and deal with the challenges that my child faced.

How do you feel about the controversy that erupted between Brooke Shields and Tom Cruise a few years ago?

I’m really glad it happened because it did a great deal to raise awareness of PPD among the general public. (It also demonstrated what an idiot Tom Cruise is and how that particular way of thinking needs to stop.)

Is there anything else you would like to tell the class regarding Postpartum Depression?

The main thing that I would like to express is that PPD is not only treatable, it is preventable as well. Many women don’t realize this, especially if they’ve already suffered from PPD. They assume they’ll have it again, and roughly 30% of women in this category even consider abortion when they find they’re pregnant again, rather than face PPD another time. I write a lot about PPD prevention on my blog and share my story of having a wonderful postpartum with my fourth baby in 2001, several years after my horrible PPD experience. As in most cases, knowledge is power, and I was truly empowered when I became pregnant my fourth (and last) time around. I knew what my PPD symptoms looked like, knew to watch out for them, knew to ask for help, to set up a strong support system of loving family and friends, and most of all, to take care of myself through the pregnancy and birth. For more information and access to some resources that I think are really great, you can always visit my blog or e-mail me.

Ashley, I cannot thank you enough for tackling this important topic and spreading awareness through your work. The more we talk about PPD, the more women and medical professionals will be educated so that one day we can bring an end to this devastating disorder.

Are there any psychiatrists out there who actually talk to you?

Passing As Myself left a good comment on my last post when I was getting to the point of ranting about how hard it is to find a psychiatrist (this was following a previous post where I ranted about how we all need to get our anti-depressants from psychiatrists and not from other doctors who don't specialize in the brain). Here's what Passing As Myself said:

"I also wanted to point out that some psychiatrists can be even worse than getting meds from a PCP (primary care physician). Many are content to over-medicate and focus on the meds and not include any talk therapy. The best mental health care I ever got was from a psychologist. When I told her I thought I needed drugs, she talked over all the options with me and then called my PCP to ask her to write the scrip. Then she and I could focus our energy on cognitive-behavioral therapy. More than one psychiatrist has prescribed drugs to me without bothering to give me options or explain why they thought their pick was best."

I thought this was such a great point that I just had to post on it.... So I started out this thread of thought trying to express my frustration that there are so many women suffering from PPD who get anti-depressants from their gynecologists or internists, etc., when those doctors clearly do not specialize in the area of mental health and have no business trying to determine brain meds. or dosage levels. I've personally gotten myself in big trouble doing this when I took a new SSRI (that seriously screwed me up) that my gynecologist prescribed, then later found out she'd been receiving "gifts" from the pharma rep. that carried this SSRI.

Here, Passing As Myself has brought up the fact that if you're lucky enough to even find a practicing psychiatrist in your area who takes new patients (hopefully without a 3-6 month waiting list) and is actually covered by your insurance, you still may not receive the care that you need. I once went to a psychiatrist who was already writing out my prescription when we were less than 10 minutes into the consultation. He barely even made eye contact with me the entire time I was there, which lasted about 11 minutes. Crazy. I've since had a couple of good experiences with psychiatrists, so I haven't lost faith in them in general. The very best experience I've had has been with a psychiatric nurse practitioner who didn't simply write up a script; she listened and talked with me for an hour each time I went to see her. Isn't this how psychiatrists used to operate? Why is it that now they're just into prescribing meds?

Anyway, what Passing As Myself has found is a fantastic option when you aren't able to find a psychiatrist who will spend the time with you that you need and deserve. I'm so glad she shared her experience!!

So what's up with our access to anti-depressants?

A woman e-mailed me this morning after reading my last post and said that she's really suffering and needs to see a psychiatrist. She gave birth to her baby after a very traumatic delivery about 6 weeks ago and she's been experiencing some troubling OCD symptoms, like obsessive hand-washing. The problem is that she has no insurance and limited funds, so when she called a psychiatrist that she found in her phone book and was told that it would cost her $225 an hour to see him, she gave up. So I started researching free and low-cost psychiatric resources in her state when this comment appeared on my blog from Moxie Mom:

"I wonder if the inconsistency stems from the availability of seeing a shrink that is affordable since many, many, people have terrible health care. It's much easier for a women to see her PCP (primary care physician) than it might be to see a shrink in that case. Of course, I agree with all of your comments: a shrink would be the best choice. Believe it or not, I have pretty good health care but I see a psychologist and get my drugs from my PCP. All the real psychiatrists wouldn't call me back, even after I left several messages. I called 5 of them. Talk about an eye-opener. Seems to me, all levels of health care providers need to start stepping up their game and thinking outside their box."

Moxie Mom's comment really made me think. I know that in my city, Phoenix, there are very, very few psychiatrists and when you actually find one who happens to be taking new patients, the wait could be as long as 3-6 months. It's ridiculous. There's no way a woman suffering from PPD, not to mention her baby, can wait that long. I could rant about this for hours....

But I still had to figure out how to help this poor woman with no health insurance.... so I'll rant about the general lack of psychiatric care later. I did find a state-funded mental health program in her state that had several psychiatric clinics spread throughout her county. At the clinics, she would be able to have access to either a psychiatrist or a psychiatric nurse practitioner to receive medication if necessary, and also a psychologist for talk therapy. If she qualified all of the services and meds would be free, but even if she didn't qualify financially, she would still receive everything at a 40-60% discount compared to private practices.

That was encouraging and I hope to hear back from her after she finds the support she needs. Moxie Mom, thanks for sharing your thoughts!

I have postpartum depression and need some Zoloft!

So I was chatting last night with a young woman who has a 9-month-old baby and is suffering from postpartum depression. She asked me where to go to get a "good" anti-depressant. She's been going to her OB who has prescribed Lexapro but so far the Lexapro isn't working for her. Before that, she went to her primary care physician who had her taking Paxil for a while, which also didn't work.

What amazes me here is the fact that neither of these doctors should be prescribing an anti-depressant to this woman who is obviously suffering. I mean, when you need medication for your heart, you go to a heart doctor/cardiologist. When you need medication for your brain, you go to (you guessed it) a brain doctor.

Why are so many women getting their anti-depressants from doctors like gynecologists, obstetricians, internists, etc??? Why are we messing around with our brains??? Would you go to a foot doctor if you're suffering from an ulcer? I think there are so many misconceptions about anti-depressants and it has gotten to where they are way too commonly prescribed -- and by any kind of doctor.

So I suggested that this young mother try to go see a psychiatrist so that she'll have the opportunity to get on the right anti-depressant or mood stabilizer or combination of medications, not to mention the correct dosage level for her. She'd never thought about going to see a psychiatrist or even a psychiatric nurse practitioner. None of her doctors had mentioned this option to her. I just don't understand why doctors who are obviously not specialized in the area of the brain feel that they can prescribe brain meds.

Taking a brain medication is a big deal -- not to be handled lightly.

Pregnant and on meds

I just love this conversation that's evolved from my post (a couple of posts back) on taking anti-depressants when breastfeeding! I set out simply to give my personal opinion on the risks involved and now feel way more enlightened on this "hot button" topic. In the midst of the mixed messages we get from drug test results and the medical community, we're left to wade our way through the murkiness of this issue while feeling guilty about whichever decision we choose.

I especially love psychologist and nationally-renowned PPD expert Ann Dunnewold's comment that "we need more honesty among women that this decision is hard" and that "women need to stop judging each other. Society as a whole is hard enough on us, setting up perfectionist, unreachable standards for mothers. We need to keep in mind the absolute truth, for the majority of women: that we are all doing the best we can do."

Several women have commented on my previous posts on this topic, openly sharing their experiences. One is now in the sixth month of her pregnancy with her second child. Not only did she suffer from PPD with her first baby, she has also dealt with severe depression since she was 13 years old. She is currently taking Zoloft and plans to stay on the anti-depressant during her postpartum while breastfeeding. She brought up an extremely valid concern that I hadn't touched on .... although we've been talking about the risks that anti-depressants pose to an infant, what about the risks involved when a mom's depression is left untreated? Studies show that the occurrence of untreated postpartum depressive episodes in a mother is linked to poorer cognitive test scores in their children. And way more tragic -- aside from the potential cognitive and development delays and possible psychological damage -- there is also the risk of a child losing a mother to suicide.

I want to thank this very strong and empowered woman for sharing her story -- openly letting us in on her decision that she's made to be on Zoloft while pregnant -- and bringing up this very important point that weighs heavily in this excruciating decision that so many of us have to face head on. I wish her all the best with the rest of her pregnancy and hope she keeps in touch so we can all celebrate with her when she experiences a joyful, calm PPD-free postpartum!

Ann Dunnewold, Ph.D, author of Postpartum Survival Guide, joins our conversation!

I've had quite the response from my last two posts that hit on the emotionally-charged issue of taking anti-depressants while pregnant and/or breastfeeding. Every comment has been great and I really appreciate the personal stories and thoughts that have been shared.

I was especially thrilled to see a comment today from Ann Dunnewold! Ann is a psychologist and nationally-renowned expert on postpartum depression. Of her several books on the topic, my favorite is "Postpartum Survival Guide." Her latest book, "Even June Cleaver Would Forget the Juice Box," provides solutions to the "mommy madness" that tends to pervade our lives as we feel pressured to aspire to perfect mommyhood.

On that note, her comment is awesome:

"I am so glad you brave women are talking about these issues. We need more honesty among women that this decision is hard--and that pregnancy or postpartum is not always a glowing Hallmark card experience.

"The official professional position is that a comprehensive "risk-benefit analysis" is necessary, because there is no "Right Answer". This means weighing the possible effects on the mother and baby of either choice —medication or doing without. There are documented serious negative effects of not treating depression and anxiety during pregnancy, including low birth weight. Over the twenty years that I have worked with postpartum moms, information has changed as research and drugs continue to evolve. Responsible, caring healthcare providers are usually glad to look at the issues for any individual’s case. If not, get a second opinion.

"For the facts about meds during breastfeeding, one of the key experts is Dr. Thomas Hale, who has a website at http://neonatal.ttuhsc.edu/lact/ and is the author of a great resource, Medications and Mother's Milk. Dr. Hale is VERY reassuring, feeling most meds are safe--but he is addressing breastfeeding, not pregnancy.

"The most important point in the posts here that I want to re-emphasize is that women need to stop judging each other. Society as a whole is hard enough on us, setting up perfectionist, unreachable standards for mothers. We need to keep in mind the absolute truth, for the majority of women: that we are all doing the best we can do. No woman I have ever seen in my office takes medication for fun. Women take them to function.

"We need to support, not criticize, each other's choices—and know that there as many valid choices as there are women in the world. Trust that you have made the best decision for you, given available info at this point in time. Don’t second guess or torment yourself with “what ifs” once you have decided."

Thank you so much, Ann, for taking the time to visit my blog and to share your valuable insight with us. You're the best!!!

More on meds and breastfeeding

Well, I've been e-mailing with a woman who wasn't at all happy with me after reading my previous blog on anti-depressants and breastfeeding. (She gave me permission to write about our communication on this blog.) She shared with me her experience of suffering from bipolar disorder and being on medication for it since she was a teen. When she and her husband were trying to get pregnant, she went off her meds. But by the end of her first trimester, she was having an absolutely horrible time so her doctor advised her to go back on her medication. She did so and went on to have a symptom-free, wonderful full-term pregnancy. Her baby is now nearly six months old and she's breastfeeding her baby and doing just fine. She feels very good about her decision to remain on medication and knows that she needed to do this in order to function and to be able to take care of her baby. She said she felt like she needed to defend her decision after reading my last post and make it clear that other moms shouldn't feel guilty about the decisions they make.

I absolutely agree with her. I applaud her for handling her illness so incredibly well and being so strong to know her options and then to choose the best one for her and her baby. Taking charge of our own health care is what each of us needs to do. The big stumbling block here, that I was trying to express in my previous post, is knowing our options. Often we're given information by the medical community (via pharmaceutical companies), without realizing we have other options. Or we're given just part of the information, or worse, complete misinformation.

I do feel fortunate that I didn't need to take an anti-depressant while I was pregnant, so I never faced that excruciating choice. I do know plenty of other moms who have and who felt like they wouldn't have made it through their pregnancies without medication. I totally respect and support their decision. I remain skeptical, however, about the safety of taking anti-depressants while pregnant or breastfeeding and think we need to demand more and better testing on these drugs. We shouldn't have to settle for an anti-depressant that is shown to cause birth defects, even if it is only a small percentage. We shouldn't have to settle period, but as women, that's historically what we've had to do when it comes to our health care.

I'm starting to ramble, but I guess what I really want to express here is that I think it's always good to discuss how we all need to respect each other's differences in opinion and different choices. Motherhood is tough enough as it is, but it's certainly way tougher if we don't pull together and support each other.

Just like the mom I've been e-mailing with felt attacked by my statement in my previous post that it's common sense to avoid anti-depressants during pregnancy and breastfeeding, I went through a similar experience when I made my decision not to breastfeed my fourth baby. I had really thought it out and made this decision because I knew it would be in my and my baby's (and my other children's) best interest for me to avoid postpartum depression so that I could be a functioning mother. For me, that meant not breastfeeding so that my hormones would become normalized faster and so that I could immediately go on an anti-depressant and not worry about it being in my breastmilk. It was a good decision for me, but I had a heck of a time expressing that to the nurses on the maternity wing of the hospital where I delivered. Although they didn't come right out and say it, they practically accused me of being a bad mom.

Twice a lactation consultant was sent to my hospital room to try to encourage me to breastfeed. I was given all kinds of "breast is best" cues and whenever I asked for formula for my hungry baby, it took forever for it to be delivered to my room. It was all I could do not to feel guilty for my decision, when I knew deep down, below the crashing hormones, exhaustion and pain from the C-section, that I had made the best decision for me.

These decisions are never easy, are they??

Anti-depressants and breastfeeding

There have been several new moms visiting this blog who have shared their concern about taking anti-depressants while breastfeeding. There are so many mixed messages on this out there -- doctors saying that it's perfectly fine, that moms need to take care of themselves first in order to take care of their babies; or that there is a risk, but it's so minimal to not really count. Then there are those who say that even a minimal risk is still a risk, so why risk it?

A recent study came out from the New England Journal of Medicine that concluded that women do not increase the risk of birth defects in their babies by taking anti-depressants while pregnant or breastfeeding. And yet it also stated that "drugs such as Celexa, Paxil, Prozac and Zoloft may increase the risk for certain defects, but, even then, the absolute risk is extremely small." AND it also stated that "even if a certain drug increased rates by a factor of four, the risk of having a child affected by the problem would still be less than 1 percent."

Confused??

Bottom line, and what no one seems to be talking about, is the fact that this study was funded by a few pharmaceutical companies, including GlaxoSmithKline, the manufacturer of Paxil.

Hmmmm.... what does that tell you?

In any case, when I was pregnant, I would never have entertained the thought of having even a single glass of wine, much less a drug that hasn't been completely tested in children, let alone infants. I don't know, but it seems like common sense to avoid anti-depressants while pregnant and breastfeeding.

What do you think? I'd love to hear about your own experience with or without medication.