Notes from a mom on SSRIs

A spirited discourse has recently emerged around the use of a type of antidepressant called selective serotonin reuptake inhibitors, or SSRIs, during pregnancy. Last month, the FDA convened a panel discussion on the topic. I’m not going to weigh in on that particular panel discussion here because public commentary on it is readily available. But considering it’s become a hot conversation topic, I see it as an opportunity to share my experience as a decade-long user of SSRIs, including during my pregnancy three years ago.

A, around 3 days old, and me (2022)

My mental health challenges began years before I considered taking SSRIs. I have lived with anxiety most of my life. Beginning in my teens, I would lash out in anger at the slightest trigger, with my parents being the most frequent target of my outbursts. And well before “FOMO” became part of the popular lexicon, I obsessed over whether or not my peers liked me, or if I was being included (or more often excluded) in their social plans. 

These highly emotional responses continued through college and beyond. I eventually began undergoing cognitive behavioral, or talk, therapy shortly after I moved to Washington, D.C. to begin my professional life in 2009. I found it helpful to have a disinterested third party listen to me describe what I was going through. I began recognizing unhealthy patterns, like how fatigue exacerbated my sensitivities. But after several years of talk therapy, I was still having angry outbursts. As I became more aware of my emotions, I felt increasingly trapped by them. 

A trusted relative confided in me that they had started taking the SSRI Paxil (generic name paroxetine), and that it had changed their life. Their emotions didn’t yo-yo as much. Moving through life for them felt smoother, less turbulent. They asked if I would ever consider an antidepressant. During that conversation and for months after, I demurred. I was worried that taking such medication would make me numb to the world around me. But at some point - probably following yet another emotional outburst - I gave it some more thought.

I brought the idea up with the therapist I was seeing at the time. He was a psychologist, a mental health professional who studies and treats behavioral issues who is not a medical doctor. He supported the idea of adding an SSRI to my medication regimen, and he referred me to a psychiatrist, a medical doctor authorized to prescribe medication. 

When I met with the psychiatrist, I gave him a brief overview of my symptoms: emotional outbursts and a general inability to keep small negative experiences in perspective. I also noted that I had blood relatives who found success with Paxil, which he said was a possible sign the medication would also work for me. Following this appointment, he diagnosed me with Generalized Anxiety Disorder (GAD), which is distinct from a diagnosis of depression, known in clinical terms as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Major Depressive Disorder (MDD). 

“Generalized anxiety” is, in fact, a more accurate description of what I experience. I do not experience the symptoms associated with MDD, like a loss of interest in activities, low energy or suppressed appetite. But I am, in general, quite anxious And that anxiety can lead to drastic swings of emotion. 

Even before I began taking Paxil, my doctor told me that in case I ever wanted to bear children, I would need to switch to a different SSRI, because there was evidence that paroxetine, Paxil’s generic equivalent, increases the risks of birth defects. He added that other SSRIs existed without any such evidence. He said with proper advanced planning, I could taper off one and onto the other with no issues.

Paxil had improved my life. My fears of the drug rendering me numb turned out to be unfounded. Rather, the medication enabled me to put more time between a triggering event and my reaction. That, in turn, helped me better understand what was really happening, and not be beholden to my initial perception of the triggering  event. If my emotions were a rollercoaster prior to Paxil, they became as smooth as a drive down a wide highway: not completely free of unpleasantness, but easier to navigate. My relationships with my parents and my then-boyfriend (now-husband) improved significantly, and I was able to focus more on the things that really mattered like my loved ones, my hobbies, and my career - rather than manifestations of my anxiety. 

Josh and I always knew we wanted to start a family together. So not long after we got married, I made a plan with my psychiatrist to taper off Paxil, and onto Zoloft (sertraline), which is similar therapeutically but has no evidence of causing birth defects. Sertraline has a C rating on the FDA scale, denoting that “animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.” 

I gradually reduced the amount of Paxil as I increased my Zoloft dosage. I experienced very few side effects, except that I remember having unusually vivid dreams during this transition period. 

Years later, when I became pregnant, I did not consider pausing Zoloft and my psychiatrist did not recommend it. As I went down the list of medications with my IVF doctor and later my OB-GYN, neither raised concerns with me continuing to take the drug. I do recall, however,  in some early meetings talking about how there is no clear evidence that SSRIs are dangerous during a pregnancy. Notably, that’s not the same as saying there is zero risk. Right now, the medical consensus is that a lot of these questions lack definitive answers. The few studies that have been done are inconclusive. On its page about sertraline, the NIH says there are some studies that suggest a higher chance for problems like preterm delivery or low birth weight. But research also shows that untreated depression or anxiety also could be linked to pregnancy complications.

That lack of clarity is scary for anyone expecting a child. But I’ve found that part of parenthood is having to make hard decisions. Staying on Zoloft was only one of the first of many choices I’ve had to make, for my daughter and me, based on balancing the advice of experts I trust with my own intuition. 

I believe that if I had stopped taking this medication during pregnancy, and allowed my anxiety to run rampant, given the added effects of the hormones that come with pregnancy, my mental health would certainly have suffered. I truly believe that potential harm to my mental health, in itself would have presented a risk to my baby’s health. 

In November 2022, we welcomed our daughter A to the world. She was full-term and a very substantial 9.2 pounds at birth. Now, at almost 3 years old, she has met all her developmental milestones. I am doing my best to raise her in a loving environment where the adults closest to her model healthy emotional regulation. I’m not perfect, but I’m doing my best. We are hoping to have a sibling for A in the near future. If I am blessed with another pregnancy, I plan to follow the same philosophy to keep myself healthy, in mind, body and spirit, as I did when I was pregnant with her.