Tough Talk about Crazy Pills.

About 8 years ago, I went through a really deep, dark and scary depression-anxiety combo platter. It was not my first bout with depression but it was the first time that anxiety rattled my brain and left me a house-bound mess. I dutifully went to therapy and practiced yoga on the rare occasion when I could peel myself off my couch. I tried my damnedest to get through it without medication. I couldn't do it. Believe me, I gave it the good old college try.

After truly suffering for about 8 months, I finally succumbed and started anti-depressants (SSRI). Within weeks, I felt as though somebody had flipped on a light switch in my body. The fog began to lift. Dramatically. I laughed, I enjoyed myself, I stopped constantly crying hysterically for no real reason. I had felt like horrendous doom was around every corner and then POOF! doom disappeared. It felt like nothing short of a miracle. It still does. Three years ago, I tried to go off of SSRIs to prepare my body for getting pregnant. We weren't yet trying and I wanted to see if I could do it. Under the care of a psychiatrist that specializes in women's health and pregnancy, I slowly weaned myself off. It didn't take long for the light to switch back off and the fog to descend. Once again, I fought for over half a year before it dawned on me that it would be pretty hard to get pregnant if nobody wanted to sleep with sad, angry me. And so, I went back on. It was hard. I struggled significantly with that decision. Shed a whole lot of tears. At the end, I knew that to be a good mother - both while pregnant and after - I needed to be a healthy, sane and happy person. For better or worse, anti-depressants are part of what help me feel like me instead of a sluggish, hateful zombie. They don't work for everyone. I'm lucky that there's a solution out there for me.

I know that SSRIs carry risks to babies. The most well documented risks include PPHN (persistent pulmonary hypertension of the newborn) and heart defects. These risks are very low but they do exist. Depression during pregnancy also carries risks: pre-term labor, low birth weight and elevated cortisol levels at birth.

What's a crazy girl to do? I can only remark on what I've chosen. I'm on sertraline (Zoloft) - the SSRI considered the "safest" during pregnancy. While I still occasional doubts about my choice, I know that my mental health is critical to the physical health of me and my future baby. There are no awards given out for abject suffering and one must deal with the demerits.

As a fertility patient, I've been making choices about my own "greater good" for some time now. Since I started on medications designed to hyper-stimulate my ovaries one year ago, I've knowingly been ingesting and injecting drugs that increase my odds of getting ovarian cancer later in life. I see this as part of the difficult trade off of modern life and medicine: we have access to drugs, hormones, and procedures that we never had before. We can survive cancer, get pregnant despite a slew of otherwise debilitating factors, test for genetic predispositions, eradicate diseases that once killed thousands, transplant organs and implant devices that make our hearts beat. On the other hand, we pickle our food with hormones and pesticides and cloud our skies and water with pollutants, some of which may cause the very conditions we work so hard to cure. I realize that my choice to stay on anti-depressants while trying to limit my gluten, dairy and caffeine intake is in some ways ridiculous. Infertility makes you nuts, what can I say?

This was all brought on by an email I received this morning from my father-in-law. He sent this link regarding anti-depressant use during pregnancy to me, J, his daughter (also struggling with infertility, also on anti-depressants) and son-in-law. A professor at the National Institute for Health and Care Excellence (UK), states in the article that the risks inherent to SSRI use during pregnancy for women with mild to moderate depression "are not worth taking." I don't believe that my depression is mild or moderate, though who is to say? It's a deeply personal, subjective assessment. It is very easy to say that there are no risks worth taking when it comes to pregnancy and the health of your child. The decision is far harder when the "safer" road presents the risk of mental illness for the mother and a set of different, perhaps less precarious threats to the baby.

My father-in-law meant no harm. He wants us to be safe and his future grandchildren to be healthy. Believe me, so do I.  My first reaction to the email was rage, then sadness and now, calm rationalism. Here is the informed choice I made after many years of anguish and research. I do what I can and pray that my choice will one day matter at all.