Wednesday, February 29, 2012

TTC when you have mental health issues - What shity decision do you even make?

This is a touchy feely kind of post. If this isn't your thing, just skip it. It's also very long. I've been holding this all in for years.

For anyone who has taken even a five second glance at my pinterest lately will see a huge number of baby related pins. It has taken The Husband and I both three years to come to agreement on the whole, will we try for another baby, issue. We are both for the first time in agreement on our family size and agree that we would like to try for one more baby. But trying for another baby has caused me many anxieties. Why? To answer that, I feel that have to start at the beginning. My beginning.

Hi, my name is Stephanie and I have clinical depression compounded with and by an anxiety disorder. The depression began around 8 and the anxiety in full force around age 16, though I wasn't formally diagnosed with depression till age ten and anxiety until I was an adult.

Throughout my middle and high school years I spent countless hours in talk therapy and on dozens of drugs. If you can name it, I was probably on it, though I tend to only remember ones with interesting side effects. To name a few, in no particular order, because I simply can't remember at this point, I took:
  • Wellbutrin - made me shake like a crack addict and felt like my body was humming
  • Zoloft - extreme paranoia, e.g. I was sure of a zombie attack that would be caused by the chemicals the government was putting in the food supply
  • Prozac - my rebound drug, didn't work for longer than a few weeks but helped me wean off others
  • Paxil - not highly effective at anything but making me sleepy
  • Celexa - same as Paxil plus extra snarkyness
  • Lithium - fantastic drug to be artsy on, everything seems so much more "real"
Then from the ages of 19 to 24 I didn't take any medication or do any therapy. I wanted to prove to myself that I could go without. I did feel happy at times. I started dating The Husband at 20 and got married at 21. I thought that I did a good job most of the time. I didn't. I was very moody. I was over sensitive. I cried a lot. I should have been on medication. For my benefit. For The Husband's benefit. For my families benefit. For everyone I ever interacted with.

At just a little over a year into our marriage at 23, I got pregnant. My marriage wasn't as strong as I thought it was now that I look back. The first six months of our marriage was rough. Very rough. The Husband was on 48 hour stand by notice to deploy. We fought. We hadn't ever lived together and the transition wasn't the happy butterflies and ponies the brochure had promised. But I wanted a baby. The Husband agreed to try and over the next six months I obsessed until I became pregnant.

I still feel like during the pregnancy I did well. I remember being happy. I remember feeling like I had it all together. Which if you have ever met a pregnant woman tells you that I didn't and I was insane.

My pregnancy was not what I expected. I'm not sure exactly what I did expect, but to feel like I had to throw up every waking moment of all nine months, was not part of it. Towards the end I developed pre-eclampsia and had a rough labor. It ended in a c-section. An unwanted c-section. I still feel sad all these years later. It sounds like a dumb thing to admit to. After all, I ended up with a healthy baby at the end. How ungrateful do I sound to say I'm sad about how my son was born? Pretty ungrateful. But it's true, I still am.

The c-section was difficult but not as difficult as the fact that I was told by three different OBs, my regular OB, the one who delivered and then the OB who was on call that weekend, that medically, vaginal deliveries can no longer be recommended for me. Apparently my hips don't move correctly during labor and my spine is off in some way that complicates the matter and made my epidural "extremely challenging" as the head of anesthesiology put it. The fact that I have never had any issues with walking or anything, I found this hard to accept. The crushing blow this had to my self esteem as a woman, as a mother, still can bring tears to my eyes.

Then there was nursing. Like birth, I failed at nursing. I thought I was doing a good job at first but I wasn't. A. had difficulties. He was a suck-suck-off, suck-suck-off kind of nurser. I had to use a nipple shield in the first few weeks, spent countless hours pumping between nursing sessions, drinking gallons of water, eating oatmeal every day and taking so many fenagreek pills I smelled like maple syrup. At three and a half months he went on one of many nursing strikes. I worked with two lactation consultants; one when he was born and one at six months. He had poor weight gain issues made worse by his reflux that he took medication for. I would nurse, feed him a bottle of formula that was double scooped and then pump. He still wouldn't gain weight and was on weekly weight checks.

For seven months I obsessed and cried every day about nursing. I was angry at other mom's who could nurse. I wanted them and their full of milk breasts to go away and stop flopping them out at the play place in the mall. I hated them for being able to nurse anywhere at any time. I hated myself. I hated my breasts.

At seven months the last LC told me that she had no other suggestions and to be proud that I had at least given him some breast milk. I still find no pride in my failure. I find no comfort that at the age of two we were told the underside of A.'s tongue is incorrectly developed and that his speech therapist was surprised I managed to nurse him at all. I will always be convinced that his poor weight gain and colic was due to my lack of milk and my failure to figure out how to nurse.

Even with the daily crying and being sad about the birth of A., I thought I was doing good. I knew logically that I was at a greater risk for developing post partum depression but I incorrectly figured that if I had managed the last few years without medication, I could handle anything that might show up. I was wrong.

Denial is a very large and very dangerous part of depression. I had all the classic symptoms. Severe distrust in individuals with A., my Mom and The Husband were included to an extent, severe obsessions with A. for example how often he ate, when he ate and so forth, every day crying, insomnia despite severe lack of sleep and extreme anger if someone questioned my ideas of how I was raising A., and by questioning, I mean actual helpful suggestions. My Mom tried to suggest there was a problem. The Husband asked if I was alright. I said I was. I lied.

This went on until I finally gave up on nursing A. at 7 1/2 months and began taking Prozac at 9 months. It seemed to help but I slowly over the next year became suicidal. Not in the, I have an idea on how to kill myself, and had no plans to do so, no, suicidal in the idea that if I could just not wake up, that wouldn't be so bad. I'm not sure if it was the Prozac itself. I'm not sure if it's because after almost 9 1/2 months of nonstop screaming from A., his constant need for skin to skin contact and my crumbling marriage, but I was mentally unstable. I did not like myself. I did not enjoy A. I did not enjoy even hearing The Husband breathe. I just wanted to sleep, all the time. I use to sit and rock with A., crying while I begged him to just please sleep or at the least to stop screaming non-stop. I eventually stopped taking Prozac and just never made a follow-up appointment. I wish I could tell you why I stopped but I can’t. It’s part of the sickness.

During all of this, The Husband and I almost separated once right after we moved into the house. We were both struggling. Both as individuals and as a couple. He was tired of me. I was tired of him. We went to counseling. It helped, maybe. We had a lot of very uncomfortable conversations. We had to learn to like each other again. Something that seems odd to admit, that you can love someone but not like them. But it's possible. We're doing better now. Like any couple we still have bad moments but overall I no longer want to smoother him in his sleep with my pillow.

Two and a half years after A. was born I had to finally accept that I still needed help. I began seeing a therapist and it helped but even going every two weeks wasn't enough. She suggested I start taking anti-depressants again and so this past summer I began taking 20mg of Lexapro as well. With the anti-depressants I began feeling like myself. Well actually not myself. Myself without medication is scary. Now, many months later, I feel better. I have stopped going to therapy as I just can't fit it into my new schedule but the medication helps so, so much. I still have moments where I cry in the shower but I suspect that will always be true for me.

So, what is the point of all of my ramblings? Where do my anxieties come from for deciding to TTC? Simply, they come from the fact that I finally after years of struggling, feel mentally stable. After years The Husband and I both want a baby at the same time. This of course leaves me with the problem of what to do while TTC with a mental illness. Anti-depressants are a class C category drug for pregnancy; essentially there are no human studies to suggest there are exact known dangers but there are no human studies to suggest there aren't dangers. Great. The fact that both my OB and my psychiatrist agree that a 10mg dose of Lexapro is fine during pregnancy, actually doesn't help like I thought it would. Ultimately, I'm left with two shitty decisions. Do I take Lexapro during pregnancy, not feeling 100% comfortable with the unknown side effects it could have on a baby but know I would still feel mentally balanced? Or do I forgo medication for the baby but then run the very real and very terrifying risk of falling back into a massive depression spiral?  I've already dropped down to the 10mg dose of Lexapro while we TTC and I try to short through my emotions.

In the end, I still don't know what to do and no matter what decision I end up making in the end, I will never feel it was the right one. My yet to even be conceived baby deserves a healthy start. The baby and my already born child also deserve a mentally stable mother. I'm not sure how to accomplish both.

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