Breastfeeding and medication

Recently, I was talking to someone on Twitter about breastfeeding on (and after) antidepressants, and it hit me once again how big a role breastfeeding can play in a woman's decision whether or not to seek treatment for PPMD. For me, among other fears (such as my child being taken away from me), I was so far into the whole "Breast is best" mindset that, when the filter of PPMD was added to the mix, the idea of having to stop breastfeeding my baby was horrifying and extremely upsetting. Concern over having to stop nursing is one that I frequently hear/see brought up and it is totally understandable.

I have written a couple of blog posts in the past about why Breast is not always best (part 1 and part 2). That is not going to be my focus for this blog post. In this post, I'm just going to share what my personal experiences have been with breastfeeding and medication.

When I was admitted to the hospital with a diagnosis of Postpartum Depression, my baby was 3 months old and exclusively breastfed. I had held off on getting help but finally realized I was at a crisis point and went to the ER, where I was transferred and admitted to a psychiatric facility. Because I specifically didn't want to have to stop nursing my baby, we tried talk therapy for the first day or two, but I could hardly even open up about how I was feeling and we quickly realized that medication was necessary. They started me on Lexapro (I was soon switched to Celexa, a generic version, for Insurance reasons), Ativan, and Ambien, which are not considered "safe for breastfeeding", so I had to stop nursing. I was extremely upset, but accepted that if I wanted to get better, this was what needed to happen. My baby did fine switching over to formula and the only discomfort was on my end because I stopped nursing/pumping cold turkey (ow, ow, ow). 5 years down the road, my daughter is extremely smart and well-adjusted, and we continued to bond very nicely. Actually, I think we bonded better because I was on medication and was able to connect better (I definitely remember the connection better after starting medication).

That first admission, diagnosis, and start of medication were in July 2009. At the beginning of December 2009, I was diagnosed with hypothyroidism (my doctors had previously missed it, but that is a whole different story for another time). Pregnancy can cause hypothyroidism, and hypothyroidism can cause mental and emotional health problems. I was promptly started on a low dose of Levothyroxine, a thyroid hormone replacement medication, and started to see my symptoms lessening pretty immediately. My dosage only had to be adjusted once to get my TSH and T4 levels back to within normal limits, and that also kicked the rest of the PPMD symptoms. After 3 months of Levothyroxine, I was able to stop taking the Celexa, Ativan, and Ambien that I had been on since July, and all was well.

I have been on this same dosage of Levothyroxine for 5 1/2 years now and it has never needed adjusting. During my pregnancies, the OB monitors my thyroid levels with bloodwork once a trimester (more often if I start experiencing anything unexplained  that could be symptoms of my thyroid medication needing an adjustment), but so far everything has been fine.

In April 2011, I gave birth to our second baby. Even though we were sure the PPMD had been related to the hypothyroidism, at my midwife's recommendation, I started taking Zoloft at 38 weeks pregnant (read what the Mayo Clinic has to say about antidepressants during pregnancy) as a prophylactic measure, and weaned off of it at about 6 or 7 months postpartum. This was shortly before finding out that, much to my shock and attempts to prevent pregnancy, I had another bun in the oven.

That second baby nursed through Zoloft, Levothyroxine, and the first two trimesters of my third pregnancy. She finally weaned herself at about 13 months. I was about to force her to wean since she had started biting (yay for teething). Let me tell you, I thought getting a tooth to the boob was painful enough under normal circumstances but with pregnancy making the girls extra tender? Yeeeeeeeeah.... "ow" doesn't quite do it justice. But, at that point she was down to usually only nursing in the middle of the night and she weaned herself, so it all worked out happily for both of us.

I started on Zoloft again at about 35 weeks with my third pregnancy. The original plan was to wait until 38 weeks again but I had some symptoms of depression and anxiety that were due to situations that were going on totally unrelated to pregnancy and we thought it best to start the Zoloft a little early. Baby #3 was born in September 2012. I was able to come off the Zoloft at about 3 or 4 months postpartum that time, again with no issues. The only issues I had were when I started using the Nuva Ring and got super tired (plus some intrusive thoughts) but that all went away when I discontinued the Ring. Baby #3 was EBF until I started school fulltime when he was ~4.5 months old. At that point, I got a good double electric breast pump and started pumping so that he got exclusively breastmilk at daycare and EBF when he was with me. With my school schedule and everything else going on in life, the pumping got to be a bit too much and eventually I stopped pumping; he got formula at daycare and breastfed when I was around. He self-weaned at 9 months.

I've done a wide range of options for feeding my children. Exclusively breastfed, Formula fed, breastfed through pregnancy and a little past the first year mark, breastfed plus breastmilk in a bottle, and breastfed plus formula. I've nursed on different medications and off of them. There is no shame or failure in any of these methods that I chose to feed my children. At the end of the day, what matters the most isn't *how* I fed my babies but *that* I fed them.

My experiences and feelings may not be yours. I can not say what is right or wrong for you and your family, aside from telling you that taking care of yourself is absolutely right, and that anyone who looks down on or tries to shame you for how you feed your children is 100% wrong. What I can tell you is that you are a good mother no matter what method (or combination of methods) you choose to feed your baby[ies]. In order to take care of others, we have to take care of ourselves first and practice radical self respect. Self-care is vital to not only our own well-being but the well-being of our babies and our families.

Whatever your choice, make it and don't let anyone get you down. If they want to say that they don't approve or agree or whatever, you feel free to send them on over to me and I'll gladly have a friendly chat with them.

"Too smart" for medication?

Have you ever read or heard something and gone "(S)he said WHAT?"? I have. Sometimes I end up laughing at the statement that caused me to have that reaction, sometimes it makes me sad, and sometimes it makes me angry. Whichever the case may be, I usually have something like this look on my face (that's my youngest baby, by the way, isn't he absolutely freaking adorableness incarnate? He melts me).

On today's installment of the "This so-called disease" series, let's talk about one of those moments that was captured in print. Prepare yourself, it's a doozy.

"You are too young, too smart not to reply on this type of medication".

I'm pretty sure they meant to say "You are too young, too smart, to rely on this type of medication", and I'm going to respond as if that's what they said.

If I'm being totally honest, I have to admit that it's really really REALLY hard for me not to stoop to insulting this person for the fact that they totally flubbed their comments. Why is it hard not to go to that level?

Because this comment flat out hurts. It HURTS. A lot. It hurts me personally. Why? On earth does it hurt me personally? It wasn't directed at me, the commenter was addressing the person who posted the status. It's not like the commenter called me stupid or anything so why get riled up about it? Why take it personally?

Because they DID call me stupid. They did insult me personally. Not only did they insult me, they insulted every other person who has chosen to take antidepressants. It sucks, it hurts, and it makes me angry.

Whether they realize it or not, what this statement says is that people who choose to take antidepressants are not smart. It says that it's a stupid choice. It says that taking " this type of medication" is not a wise decision.

Why is it stupid? Why is it smarter to not take medication? For some people, prayer isn't enough, yoga doesn't do the trick, diet change doesn't change the state of their/our mental and emotional health, and changing how they/we think doesn't change the fact that they/we have Postpartum Depression, Postpartum OCD, etc. Those things work for some people and that's fantastic, it really is. I am truly and genuinely happy for those who can navigate the treacherous waters of PPMD without medication as their compass. Therapies that don't involve medication are perfectly legitimate and work very well for some people. That doesn't mean that those of us who need to take medication are choosing a treatment plan that is any less valid.

After my first kiddo was born, I went several months without medication. I spent that time praying that I would feel better and that God would "fix whatever is wrong with me". I tried to just make up my mind to be happy. I struggled. I fought. I tried to make it without medication, without talking to doctors, without saying "I need help". I tried to do it the "smart" way. You know what that got me? A trip to the ER followed by two separate inpatient stays at a psychiatric hospital because I let it go so long that I became a danger to myself and wound up at the top of the stiars thinking about throwing myself down them and then went and pondered over-dosing on pain medication.


Is it smart to suffer just so you can say you're not taking medication? Is it smart to risk ending up dead by your own hand in the name of no taking antidepressants? Does it somehow make you a better person to choose to go the drug-free route when you NEED medication, all so you can say you're making the "smart" choice? Does it make you a better mother, wife, friend, daughter, sister, whatever, to suffer in the name of refusing medication because it's stupid?

NO.

Let me say that again, in case there's any doubt. NO. A thousand times NO. Not just NO, but a big, gigantic, humongous HELL NO. And yes, that is me shouting over the internet.

If you can treat and manage your depression without the use of medication, awesome. I've had friends who were able to go that route, and did very well with it. But for me, that didn't help. It didn't make me a better anything (other than better at sitting in a rocking chair like a zombie, better at snapping at my husband, better at avoiding the stairs thanks to intrusive thoughts, better at coming up with excuses to stay home, etc., and none of those are things I would really consider "betters" to brag about). It only made me more miserable for longer.

Whatever route you take in treating your illness, don't feel like it's stupid. If it works for you, if it helps you, that's what matters. You have to do what is best for you, your baby, your family. Don't believe this kind of crap. Don't let yourself feel inferior for choosing medication, or for choosing a non-medication route. What is important is that you're taking care of yourself. As long as you're not hurting yourself or someone else in the process, don't worry about the "how" as much as focusing on the "what" of getting better.

I'm not stupid. You're not stupid. We rock. Don't let anyone tell you otherwise. <3 p="p">

I would not take any of these drugs

Welcome to the second post in my series This So-Called Disease. In the first installment, I talked about the person who left this comment on someone else's status about Zoloft vs. Celexa.

In that first post in the series, I touched on how the use of the phrase "this so-called disease" and others like it trivialize and make light of mental health in general and Postpartum Mood and Anxiety Disorders specifically. I'm still seething about that...

In this post, I'm going to examine the first sentence of this comment and try to express how it makes me feel as a survivor of Postpartum Depression, Postpartum OCD, and Postpartum Anxiety.

"Pardon me, but I would not take any of these drugs."

When I think of how I would respond to someone saying that, I'm torn between "That's nice. Good thing I'm not you" and something slightly less snarky. In my experience, people who say things like this usually respond to a smartaleck response with something along the lines of getting offended and huffing about "Well I'm only trying to help" or "You don't have to be so rude". Alright. First off, it's rude of YOU to come in here and tell me "I wouldn't take that" and act like you know every facet of my situation and medical history, and the factors my doctor and I are looking at. And that's without even starting to look at how incredibly rude it is to make light of someone's illness and basically blow them off. So don't go firing the first shot and then be upset when the person you've just gone after on a very sensitive topic shoots back.

If I were a better person, my first instinct would probably be to respond with something more along the lines of "Thank you for your input but my doctor and I have decided that this is the best course of action for me. Here are some facts and statistics about Postpartum Depression and mental health. Let me educate you.". But by golly, it gets so frustrating to constantly and continuously hear people who have never been in your shoes tell you that they know better than you what you're going through and how you should handle it.

When someone tells you something like "Pardon me, but I would not take any of these drugs", it's very easy to feel like you're being told that you're making the wrong decision and doing the wrong thing. Considering that when I was fighting this nasty battle, one of the worst parts was my brain telling me that I was doing everything wrong and I was a colossal screw-up, I sure as heck didn't need other people (who didn't really know what they were talking about) telling me what I was doing wrong or what I should do better/differently. I was already beating myself to a pulp,; I didn't need any outside help taking a hammer to me or even handing the hammer to me.

On top of that, you're not me. If you've never been in my shoes, you can't know what you would or wouldn't do if you were me. You can THINK you know, but you don't. Not really. Until you're inside my head and my heart, feeling what I feel, thinking my thoughts, seeing things the way I do through my lens of PPMD (and everyone's lens is a little different, no two people have the exact same filter), you don't know, so stop trying to tell me what YOU would do and try supporting me,

If you really feel that your concerns about whatever treatment I'm considering are that big that you really have to say something, do some research first and then come to me privately and say "Hey, so I have some concerns. Here's what they are, here's why I feel this way, and here's what I found when I looked into it. I'm not trying to tell you what to do. I just want what's best for you and I want you to know that no matter what, I love and support you and I'm always here for you.". Do you see the difference?

It's been my experience that people don't usually like to be told that they're wrong, even about small things. When it comes to something as important and sensitive as how they're considering or choosing to treat an illness, it's even more so.

I don't know many people who go into decisions about things like mental health treatment and antidepressants lightly. I know the person this comment was directed towards certainly isn't. I definitely didn't; not when I was hospitalized the first time, not when I decided to take Zoloft starting at 38 weeks when I was pregnant the second time, and not when I decided to start Zoloft at 35 weeks this last time instead of waiting until 38 weeks. None of these decisions were made lightly. They were all made with a great deal of research and talking to my husband, my medical professionals, and friends who had dealt with similar situations. In my opinion, it is the height of arrogance to set yourself up as an authority on the decisions a person is making about this type of thing when you are anything but, and to tell them loftily "Well that's not what I would do". Not only do you set yourself up to potentially lose a friend and make yourself look like a complete jackass in the process, you can potentially do a lot of damage to the person you're giving this "advice" to.

You wouldn't take these drugs? That's nice. You're not me. You don't know what I'm dealing with. And you're not my doctor. So until you can be supportive instead of being a jerk, just take this particular piece of advice and shove it. I won't tell you exactly where to shove it, I'm sure you can figure that out for yourself.

Suggestions for battling PostPartum Depression

Today, I read a comment on my Strong Start blog post, asking for suggestions on how to overcome the Postpartum Depression. At first, I was just going to respond in the comments but then I thought that maybe this would be blog post material.

I feel that it's important to keep in mind that there is no one single right method for beating PPD. Not everyone responds the same way to the same things so not every suggestion or method will work for everyone. However, I'm more than happy to share some suggestions that work for me or that have helped other people I know. Please note that these are not in any particular order of preference or recommendation.

1. Therapy - Therapy was immensely helpful for me, both group and individual. It was good to be able to voice my thoughts and feelings to people I wasn't worried about offending or hurting, and to get the feedback and perspectives of people outside of my situation. And of course, the therapists often had good input and suggestions for coping mechanisms.
2. Medication - When I was admitted to the hospital the first time (after the night I wanted to kill myself), the doctor was willing to try a course of only talk therapy before putting me on medication, in hopes of being able to continue breastfeeding. In my situation, talk therapy alone wasn't enough and the medication I needed that time required that I stop breastfeeding so I wouldn't pass the medication to my daughter through my breastmilk. The medication got me leveled out. Bear in mind though, taking medication for PPD does not automatically mean you need to stop nursing. There are medications the doctor can prescribe that will still allow you to continue breastfeeding your baby, they just weren't what I needed in that specific situation.
3. Yoga - Several friends of mine have found yoga to be helpful to them in battling PPD. I haven't ever tried it but if I can make it work with my schedule, I hope to give it a go once my doctor gives me the all clear at my 6 week postpartum checkup.
4. Exercise - This one was tricky for me because it was hard to find the motivation or energy to get out and exercise. There were no shortage of excuses for why I couldn't get out and do it. However, when I actually did get off my butt and work out, it helped me feel so much better, it helped me have MORE energy, and of course, helped me lose my baby weight which helped me to feel better about myself and how I looked.
5. Music - I had to be careful of what kind of music I listened to because sad stuff would just perpetuate my mood and prolong it. However, listening to calm music of the variety you hear at a spa helped me center myself and regain a sense of peace. If I had no energy, listening to upbeat music could help me find a spark.
6. Massage - Who doesn't love a good massage? A massage helped me to feel better physically, which lifted my spirits. It also helped me focus on relaxing and taking care of myself.
7. Me Time - It's always hard to make time for myself but it is such a necessary thing. By Me Time, I don't mean going to the grocery store by myself to do the shopping, but doing something away from the house by myself that makes me feel better. If grocery shopping is your hobby then by all means, go at it, but I personally don't consider it quite the same thing. For me, it would be something more along the lines of going to the beach, going for a drive along the coast (except for right now when the gas prices alone are enough to induce stress and anxiety), going to the salon for a pedicure, or even just going to Ulta and wandering around drooling over the nail polish selection (have you SEEN the collections OPI is coming out with this year?!? GORGEOUS!!!).
8. Hobbies - I had to put some thought into this one since hobbies aren't something I have a lot of time for right now... haha. But seriously, engaging in a hobby is a big one for me.
9. Scripture study/church - For me, as a Christian, making sure to take the time to read the scriptures, listen to some worship music/hymns, and go to church were very helpful. Prayer isn't the only solution and it does irritate me when people say things like "Just have more faith" or "Just pray more", but that doesn't change the fact that for me, prayer does help.
10. Writing - Go figure. A blogger who likes to write. Seriously though, writing about PPD has been a fantastic outlet for me and I've heard many other people say that it helps them too. For me, it helps me to regain control and take back the power because *I* am the one deciding what I say, rather than letting the PPD and negative emotions decide that. Even before I felt comfortable being open about my experiences, writing in a journal was still something that was a huge help. Journaling has always been a catharsis for me, regardless of whether or not I plan on ever letting anyone read what I write. 

There you have it. This is by no means an exhaustive list. There are as many different ways to combat PPD as there are people in the world and different things will (or won't) work differently for different people. However, these are some of the things that I found helpful or know that others have benefited from.

What outlets or methods have you or your loved one had success with? Let's exchange ideas!