The Stigma Around Antidepressants During Pregnancy Made My Postpartum Life Even Harder

The moment I saw two pink lines appear on a pregnancy test, my mind began to spin with the potential ways I had unintentionally put my unborn child at risk. The unpasteurized cheese I had eaten, my fresh blonde highlights, and, of course, the antidepressants I had been taking for the past decade. I had spoken with my doctor before we started trying to get pregnant, and she assured me that the antidepressants I was on were completely safe. But, once a baby went from idea to reality, I began to have doubts.

Like many millennial parents, I turned to Dr. Google for answers. “Are antidepressants safe to take while pregnant?” yielded page after page of inconsistent, vague information. Some websites offered tentative answers filled with caveats. Endless sources spoke to the mental, physical and long-term defects that SSRI usage can induce in children. Many experts said they were unequivocally safe.

I was concerned but also worried about my anxiety and depression returning if I were to stop taking the drugs. In every conversation I had with my doctor and midwife, they were emphatic that I should remain on the SSRIs (selective serotonin reuptake inhibitors) and continue managing my mental health. “Happy mom, happy mom,” was a phrase I heard repeatedly until my son was born.

Anti-Depressants After Birth

After a long labor and many exhausting hours of pushing, my baby was brought into the world via an unplanned C-section. We were quickly sent to the NICU due to some concerns about my son’s breathing. He was tucked in a clear plastic bassinet beside me, as I laid in bed, dazed, swollen and in disbelief he was mine. I watched his tiny arms occasionally twitch and flail, emitting a flurry of beeps from the machines he was tethered to.

After the nurses came in to check on him, I overheard them whispering in the hallway: “It’s SSRI withdrawal, the mom is on antidepressants.” Their words stung, and I felt as if I had been caught. Only a few hours into motherhood and I had already done something to put my son in danger. While my shame lingered, the withdrawal symptoms subsided, and we were sent home with a healthy baby boy.

My antidepressants came up once again when I was struggling to breastfeed. Lactation consultants and midwives said that my low milk supply could be a result of the medication I was on. I was wracked with guilt and despite already being on SSRIs, a dark cloud of postpartum depression followed me for months. The shift in conversations about antidepressants from when I was pregnant to postpartum left me confused and feeling like I had already failed as a mom.

Postpartum Pressures

Studies show that up to 15 percent of women experience symptoms of depression during pregnancy, increasing to over 21 percent the first year after birth. A recent report from the Centers for Disease Control and Prevention (CDC) found that issues related to mental health, like depression, anxiety and death by suicide are the leading causes of maternal death. Reading these staggering stats, I can’t help but wonder how many women are avoiding treatment due to shame and conflicting messages.

Darci Skiber, Executive Director of Mental Health and Substance Use Programs at BC Women’s Hospital, says that physicians often contact her team seeking support on how to work through anxieties about medication side effects with their patients. Skiber and I discussed the overwhelming amount of information that parents are inundated with and the fear this incites, particularly in moms.

As a mom to three herself, Skiber notes: “You kind of lose your identity [when you’re pregnant and postpartum] and suddenly everyone has an opinion about what you’re doing. You don’t want to do anything to hurt your baby, so you let these opinions and rhetoric come at you.”

With this onslaught of information and judgment, it’s no wonder that moms grapple with making decisions about medicating for their mental health. Skiber also speaks to the effect of toxic positivity: “There’s an expectation that when you’re pregnant or just had a baby you should be celebrating, glowing and thinking everything is amazing. Who wants to be the person saying: I’m having a hard time getting out of bed?” 

The Effects of Untreated Depression

Dr. Deirdre Ryan, Medical Director of the Reproductive Mental Health Program at BC Women’s Hospital claims that “there is a lot of concern about exposure to medications during pregnancy, but we also must think about the risks associated with exposing mom and baby to untreated depression and anxiety.” These risks can include everything from the impacts of sleep deprivation, not being able to care for yourself physically or mentally, suicidal thoughts and relapses in comorbid conditions like eating disorders or addiction, notes Ryan.

The guilt I experienced being on SSRIs in the postpartum period felt painfully isolating, and I know I would have felt less alone if I had been exposed to the work of Catriona Hippman, a postdoctoral research fellow at the BC Women’s Reproductive Mental Health Program. Her doctoral work includes Creating Comfort in Choice, a video that explores how and why women decide to take antidepressants during pregnancy.

Both Hippman and Ryan emphasize that when it comes to SSRIs, they are safe if the benefits outweigh the risks. Ryan shares that “some babies will develop transitory symptoms” or “neonatal adaptations,” causing them to be a “bit jittery following birth.” “These symptoms usually resolve without treatment within a few days and don’t have any long-term significant effects on the baby.” My gorgeous, vibrant and thriving three-year-old son is a true testament to this.

Lessen the Guilt for Expectant Moms

So, how do we make the experience of choosing to treat mental health with medications less traumatic for moms? Dr. Ryan says that communication is critical: “Everyone involved in a mother’s care should be aware that she is taking medication, including her family, midwives and doctors. While there should be some monitoring, it is important that everyone is practicing awareness in this to not add more guilt.”

While medication may not be the right path for every mom, it was for me, despite the guilt I endured. It seems to me that the stigma that continues to surround antidepressant use during pregnancy and postpartum is about more than medication—it’s a symptom of a patriarchal system that has made self-sacrifice synonymous with motherhood. Whether through counselling, self-care or SSRIs, my hope is that moms unapologetically prioritize treating their mental health in the same way they would any other health condition.