Child Loss & Prozac

A guest post written by Caitlin Lastuka

This guest post for the Mental Health & Motherhood series is written by Caitlin Lastuka in WA.

In November of 2020, I had a miscarriage while I was at work.

Let me rephrase that. In November of 2020, I had what I suspected was a miscarriage, or the start of one, while I was at work.

It took an entire week to get a definitive answer and another week waiting for a D&C as my body had not recognized that I was miscarrying. Following my D&C, I wracked my brain for things I could have done to cause this; what did I do wrong, why did this happen. Ultimately, we got no answers, the reason we lost the baby is a mystery.  

A few weeks later when my husband and I were discussing the idea of trying again, we decided to go meet with a midwife instead of the OB we had been seeing and she made an off-hand comment about how my anxiety medication, the same medication I have been taking since I was 8, comes with an increased risk of miscarriage.

I panicked. I was diagnosed with Tourette Syndrome when I was in first grade, as well as having severe anxiety, ADD, and OCD. After trialing multiple medications, I was put on Prozac, an SSRI for my anxiety which in turn affects my Tourette Syndrome. Minus a small rebellious stint as a child, and a trial run off of my medication at 18, I had never been off of my Prozac before.

I went home and did a ton of research. I found an old study from 1993 that had been published through the MotherRisk Program, Hospital for Sick Children out of Toronto, Ontario Canada.

The study stated that rates of major malformations were comparable between the three study groups and no group exceeded the expectations for pregnancy malformation than the general public did. However, women treated with Fluoxetine, the generic name for Prozac, had a tendency for increased risk for miscarriage. (A Pastuszak, 1993).

Another study, this one from 2016, through Epidemiology Volume 27, issue 4, showed that in a study of 14.964 pregnant women, first trimester use is associated with an increased risk of miscarriage when compared with either non-depressed women or depressed women with no exposure to anti-depressants. (Almeida, Basso, Abrahamowicz, Gagnon, & Tamblyn, 2015)

My mind was made up, I was pulling myself off of my Prozac, anxiety be damned, because I was not going to run the risk of another miscarriage.

What followed was a high-risk pregnancy, a speedy labor and delivery, followed by months of awful unrecognized and undiagnosed post-partum anxiety. My anxiety was so high, I physically could not be in another room than my daughter without catastrophic, intrusive thoughts keeping me awake and paralyzed.

When my husband would take our daughter so that I could get a few hours of sleep un-interrupted between breastfeeding, I would lay in bed and strain to hear even the slightest noise, convinced my daughter needed me and no one else. I would crawl out into the living room, and sleep on the couch next to my husband and daughter and jump awake at every squeak she made.

Delirious from lack of sleep, still itchy from a PUPPPS rash, and with a baby on my breast I went to my 6-week appointment and informed my OB I was fine, minus some new mom-nerves that we laughed off.

We got an Owlet baby monitor in the hopes that it would give me better ease of mind and I would stay up at night monitoring her oxygen levels and heartrate on the app. I refused to move her into her own room, I only wanted her in our room, where I could reach out an arm and put it on her chest and make sure she was breathing, and when she did finally move into her own room I could creep back there and check on her or obsessively check the baby monitor.

Was she alive, was she breathing, was she too warm, was she too cold? 

Nothing helped, my anxiety was sky high, but everyone around me told me they didn’t notice, “I was doing fine”, “it was new mom jitters”. My husband thought I was overbearing and unable to just let him parent… my mom said she thought I was doing a great job and that she would tell me if my anxiety seemed out of control. My grandmother questioned why I didn’t go back on my meds and I insisted that I was fine, Nora was fine, everything was fine and everyone was watching out for me to make sure I didn’t lose my marbles completely.

After 15 months of breastfeeding I went to my primary care physician and begged him to put me back on the Prozac.

I was stopping breastfeeding for a different medical reason, and if I was stopping I wanted my life back under my own control. Within two weeks of taking my medication I felt more level. I was still having intrusive thoughts (what happens if my daughter falls off the ferry? How long would it take me to jump after her? Would she hit anything on the way down? Could she survive a fall that far?) but they were easier to handle. I started sleeping better at night, I gave my husband space to parent, even if I was internally panicking while he tossed her around and taught her to climb things. 

In hindsight, I can recognize that I had out-of-control postpartum anxiety and that at the advice of a midwife, had tried for a baby sooner than we were mentally ready for following a traumatic miscarriage.

Now that we are through the trenches, my daughter being almost two, and discussing another baby in the future one day, I know that I won’t be coming off my medications.

That ever-so-slight increased risk of miscarriage is balanced out by my daughter having a mother that is mentally sound, instead of a mother panicking at every little twitch.

It’s hard to weigh risk versus reward, even harder when a life is potentially on the line, but knowing what I know now, that the risk truly is so minimal it hardly exists, it’s a no-brainer for me that my mental health needs to be in balance with my wants for a family.

There is no reason to suffer, there is no award for suffering and feeling alone in your own mental illness, especially not in the trenches of new motherhood. 

If there is one thing that I wish I could go back in time and change about that post-partum period, it would be to go back and tell myself to be honest with my OB. Get the help, get back on the medication. I would tell myself “you matter. Your mental health matters. You are not alone.”

You are not alone. 

References

A Pastuszak, B. S.-B.-M. (1993 ). Pregancy outcome following first-trimester exposure to fluoxetine (prozac). JAMA Network, 2246-2248.

Almeida, N. D., Basso, O., Abrahamowicz, M., Gagnon, R., & Tamblyn, R. (2015). Risk of Miscarriage in Women Receiving Antidepressants in Early Pregnancy, Correcting for Induced Abortions. Epidemiology, 538-456.