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Withdrawal

Withdrawal

I’m not sure that I’ve gone into this in detail before, but ordinarily I am on a regimen of 225 mg of Effexor per day to treat my major clinical depression. This treatment has worked for me pretty well for several years now, though before I began with the Effexor I was on a cocktail of Wellbutrin and Lexapro, which more or less does the same thing as the Effexor, but for some reason it stopped working after about ten years of use. When I’m medicated, I go through life almost as if I’m not a depressed person, but for keeping my regular psychotherapy appointments and my tendency to be attracted to cultural productions that veer toward the morose (e.g. music by The Smiths, novels by Kazuo Ishiguro, and movies that are about “basically just chicks and being depressed,” as per Mr. Right-Click).

In recent years, many studies have suggested that a mother suffering from major clinical depression is better off to stay medicated whilst pregnant, mostly because of the tendency for the body to produce stress hormones that are likely to be more damaging to a developing fetus than any drug side effect. For people who are on traditional serotonin reuptake blockers (e.g. Prozac, Zoloft, and the like), the choice of whether or not to go off medication when pregnant is pretty clear — there have been so many studies and examples of successful pregnancies while medicated that it’s (relatively) easy to decide to stay on the drugs.

Naturally, my situation is more complicated, as I am a special snowflake.

There haven’t been many studies on being medicated with Effexor while pregnant. The few that have been done suggest that the first and second trimester are fine, but the third is risky because of withdrawal for the kid when it finally comes out. Before I got pregnant with Mini, I had been on the Wellbutrin/Lexapro cocktail, and few studies had been done on that combo. So I went off the medicine, because I was worried about what might happen, and because nobody could give me any concrete answers about the right thing to do.

I made it into the second trimester before I had to go back on a low dose of Lexapro, white knuckling it through the rest of the pregnancy and breastfeeding (which with Mini was a short six weeks because of his protein intolerance) before I finally got back on my regular meds.

A year is a really long time to not feel like yourself.

But then, even non-depressed people don’t feel like themselves when they are pregnant. I’m not sure whether I made the “right” decision that time — I do know that I made it through, and that Mini is healthy, and in retrospect whatever I had to deal with during pregnancy was worth it a million times over.

And I’m really glad I have that experience to draw from this time, because last time I wasn’t totally convinced that it would be worth it. I really wasn’t sold on it, particularly during the first trimester when I had the double whammy of no depression medication and HG to deal with. Now I’m right back where I was about four and a half years ago, and sometimes I have to say to myself, “I love Mini so much, I love Mini so much,” just to make it through the rest of the day.

Yesterday, I came downstairs to give Mr. Right-Click his Valentine’s Day present. Mini, who hadn’t seen much of me for the whole weekend, was disproportionately excited to see me. “Mama, are you better? Are you all better now?” he asked.

I want to be able to write about other stuff but it seems like this is what my life is about now, for better or worse. I hope you all will stick around and see how it turns out.

Comments (32)

  1. Feb 14, 2011

    ::nodding::

    i get it. and i wish you well.

  2. Feb 14, 2011

    Writing about other stuff can wait. You are more important than anything else right now.

  3. Feb 14, 2011

    I like your writing so much that I’d read it even if you were talking about nappy rash cream. Truth.

  4. Feb 14, 2011

    I get to be a special snowflake (especially when pregnant), too. It’s no fun. Just try to keep your sense of humor. And I’ll keep reading.

  5. Feb 14, 2011

    One of the reasons that I decided not to have kids was the terror that I felt every time I thought of having to go off of Effexor or the other less successful meds that I have used for my depression over the years. Your post got me out of my lurking to give you a high five and a “we are behind you!”

    Best reason to go off meds ever! One day, and one hug from Mini at a time.

  6. drhoctor2
    Feb 14, 2011

    Can you switch to something more tolerable to pregnancy even if it is not as effective for your depression as effexor ? I went off prozac with my last child but I’m odd,because preg hormones keep my depression under control.
    After an event of my own, I was switched to effexor on a see if it helps dealio..it didn’t and I insisted on prozac again. I didn’t feel particularly bad when going off but it seemed like I dodged a bullet as I read several accounts of very difficult withdrawl symptoms for some (a LOT) of people. I hope you are spared any sort of ordeal over this.
    I’m calling everything that ever happened or will happen to me an Event from here on out. We had a homework event yesterday !! I had an EVENT ! with a surly cashier..etc…I’m sure everyone I speak to will be heartily sick of it very soon…ahhhh..I DO amuse me so !!
    Don’t apologize over your content..I am fascinated by pregnancy, anyway. Perhaps you’d feel better if you wrote a post on how you are now a really bad m0m, but not really. 😉 Title it something arty but do NOT cite the author. Thats for the little people. Who are not pipes.
    The Mini would have puddled me right up with that greeting. Hang in there.

  7. Feb 14, 2011

    I lived this, too. And good for you for talking about it, because there are too many mamas who are losing their shit or have to go off their meds and are terrified to talk about it. Keep writing.

  8. Feb 14, 2011

    Dealing with lack of the meds that sustain our ability to function in order to bring a baby safely into the world is a major pile of stinking poo to deal with. You have my thoughts and prayers.

  9. Feb 14, 2011

    I will stay on my meds while pregnant. I was CRAZY while pregnant with Sam and I don’t think I can go through that again. I’ll probably opt for Zoloft, as it’s been studied rather extensively, and go off of it in the third trimester. But oh m’lands, won’t do it again.

  10. Feb 14, 2011

    I’m scared of getting pregnant, hell I’m scared of going off the pill because I know how awful my hormones made me pre pill :

  11. Feb 15, 2011

    I have no advice (still). All I can say is that you will get through it, and OF COURSE we will all still be here.

    I remember especially that guilt of being too sick to really be present for the older kid. It sucked. She survived though, and it actually gave her and her daddy a chance to bond, which ended up being a good thing.

    One day at a time.

  12. You are a special snowflake. Thank goodness.

  13. Feb 15, 2011

    I actually didn’t know that people could stay on Prozac while pregs. Interesting. I’ll have to look into it further. I don’t know what it’s like for you but I know I’ll be bummed to go off Prozac if I have to. I feel like I FINALLY became normal and happy recently when I discovered it and it will suck to go through withdrawal and go back to the swings. But I don’t know – I’ll have to look at the risks.

  14. Feb 15, 2011

    OK – I am not happy with that comment. I kind of do know what it’s like for you because you have written about it. I didn’t mean it that way. I just meant I don’t know what it’s like for anyone else except myself. Sigh. Comment fail

  15. Feb 15, 2011

    Thanks, Susan.

  16. Feb 15, 2011

    Well, that’s fortunate, because I’m sure I’ll go through that stage as well. Wait, I already did, come to think of it.

  17. Feb 15, 2011

    Thanks, Brea. There’s still lots of comedy, it’s just more of a gallows humor kind of thing these days. But that might be appealing too.

  18. Feb 15, 2011

    Thanks, Gwen. It is absolutely worth it in the long run. It just doesn’t really help that much in the short term, sadly. But having support here actually is really helpful, so thank you.

  19. Feb 15, 2011

    I actually will probably go on a low dose Lexapro once I get past the first trimester. That’s what I did with Mini and I kind of feel like I need to give this kid the same benefit. It may be that all of this is silly and we’ll find out that it’s no big deal in a few years, but it’s just tough to say. The SNRIs (Effexor, Wellbutrin, Cymbalta) have just not been as tested as much, so it’s kind of iffy.

  20. Feb 15, 2011

    Thanks, Pamela.

  21. Feb 15, 2011

    If you’re on an SSRI there’s no reason to go off the meds — I’m only doing it because I’m usually on an SNRI and the SSRIs don’t work very well for me, so to switch would be kind of absurd. I could switch right now, but it would not be very effective and so I’ll probably wait until the second trimester when there’s less going on anyway. But I absolutely would stay on Zoloft or one of the other SSRIs if that were a real therapeutic option for me. I hope more women will make that choice too as people learn more about it.

  22. Feb 15, 2011

    Thanks. I made it through once so I know I can do it again. I just hate these first few months.

  23. Feb 15, 2011

    Well, not everyone hates pregnancy as much as I do. Bear this in mind! You might be one of the lucky ones.

  24. Feb 15, 2011

    It’s kind of absurd how bad I am at the one day at a time thing, given my sobriety. But yeah, I suck at it.

  25. Feb 15, 2011

    🙂

  26. Feb 15, 2011

    Hah, don’t worry about it. I’m not sure how much research has been done on Prozac in particular (though I’m sure there has been a lot), but I know that other SSRIs are considered safe. So at the very least, you could switch to another very similar drug while pregnant and not have to go off meds. Many, many women have done this safely and have healthy babies.

  27. Feb 15, 2011

    Erica, Prozac is the only one that has really been researched extensively, and most doctors won’t even blink if you want to stay on it. Zoloft, too, though I’m not sure it’s as broad.

    They MIGHT recommend you go off for the last few weeks because of lung development/withdrawal, but even then, they’ll tell you that the benefits outweigh the risks if you’re worried about it.

    I was recently pregnant but miscarried, and my doctor is a professor of medicine at UMass Memorial med school, and authored a bunch of papers on this stuff. She gave me an awesome body of research and conversation about it when I was deciding what to do.

  28. Monique
    Feb 15, 2011

    “Well, not everyone hates pregnancy as much as I do.” I do! I feel so much sympathy and empathy for you right now. I love my daughter in ways I never imagined, but my pregnancy was a full on nightmare from start to finish. You cope and deal with it the best way that works for you and write about whatever you want to. Hang in there.

    p.s. I spent a lot of my time on the floor in the shower too and constantly raged/cried about why modern medicine has still not come up with a cure for the horrible nausea. Not cool!

  29. Kate
    Feb 15, 2011

    A big concern I have about having a baby is that I might have to come off my antidepressants. I know what happens when I just miss a few days and can’t imagine missing months worth. I like these types of posts. Might be “off-topic” but I like reading someone’s honest point of view about real life issues.

  30. Feb 15, 2011

    I’d rather give birth 3 times in a row than go through Effexor withdrawal again. Loved how I felt on it, but coming off made me sicker than I had ever been in my life. Perhaps it is adding to your insane nausea and once it is totally out of your system, other than a mild case of the crazies here and there, you might feel physically awesome compared to how you feel now.

    Just trying to find a silver lining for you here. Other than the whole squishy ball of tiny human at the end of the journey.

  31. Feb 15, 2011

    I’m lucky and use SSRIs so was able to go on Zoloft when I was pregnant. I hope that things go okay until you can get back on the good stuff. (Hugs)

  32. Feb 16, 2011

    I was on Effexor FOR YEARS and experienced a terrible, terrible withdrawal from it. While deciding whether or not I wanted to stay on it, I read a couple things about babies having withdrawal symptoms and that pretty much made my decision easy. I hope it’s all out of your system soon!

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