Resilience—My Struggle with PMDD on the Fertility Journey

I was 21 years old and home alone for the weekend when suddenly I couldn’t breathe.

I was deeply afraid of being alone and couldn’t stop crying for three days straight. This lasted for a few weeks and eventually dissipated. A few weeks later, it was back. I was staying at my parents’ house, taking off school and work, trying to understand why my normally easygoing self was suddenly paralyzed by the simplest tasks.

This played out monthly as a flood of crippling anxiety and deep depression for the two weeks prior to getting my menstrual cycle. After repeated months of spiraling, my doctor diagnosed me with Premenstrual Dysphoric Disorder (PMDD) and prescribed me with an SSRI (a drug used to treat anxiety/depression).

Over the years, I’ve learned to manage. I have remained on medication at a low dose and relied heavily on meditation, regular exercise, and setting self-care boundaries. My anxiety greatly improved - I experienced it only slightly when in large groups of people, in situations that felt out of my control, and sometimes when traveling.

This all changed when my husband and I decided to have a baby. 

Ten years had passed, and I was feeling good – excited and optimistic about expanding our family. In anticipation, I had several conversations with my OB and psychiatrist about the effects of being on medication while trying to conceive. Both recommended I try to wean off my medication, given how well I was doing, and reevaluate as needed.

With the best intentions, I started this process. I began to judge myself harshly for using medication in the first place and felt empowered simply by making the choice to try alternative mechanisms to support my mental health. This was reinforced by the amount of information available about having an obsessively healthy, chemical free, “organic” pregnancy.

The first several weeks went very well – I was feeling good and was excited about starting to try to have a baby.  As the months went on, I noticed a significant change – I began to struggle with the simplest things, particularly traveling, even on the train to work each day. I was very nervous in small spaces and had irrational fears about being in busy public spaces. This was immensely difficult to deal with given I was traveling almost weekly for work and often to large, populous cities (New York City, London, San Francisco, etc.). I found myself dreading going to work with fears of the train getting stuck, something horrific happening to me or my family, and paralyzed by normal activities that I traditionally enjoyed. My mood swings were significant – from true excitement to a feeling of hopefulness when trying to conceive, to laying on the floor sobbing and searching for an excuse to get out of an annual 5K run on Thanksgiving Day. I was quite literally in survival mode every single day.

Unsurprisingly, neither my body nor I was ready to have a baby. We tried for nearly a year before reevaluating and prioritizing my health.

I found a new OB who had specific training in mental health. She shared something that really resonated with me – stress is toxic for a baby and for a mother who is hoping to conceive. Moreover, she felt that it was irresponsible for my psychiatrist and my previous OB to recommend weaning off medication without monitoring me throughout the process. Then, she fully educated me on the real risks of being on an SSRI while pregnant.

She explained that SSRIs are generally thought to be safe -  and based on the data from scientific studies it doesn’t seem like there are significant risks. There was some thought that women taking SSRIs would have a higher risk of miscarriage, but studies have shown that these women have a similar risk to those who stopped taking SSRIs three months to a year before conceiving.

With this information, my own research, and in partnership with my husband and care providers, we weighed the benefits of being on medication and the importance of my physical and emotional balance.

I am happy to report that I went back on medication nearly one year ago and I am currently 19 weeks pregnant with a healthy baby boy! I hope my story serves as a reminder that everyone has their own experience with conception and pregnancy, and you know yourself best.  

From conception through new motherhood, women who suffer from anxiety and depression are put under tremendous pressure - faced with what may feel like an impossible choice between taking medication vital for their own mental wellbeing and protecting the health of their growing baby. Rather than focusing on the mother’s needs and educating her on the relative risks and benefits based on scientific evidence, the concern is often placed solely on baby and removing every possible potential harm. Though this conversation is beginning to shift, there is a lot of work to be done in the medical community and in our culture to keep the momentum going. By helping to educate women on these topics, we can empower them to choose what is right for their bodies and families.

I still rely heavily on meditative practices, exercise and talk-therapy. Today, I’m proud of the decision I made to go back on medication and care for myself in the best way possible.

——————

MTM does not offer personalized medical diagnosis or patient-specific treatment advice. While there may be information on this web site related to certain medical conditions and their treatment, be sure to consult your physician or health provider for any medical advice.