For much of my life I haven’t wanted children. In many ways this has been selfish; I wanted to live my life for me, and I wanted to be able to travel and do things that would be hard to do with a little one in tow. My perspective began to shift after my first episode of depression, particularly after it became clear that it was going to be a recurring illness. Safety became a flashing neon sign that there’s no way to ignore.
You occasionally hear horror stories of mothers who killed themselves and their infants due to postpartum depression, and I seriously worry that I could be that next horror story. If postpartum depression can wreak havoc in the lives of women who don’t have a pre-existing mental illness, what is likely to happen to a woman with a history of depression with psychotic features and multiple suicide attempts? I’m inclined to look at depression during pregnancy and/or postpartum as almost a foregone conclusion if I were to get pregnant, and while I might be exaggerating the risk to some extent, there is very real cause for concern based on my history. It doesn’t help that this is not something that easy to talk about. There is so much stigma around this issue, despite the courageous women who speak up and share their stories (like the amazing ones here on WordPress).
Medications are also a safety issue in pregnancy and, to a lesser degree, in breastfeeding. Most of the meds I’m on are relatively benign, but lithium is known to increase the incidence of Ebstein’s anomaly, a type of heart defect. In my case, the risks of going off lithium would almost certainly outweigh what is still a small absolute risk of this birth defect, but the idea of putting something in my body that is known to pose a risk to a fetus is disturbing, to say the least. I can’t even imagine what women stabilized on highly teratogenic (i.e. likely to cause birth defects) psychiatric medications like valproic acid must struggle with when planning for a family.
Electroconvulsive therapy has been shown to be safe and effective during pregnancy, although it is not often used. ECT has been helpful for me in the past, and it’s likely something I would turn to again if I got pregnant. I have to wonder, though, what level of stigma would go along with that. I would imagine that most people’s initial gut reaction would be that this must be dangerous for the fetus, and to be honest, I would probably have a hard time silencing that thought in my own mind. Postpartum, I would be concerned about my ability to care for a child if I was getting ECT, since I tend to have significant memory problems as a side effect.
Then there’s the issue of passing on genetic susceptibility to mental illness. I don’t want to put a child through what I’ve had to struggle with. The interplay between genetics and mental illness is complex and not well understood, and there are genetic counselling services available to get a more realistic evaluation of the risk, but I’m not sure if that would set my mind at ease. My own family psychiatric history consists of one great-uncle with schizophrenia. Period. Yet I ended up with major depressive disorder. Why did I get sick? Who knows, Maybe there is no rhyme or reason to life kicking your ass.
For the time being this remains an abstract question for me, but with my biological clock ticking and my most fertile years behind me, it’s likely a question that will continue to nibble away at my mind. Maybe I won’t have kids, maybe I’ll adopt, maybe I will have biological children, but regardless of which path I take my illness will never be far from my mind.