The Secret Sadness of Pregnancy With Depression – Pregnant women often fear taking the antidepressants they rely on. But not treating their mental illness can be just as dangerous — (New York Times Magazine)

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New York Times Magazine

For some women, the anxiety of expected motherhood can be fatal. Credit Carla van de Puttelaar for The New York Times

At the beginning of spring in 2013, Mary Guest, a lively, accomplished 37-year-old woman, fell in love, became pregnant and married after a short courtship. At the time, Mary taught children with behavioral problems in Portland, Ore. Her supervisor said that he had rarely seen a teacher with Mary’s gift for intuiting students’ needs. “Mary was a powerful person,” he wrote to her mother, Kristin. “Around Mary, one felt compassion, drive, calmness and support.”

Mary had struggled with depression for much of her life. Starting in her 20s, she would sometimes say to Kristin that she just wanted to die. “She would always follow up by saying, ‘But you don’t need to worry, Mama,’ ” Kristin told me. “ ‘I don’t have a plan, and I don’t intend to do anything.’ ” In recent years, Mary and her mother went for a walk once a week, and Mary would describe the difficulties she was having. She was helped somewhat by therapy and by antidepressant and antianxiety medications, which blunted her symptoms.

Mary’s friends appreciated her wacky sense of humor and her engaging wit. Colleagues said that her moods never impinged on her work; in fact, few of them knew what she was dealing with. Yet for years Mary worried that she would never be in a stable relationship and experience love or a family of her own. She said plaintively to Kristin, “I think I would be a really good mother.”

So when she discovered that she was pregnant, she was delighted, and she expected the experience to be blissful. She decided to discontinue her antidepressants, having read about their potential danger for a growing fetus. Given her history of severe depression, she was monitored closely by a psychiatric nurse practitioner, who told her that she could call anytime for an immediate prescription. But Mary elected to stay off medication.

As the months went on, she became gripped by the idea that something was wrong with the fetus, despite genetic testing and multiple ultrasounds that showed it was healthy and strong. Some nights, she spent hours online, poring over descriptions of everything that could go wrong. “We could see her spiraling downward,” Kristin said. “The really irrational obsession, the inability to see otherwise, tormented her. Her doctor tried to reassure her. But that was being rational, and rational wasn’t where she was.” One autumn day, Mary told Kristin: “I just can’t imagine being a mother.”

Mary Guest in fall 2013, when, during her pregnancy, she grew convinced that something was wrong with her fetus. CreditHolcomb Elementary School

By Thanksgiving, Mary, though still functioning at work, was too tired to do anything on the weekends. Her husband cared for her at home, Kristin said, and sometimes Mary would go to her parents’ house and just sit there. She was sleep-deprived because she often woke up in a panic, terrified that there was something wrong with the baby. Near the end of her fifth month of pregnancy, she finally, reluctantly, resumed taking an antidepressant. 

On Dec. 9, Mary went over to sit with her mother for a while. The next day, after school, she had a therapy appointment scheduled, but she left a voice mail message, saying: “I can’t make it.” Then she went to the 16th floor of the building where her parents lived and jumped to her death, six and a half months pregnant.

“We are totally convinced that in Mary’s mind, what she did was an act of love,” Kristin told me. “That’s the only place from which Mary ever came. She was tormented that the child was going to have some serious problem, and felt it would be better not to bring this child into the world than to birth her and not be able to take care of her. We feel, rightly or wrongly, that if Mary had stayed on her medications, or even gone back on them sooner, it’s possible she would have survived.”