Expecting Trouble

City Paper

The director of the upcoming documentary “Women and Meds” wasn’t really one of those women. You know the ones—women who had “just known,” since forever, that they wanted kids.

Sure, Baltimore-based filmmaker Dina Fiasconaro liked kids well enough—other people’s kids. She was an avid babysitter, that kind of thing. But her desire to have her own family didn’t develop until she was almost 30, partly because she had struggled with intense anxiety since she was a child. “[Having dealt] with mental illness, I was never certain I would either be able to handle a kid, or want to take the risk of passing it down to them,” she says over tea at a coffee shop in Hampden.

Still, the director of the upcoming documentary and her husband, a fine artist, decided to start trying when she was 37. They were happily surprised when Fiasconaro got pregnant right away, though the intricacies involved in treating her psychiatric issues during pregnancy proved to be overwhelming. Namely, all the conflicting information haphazardly lobbed at her by doctors who seemed woefully under-informed about the issue.

The filmmaker channeled that frustration into “Women and Meds” tentatively slated for release next spring. It tracks multiple women’s mental health and medication struggles during pregnancy, touching lightly on her own as well. Fiasconaro had been on a rotating carousel of anxiety meds since 2001, and was taking Neurontin and Klonopin until she purposely weaned off them two to three months before trying to conceive. She decided to go psych med-free because, she explains, “I decided I’d rather get off it and not worry about whether something was going to happen to the baby; [I’d] struggle if I needed to, but at least I’d have peace of mind.”

Still, Fiasconaro’s medication-and-pregnancy-related concerns didn’t end there. She recalls having a hard time getting a doctor’s straight answer even about the safety of drugs as seemingly innocuous as over-the-counter sleep aids during pregnancy. She says, “I would ask my psychiatrist if it was OK to take half a Unisom at night, and she’d be like, ‘No, talk to your OB.’ So I’d ask my OB, and she’d say ‘go call the pharmaceutical company,’ so I called the pharmaceutical company and they sent me a form letter back that basically said nothing. No one wants to take ownership [of this issue].”

And her therapists weren’t much help, either. “My therapist at the time [said], ‘You’re doing great,’ and my OB was really dismissive about [my anxiety meds being a concern]. She just blew it off, like ‘all women are anxious,’ and didn’t help me in any way when it came to mental issues.”

It’s crucial that both doctors and pregnant (or possibly pregnant) women get educated when it comes to the intensely personal subject of pregnancy and psych meds. According to American Family Physician, here in the U.S., every year about 500,000 women get pregnant who already have, or will develop, a psychiatric condition during the course of their gestation. Of course, any type of drug can pose risk to a fledgling fetus, but the National Alliance on Mental Illness (NAMI)’s website notes that specific types of mental-health meds can pose unique challenges, suggesting that women, “if possible, stop using the drugs before trying to conceive.”

Some treatment modalities are safer than others, though. ECT (electroconvulsive therapy) is most likely “the safest way to treat severe depression in a pregnant woman,” according to NAMI. A selective serotonin re-uptake inhibitor, a type of antidepressant, may be fine in some cases, but NAMI specifically warns against certain antidepressants, as well as benzos such as Klonopin, and lithium for bipolar disorder, though it also says that “the possible consequences of an untreated episode (injury, severe stress, dehydration, malnutrition, profound sleep deprivation, and suicide) can be riskier to the fetus than the side effects of lithium.”

One size clearly doesn’t fit all when it comes to women and meds, a fact that Fiasconaro seeks to highlight in her film. Though it recounts some of her own journey in going off psych meds (as she says, “my [perspective] speaks to the idea that some women can get through [this] and be fine”), the heart of the film focuses on other women’s experiences. Fiasconaro interviewed each woman at regular intervals; she also gave cameras to a couple of them to self-document what they were going through.

What they were going through was similar in some ways, but in other ways, very different. Kelly of Maryland—who requested we omit her last name—  developed suicidal depression and anxiety during her pregnancy with her son. As Kelly explains in an email, “It’s hard for outsiders to truly understand the feeling of being torn because you want to feel ‘normal’ and happy, [while] knowing you can hurt the life growing inside of you. [It] causes a huge struggle.”

Another woman featured is Vickie Stevens, an actor, dancer, and single mom in New Jersey. Stevens has fought depression all her life and previously took Zoloft, but she still felt unprepared for the intensity of the anguish she experienced during her medication-free pregnancy. Compounding matters was the fact that she lost both her job and her health insurance at the three-month mark. Now that she’s safely on the other side of giving birth, Stevens hopes to get back on meds as soon as possible.

Stevens shares Fiasconaro’s lofty aim to help chip away at the stigma surrounding mental illness and pregnancy. She writes via email that she wants women to see the film and “understand that there are [other] women out there who are going through, or have gone through, what they are experiencing, [because] then it makes the battle a whole lot easier to push through.”

Overall, Fiasconaro hopes her documentary elevates the cultural dialogue about mental health and pregnancy and might help nudge more doctors into “taking this more seriously, [and getting] trained to look for these symptoms.”  

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