Making Decisions Surrounding Motherhood While Living with a Mental Illness

Like most little girls in America, I grew up believing that I would have kids of my own. I was never the little girl who imagined her wedding or had visions of a happily ever after. When you walk out of the womb anxious, you can’t always see a clear future for yourself. But I assumed that I would be a mom because that’s just what women did, right?

I never imagined that story wouldn’t be true for me. Until I was in my early 20’s, when I was sitting in a psychologist’s office receiving a major depression and bipolar 2 diagnosis. It was at that moment that I realized my life might look very different from what I thought. 

I always felt that I was a burden…different, overly sensitive. Now, these diagnoses felt like proof. They brought shame and sadness.

• Would anyone love me, let alone tolerate me?
• Would I have to tell people?
• What will people think of me?

Over the next few years, I went looking for the right cocktail of medication. One of the first was Depakote. Not only was this a very poor physiological choice for me, but it also left a lasting imprint on my future. Depakote is one of the worst drugs you can be on if you want to get pregnant. 

I heard the clinician mention the very real risk. And my life changed forever. 

Take this med and feel and be quasi-normal for once in my life? Or don’t take this med and have kids? 

The choice felt very clear. But nobody explained it wasn’t so black and white. Nobody mentioned there might be a safer option, or that women with my diagnosis have babies and plans and good lives all the time.

I just heard “not safe for pregnancy” and filled in the rest myself. 

I had so many questions but was too afraid to ask:

• How could I have kids if I was on these medications?
• How could I go off these medications if I wanted to have kids? 
• Would I pass these conditions down to kids?
• Could I even handle motherhood?

Here’s the thing: I’m not the only one. So many young women are grappling with these tough questions and aren’t being told the risks or the alternatives. In a 2021 inpatient psychiatric chart review, nearly a fifth of encounters discharged women on a medication that could impact fetal development, but fewer than 10% documented contraceptive status, and only one case documented any discussion of the medication’s reproductive effects

As for me, I just didn’t talk about it. I continued on with my trial-and-error of finding the right medication and convinced myself that I wasn’t interested in having kids. I accepted my fate and lived in the utmost shame. 

Sure, I Googled and did my own research, but information isn’t as accessible as it is today. Not to mention, this was before my days in biotech, so I didn’t understand the academic language the same way I do now.

That downplaying of my condition became my whole personality. And it turns out I am not alone in this fear of stigma. A 2024 Lancet editorial found that 70% of women hide or downplay their mental health symptoms because of stigma. I wasn’t the exception to the rule in hiding my shame–I was the rule. 

And here’s what gets me: a woman of childbearing age today arguably has it worse than I ever did. She’s not just sitting with the fear as I did. She’s on TikTok at 2 a.m., getting her medication information from people with no training, on an app built to reward the scariest version of the story.

She is more connected than I was, and somehow getting worse information. The dangerous part is that she’s getting this information and probably discontinuing her medication in the middle of a pregnancy. She’s is too scared to say anything because the stigma still very much lives today.

Maybe she’s making choices she doesn’t have to. Because for a lot of these medications, antidepressants especially, the fear is bigger than the actual risk. Women routinely overestimate it, and good counseling helps them stay on, or restart, something that keeps them well.

For other medications, like the one that scared me off in the first place, the risk is real.

Though here’s the kicker. I didn’t even stay on Depakote. It was one stop on a long road to the right cocktail. By the time I’d figured out what actually worked, the drug that made me write off motherhood was long gone. But the decision I made because of it is what stuck. 

I have no regrets because I got lucky. I met my partner, who already had kids, which was the perfect solution to my “kids versus medicine” conundrum. That was 14 years ago, and today we have a great life, so it worked out for me. 

But every woman is different. For some women, staying on meds is the answer. For some, it’s not. For some, like me, finding a wonderful man with a family is the perfect answer.

That’s why women need a real conversation and not a Google search at midnight or a stranger on TikTok.  

The stigma around mental illness is decreasing, but it is still out there. At the same time, misinformation is more prevalent than ever. These two facts make for a dangerous combination for the woman sitting up at night, convincing herself that motherhood isn’t for her.