Musician and social media influencer Casey Goode, best known as Quigley, welcomed her first child—a son named Max—on September 14. The newborn spent the first few days of his life in intensive care—and Goode has now explained why.
The singer, who made it to the final 36 of American Idol in 2009, shared her experience in a candid Instagram post, writing that she was "finally ready to open up and talk about WHY Max was in the NICU for a week."
First, Goode went back to 2019, when her "anxiety and depression were at an all time high." She revealed that she felt like "nothing mattered" and there wasn't a week where she didn't "full on cry my eyes out." After a panic attack at an airport, Goode was referred to a psychiatrist, who put her on a low dose of Zoloft (sertraline, an SSRI antidepressant medication).
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When she found out she was pregnant two weeks later, Goode thought about going off her meds, but after her obstetrician and psychiatrist told her the dosage was so low it wouldn't impact the baby, she decided to stay on them.
"It was the best decision I've ever made," Goode wrote. "I actually enjoyed my pregnancy. I'd be pregnant over and over again. It was a dramatic contrast to the year before. I truly only had maybe two times during my whole pregnancy where I felt despair or pushed to my breaking point."
After Max was born three weeks early, he went to the NICU and was put on an antibiotic to prevent lung infection. To accelerate his recovery, the doctors recommended formula feeding. "Despite my protests, my milk hadn't come in yet… so I agreed," Goode wrote. "In the next few days, I was told that Max's 'fussiness' was due to symptoms of withdrawal from my Zoloft."
Goode went on to describe her mixed emotions that Max had to stay in the NICU because of her decision to take antidepressant meds during her pregnancy. "I went back and forth from feeling selfish and angry that it was 'on me,'" she wrote. "I felt a lot of anger at the doctors for blaming it on the Zoloft when they really didn't have any hard evidence to back it up. I don't want to sound like I'm blaming them, as I was so thankful for the care they were giving Max. But I did feel a stigma there."
A newborn who exhibits "withdrawal" symptoms after being to exposed to antidepressants during pregnancy is known to have "neonatal adaptation syndrome," board-certified psychiatrist and neurologist Elisabeth Netherton, MD, tells Health. Typically, the symptoms—fussiness, jitteriness and sleep difficulties—are mild and time-limited, lasting only a couple of days.
Dosage and type of medication can affect likelihood of neonatal adaptation syndrome, Gail Saltz, MD, an associate professor of psychiatry at the NY Presbyterian Hospital Weill-Cornell School of Medicine and host of Personology podcast, tells Health. "A lowest possible dose can decrease likelihood of withdrawal," she says. "However, tapering off or stopping meds in the mom just weeks before birth does not seem to decrease likelihood of withdrawal in the infant."
Neonatal adaptation syndrome can happen from any antidepressant—Dr. Netherton, who specializes in women’s mental health issues and the psychiatric treatment of women and men before, during and after the birth of a child, stresses that there's no "best" antidepressant to take during pregnancy. "Because drug companies don't do randomized controlled trials of psychotropic medications in pregnant women, the data we have is imperfect," she explains.
Having said that, SSRIs (with the exception of Paxil) tend to be the first-line choice for expectant moms because there is so much more safety data about their use in pregnancy than other types of antidepressants. Levels of transmission in breast milk is another consideration. "Zoloft tends to have very low rates of transmission for babies who are nursing," Dr. Netherton says. On that point, she says that breastfeeding the baby could potentially help with the symptoms of neonatal adaptation syndrome.
Dr. Saltz agrees that Zoloft is one of the safer choices if a mom needs medication. "It can be associated with preterm labor and maternal weight gain, but most studies find it is not associated with any birth defects," she says. Medication recommendations might change based on specific factors in the mom, like a history of symptoms or a history of response to specific medications, Dr. Netherton adds.
As well as being aware of the risk of neonatal adaptation syndrome, the experts point out that it's important to realize that untreated depression and anxiety in pregnancy carries significant risks for the baby (as well as the mom). It can impact infant and childhood development, including communication and social skills, plus the development of attachment with the mom.
Goode finished her Instagram post on a positive, encouraging note. "Now I'm home and I've processed it all… I'm happy with how I handled things," she wrote. "I don't feel guilt for being on Zoloft during my pregnancy. I haven't had an ounce of Postpartum depression, and I know that is because I have taken the steps I need to keep my body chemically balanced. I'm writing this to let you know you're not alone if you've gone through any of these thoughts or feelings during your pregnancy or life in general (sic)."
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