“Baby. Baby. Are you ok?”

“You, go get help. Call 911.”

Looking.. listening…

I put my first 2 fingers together at the center of that tiny little (plastic) sternum and do 30 chest compressions before giving 2 breaths over a face the size of my cat’s.

This was the scene from an infant CPR training.

I was at least 15 years older than everyone else at this Before the Baby Arrives course, but all of us were anxious (excited?) to become new parents!

Some people would think this is morbid. Infant CPR while 7 months pregnant?

Why not take your partner shopping for cute newborn onesies?

Or scroll through whimsical art prints on Etsy while sharing salted caramel gelato? (yum and cold!)

Nope. We were the practical ones. This class was filled with soon-to-be parents that wanted to take a little control before everything went to hell in a baby stroller.

CPR is a very reasonable thing to learn. It makes sense because it covers pretty much the worst case scenario and gives very specific directions of what to do. It feels good to be “prepared” when stuff goes wrong.

I also learned stuff that I'd use every day like

• how to swaddle a very old and unattractive plastic doll which was stiff as a board and not at all like the wiggly, squishy thing my actual baby ended up being
• snapping in a car seat and listening for that satisfying click that the carrying-the-baby part was stuck on the seat correctly; like an airplane seatbelt (except tight so it would actually work in an accident)
• and of course, how to change a diaper including wrestling with the diaper genie (we never did figure that contraption out!)

I still feel a little silly (old) when I look back on this course but it really was one of the most helpful things I did to prepare for becoming a mom. And I could swaddle my baby more snugly than a corset on the set of Bridgerton. Mad skills.

But the more serious topics, car seats, accidents, CPR, that’s what helped me feel more comfortable because I was capable of thinking through a scary situation and creating a plan for what to do next.

All this to say that the day-to-day stuff with meds can seem small and inconsequential when compared to some of the giant scary bad things that can happen with antidepressants.

This week I have 2 short videos on 2 very scary topics: serotonin syndrome and the black box warning for increased suicidality.​

They each have a case to help you get the feel for what’s at stake here (without the weird plastic doll and too small blanket that makes the baby burrito impossible)

So what’s important here, Reader?

Serotonin Syndrome is considered rare in mental health outpatients but we don’t actually have good data on this so I don’t have stats to share.

Taking a bunch of meds that block serotonin can make this more likely (especially with pain meds)

Symptoms of serotonin syndrome generally feel really bad or are unusual enough to prompt someone to actually want to go to the ER (or a family member to call 911), which is the correct course of action!

Increased suicidal thoughts can happen from depression itself OR from taking an antidepressant. We’re not really sure why meds may cause this though.

There is a balance between treating depressive symptoms and dealing with risks like increased thoughts of death. The prescriber and patient should agree on the next steps whether it’s stopping, switching, or staying on the medication with close monitoring.

I think cases are really helpful in a situation like this when you may (hopefully) never run into these things.

It’s not likely but it’s still possible! I mean, someone gets serotonin syndrome or I wouldn’t have had 17 questions about it on my board exam! But I’ve never seen a case in my 16 years of practicing.

And you don’t even have to pretend to do anything here! You can just sit back, soak it in, and feel better knowing you can answer your client’s question about that scary black box on their new bottle of pills.

You could even watch the video with them or share the link! Easy peasy, swaddle squeezie (like a giant blanket hug!)

Ok Reader, that was a weird trip down memory lane for me. My daughter just turned 11 this month so that’s probably why this seemed like a good topic. The baby class part. Not the serotonin syndrome or suicidality! 😳

Cheers to healthy brains,

Dr. B

Jessica Beachkofsky, MD

Your friendly online psychiatrist!

P.S. I am not making light of risk. CPR saves lives. And knowing the signs and symptoms of serotonin syndrome or the risk of increased suicidal thoughts with antidepressants can save lives too!

P.P.S. Stay fabulous! (and cool! It's HOT out there!)