Pregnant Women With Depression Face Tough Choices, No Easy Answers

Transcript

TERRY GROSS, HOST:

This is FRESH AIR. I'm Terry Gross. Dealing with depression is especially problematic for women who are pregnant. Antidepressants and anti-anxiety medications can be harmful to the developing fetus, but discontinuing the medications can create serious problems for women who are profoundly depressed. My guest, Andrew Solomon, wrote about pregnancy with depression in Sunday's New York Times Magazine. His 2001 best-seller, "The Noonday Demon: An Atlas Of Depression," has just been published in a new edition with a new chapter about the latest developments in treating depression. We're going to talk about that too and discuss his own experiences with depression and how becoming a father has affected how he handles it. Solomon is now a professor of psychology at Columbia University and a special consultant on LGBT issues at the Yale Medical School Department of Psychiatry. He's also the author of the 2012 best-seller "Far From The Tree: Parents, Children And The Search For Identity." Andrew Solomon, welcome back to FRESH AIR. Why did you want to write about depression during pregnancy?

ANDREW SOLOMON: I was struck by the fact that many women experience postnatal depression, postpartum depression, and that we've opened up as a society to discussing that a lot more, especially with celebrities such as Gwyneth Paltrow and Brooke Shields coming out and describing their experiences. But I was doing my doctoral work, which involved interviewing women about their experience of becoming mothers. And over and over again, they said to me in an embarrassed, hushed way that they had been depressed during their pregnancy and that they felt ashamed of it and that they hadn't sought treatment. And I then discovered that a full half of postpartum depression begins during pregnancy. And I thought, this is an epidemic, and it's a hidden one.

GROSS: Pregnancy is supposed to be this, like, joyful time. And do you think women who experience depression during pregnancy are afraid to say anything because it seems like they're out of sync with what they should be feeling?

SOLOMON: There is enormous shame around depression of any kind and at any time. And there's enormous social stigma attached to it, which we need to go on fighting. But I think that the sense of depression during pregnancy and early motherhood has been particularly stigmatized, that people especially feel that should be the happiest time of your life. What do you mean you're depressed at that point? When I talked to someone who counsels women who are depressed during pregnancy, she said to me that many of the women had to communicate with her by text message because they were afraid if they spoke on the phone, their husband might hear what they were saying. And they were trying to keep this secret, even within their own relationships. And let me tell you, depression is exhausting and overwhelming and difficult. And keeping secrets is exhausting and overwhelming and difficult. And to be pregnant and depressed and trying to keep a secret is to put someone under an almost inconceivable strain.

GROSS: And, of course, women, or at least a lot of women, who take antidepressants or anti-anxiety medications are afraid to take it during pregnancy because of the effects it might have on the baby that they're carrying. So before we get into the research, you tell a very tragic story at the beginning of your New York Times Magazine article about sadness during pregnancy. And I'm going to ask you to tell that story. It's about a 37-year-old woman who had been on antidepressants and anti-anxiety meds. She went off of it to protect the baby she was carrying. And she started to get profoundly depressed. Would you summarize what happened to her?

SOLOMON: Yes. She became obsessed with the idea that there was something wrong with the baby. Her doctor, her husband and her mother all kept telling her that all the results showed that the fetus was healthy. She would sleep for a few hours at night and then wake up and read obsessively on the Internet. Her family began to say to her that she really should go back on her medication because she was falling apart. But she had read that medication could be dangerous for the developing fetus, and she was determined that she would stay off it. And she stayed off it and stayed off it and stayed off it. And finally, when she was six and a half months pregnant, she jumped off her parents' building, off the roof, and committed suicide, killing both herself and the fetus.

GROSS: What did her mother say? You interviewed her mother. What did she say about why she thought her daughter took her life and the life of the child she was carrying?

SOLOMON: Her mother said that she felt that anything Mary did came from a place of love. And she said, somehow, Mary must've thought that that was the loving thing to do. But she also said, we believe that if she had stayed on her medication, she and the baby would likely both be alive. And her mother said - which was very poignant - she said, I know there are other people who took medication and whose children have problems and who blame the medication for those problems. She said, but I have decided to be open and to speak about what happened because I know that there are pregnant women who are committing suicide and pregnant women who are almost committing suicide. And nobody knows about it, and the information isn't out there.

GROSS: What does the research tell us about the impact of antidepressants and anti-anxiety drugs on the developing fetus?

SOLOMON: There is an enormous amount of research which establishes relatively definitively that the drugs don't cause what are called major malformations, significant birth defects. But about a third of children will have neonatal adaptation syndrome, in which immediately after being born, they sneeze, and their breathing is not as animated. They'll have a variety of other relatively minor deficits. Now, the fact...

GROSS: Do those things go away?

SOLOMON: Those things go away, yes. And those things go away quite rapidly. But there is also an increased risk of preterm birth, only by a couple of weeks, but there's an increased risk of that. There is a slightly increased risk of miscarriage. And then there's the larger question, really the haunting question. These drugs do cross the placenta. They are in circulation in the developing fetus. In someone who is an adult who is taking these medications, they change the function of neurotransmitters in the brain. That's what happens in a developed brain. But the jury is still out on what happens in a developing brain and whether those people, as they get into adulthood, will have slight shifts in their personality or consciousness or their vulnerability to depression on the basis of that prenatal exposure.

GROSS: So what are the limitations on the research studies that are being done because it's difficult to perform control group studies with drugs on pregnant women?

SOLOMON: We allow people to take significant risk for themselves. So we can say to a group of non-pregnant women, we're going to give half of you Prozac, and we're going to give half of you placebo. And we're going to follow you for the next three months and see what happens. It is outside of ethical guidelines to do the same thing with pregnant women. You can't have people taking that risk for a developing fetus. And you can't say, we're giving half of you this drug and half of you a placebo, and we'll see what happens. Instead, studies of the effects of drugs on fetal development or on pregnant women are based on retrospective work. You say, let's look at all of the children who have a particular cardiac defect and see how many of their mothers were taking medication. Or you say, after the whole thing is over, let's see how the women who were voluntarily taking medication faired as most opposed to the women who chose to stay off it. But those are often not comparable groups. The people who choose to stay on medication during pregnancy are likely to have more severe depression than the ones who are able to go off or to have a very different structure of personality that makes it harder for them to deal with the depression. And so the confounding factors are enormous and confusing, and the research is therefore never very definitive. I mean, it's always easier to prove that something is dangerous than to prove that it's safe. It's dangerous if you find some people who have problems, but it's not safe because you found some people who don't. So I think the data is very confusing and very limited.

GROSS: Pregnant women are understandably afraid to take antidepressants and anti-anxiety medications for the reasons that you describe. On the other hand, there are hazards of suffering with a profound depression when you're pregnant and not being treated. There's also the issue, which you write about, of cortisol, which is a hormone that's produced when you're feeling a lot of stress. We know that that's not a particularly good hormone for an adult to have in their body for a long period of time. What is the effect of cortisol on the developing fetus? Is there an effect? Do we know that?

SOLOMON: It appears that cortisol is implicated in the constriction of the uterine artery, which means that it reduces the blood flow to the placenta. That is a very serious matter that warrants consideration. It would also appear that some of the other chemicals that circulate in the brains and therefore in the bloodstream of people who are depressed will be circulating and making it through to that placenta and that fetus. And they will be having a direct effect, which may be comparably dramatic to the direct effect of antidepressants. But there's another layer, which is that women who are depressed are less likely to keep all their obstetrical appointments, are more likely to drink or use substances of abuse, are less likely to regulate their exercise and what they eat in the ways that are best for a developing fetus. It's harder to be good at pregnancy when you're depressed. And a large portion of women who are depressed during pregnancy will be depressed after the baby is born. It's not as though the baby comes out and suddenly, the whole thing goes away. And depression in the early stages of taking care of an infant involves terrible suffering for the mother, who feels utterly overwhelmed and unequal to what she is now required to do. And it's not good for the baby because depressed mothers tend to be irritable and inattentive. And neither of those is a good way to be with a newborn.

GROSS: It sounds like there's not a lot of good choices here for a pregnant woman who's depressed. There's the risk of antidepressants having an adverse effect on the fetus that you're carrying or long-term effects on the developing child. And then, there's the risk that if you don't take it, there's the possibility of severe suffering for the women that might impact the baby. There's bad hormones that might impact the baby. And then you write, even if you seek advice from your obstetrician and your psychiatrist, the advice might conflict 'cause they're seeing different pieces of the puzzle.

SOLOMON: Yes. The obstetrician in general is focused on the health of the fetus. The psychiatrist is more focused on the health of the mother. The people who deal with this in an enlightened fashion I think say, as Betsy Fitelson at Columbia University said to me when we talked about this - she works with high-risk pregnancies - she said, I don't like to talk about what's best for the mother versus what's best for the baby. I like to think of it as a system. We're treating the system. We have to make sure that this mother can go on with her life, can stay in her marriage, can take care of this baby when it arrives. She said there are many, many factors to consider, including the mother's own suffering. My experience is that almost any mother will follow the basic directions if she knows what they are. You know, I could say, these drugs are completely risk-free, and everyone who's depressed should be taking them; it's better for the baby. Most women would, I mean, not because I've said it but because it would be the truth. And I think equally, if somebody said, you know, these drugs cause terrible, terrible consequences that vastly outweigh the bad consequences of depression during pregnancy, that most women would find a way to white-knuckle it through. The problem is that it's a very nuanced question. Our research is very incomplete. And it's very confusing. I think almost always, it makes sense for people to attempt to treat their depression in non-pharmacological ways. And if they're able to recover through talk therapy or through meditation or through any of the million other things that are out there, that's really the best option. But if the depression is really severe, then in each case you have to weigh out what are the risks of the medication for this person in this circumstance, and what are the risks of the depression for this person in this circumstance. And while the news seems as though it's very discouraging insofar as there is a lack of clarity, and there are potential dangerous outcomes, it's also, in some ways, reassuring to feel that there is now more information on both possibilities and to recognize that many, many women who've experienced depression - as many as 20 percent of women will while they're pregnant - many of them have produced healthy children, whether they've been on medication or not.

GROSS: If you're just joining us, my guest is Andrew Solomon. And the subject we've been talking about, depression during pregnancy, is the subject of an article that was published in the New York Times Magazine last Sunday. It's also available on The Times website. Andrew, let's take a short break, then we'll talk some more. This is FRESH AIR.

SOLOMON: Great.

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GROSS: This is FRESH AIR. And if you're just joining us, my guest is Andrew Solomon, who is famous for his books, "Far From The Tree," and from the book "The Noonday Demon: An Atlas Of Depression," which is all about how depression is experienced and treated around the world. It includes his own story about his own depression. There's a new edition, which has a new chapter, which has updated information about depression and antidepressants. And part of that chapter is about postpartum depression and about depression during pregnancy. And that material is excerpted in a New York Times Magazine article that was published on Sunday.

You know, in the new chapter in your book about depression, I was surprised to read that the pharmaceutical industry has largely abandoned work on antidepressants. Why is that?

SOLOMON: A few reasons. One is that everything related to the biological insights we've had so far has been fairly well-developed. And so there's a need for a really huge leap in order to have products that will be meaningfully different from the ones now available to us. And I think the companies don't feel confident that they're able to make that huge leap, at least not immediately. The other is that because there have been people complaining about side effects of antidepressants and so on, the approval process has gotten very difficult. And the third is that I think they perceive it as a saturated marketplace and feel that while they might get people to switch from one drug to another drug, that there just isn't a big financial incentive in developing treatment.

GROSS: So is this bad news for people who are prone to depression?

SOLOMON: Well, I think in many ways it's terrible news. I mean, on the one hand, I, as someone who's suffered from depression myself, feel, as do so many of the people I've talked to, incredibly grateful to live in an era in which medication is available to us. And we can go on and have functional lives. But there are a lot of side effects to the medications I take and to the medications that such a large percentage of Americans take. And all of us would like to see drugs developed that are more rapidly effective and that have fewer side effects. To stay just where we are indefinitely feels, you know, regressive.

GROSS: What are some of the side effects you have to deal with?

SOLOMON: Well, one of the medications that I take has caused me to gain a certain amount of weight - not a huge amount, but I do gain weight from it. I take something that tends to make me tired. I need more sleep than I think I would if I weren't on these medications. And they can have, as they famously do, a kind of deadening effect on one's sexuality. I have found various ways around that and to deal with it. But it's something that requires constant negotiation. And frankly, having to get up every day - because I'm on a cocktail of medications - and count them out and take them and so on, it's sort of psychologically disturbing to feel that the integrity of yourself rests in a handful of pills you swallow twice a day.

GROSS: Can I ask how your medications have changed since 2001, when "The Noonday Demon" was first published?

SOLOMON: They have changed a little bit but not enormously. I have started taking Provigil, which is a drug that was developed to treat narcolepsy. It helps offset the sedating effects of the Zyprexa that I also take. The Zyprexa, which I wrote about in the book in 2001, I've discovered is the easiest thing to move up or move down. So if I feel like I'm falling apart, I up my Zyprexa. And when I feel more on top of things, I bring it back down. It's the one that I kind of monkey around with the most. And with my psychopharmacologist, I've worked out how to do that. I also sometimes take propanolol, which is a beta blocker. It was prescribed for the possibility of stage fright and as something that was helpful there. I don't get terrible stage fright, but I thought I'd try it and see how it worked. I found that I was so calm and serene going into a stressful situation in which I had to perform in front of a large group of people. And over time, I found that when I'm feeling anxious, that the physical effects of the propranolol - which is not affecting sort of neurotransmitters and so on, but it's affecting your breathing and your heartbeat and so on - that it gives me a feeling of calm, which can be very, very helpful when I'm confronting a stressful interaction.

GROSS: You know, because you've written so extensively about depression over the years and spoken to so many people who've suffered with depression, it's easy to assume, well, Andrew Solomon, you know so much about depression and are so respected for the work you've done in that area that now you can probably deal with it a lot better during those times when it strikes. So I know you're able to cope with it now with the help of medications and talk therapy and the knowledge that you have, and you don't deal with depression as much as you used to. But when it strikes - and I know it still does - is it qualitatively different because of all the work you've done?

SOLOMON: The primary difference is that I have been through it before, and I have survived it before. And I therefore know, at some level at least, intellectually, that I can survive it again. I haven't had the desperate, plummeting descents that I had when I was off medication. But I still am vulnerable. I mean, I just dealt with a stressful situation. And it was quite difficult to sense, as I went about my daily life, that I had to deal not only with the stress of the situation but also with the stress of thinking, I wonder if this is going to push me over the edge again. Part of the point of what I've written is to say that you - you always have to be vigilant with it. You always have to deal with it. It is, for most people, a lifetime condition. And it requires constant management. I go and see a psychotherapist every week, not so much because what happens in any individual session is transformative but because I feel it's important that there be someone, a trained professional, who is watching what's going on. And he said to me one day when I was being a little cavalier about some of what I thought were minor symptoms of depression - he said, let us never forget in this room that you are very capable of taking the express elevator to the bargain basement of mental health. And I think that consciousness has had to be something that I've learned. And in talking to so many people, really what I've come to is the feeling that depression mostly is manageable. But if not well managed, it can be tragic and that most people who are seeking treatment are not getting very good treatment and that many people who would benefit from treatment are not even seeking that treatment.

GROSS: My guest is Andrew Solomon. His article about pregnancy with depression was published in Sunday's New York Times Magazine. His 2001 book, "The Noonday Demon: An Atlas Of Depression," has just been published in a new edition. After we take a short break, we'll talk about how becoming a parent affected how he deals with depression. I'm Terry Gross, and this is FRESH AIR.

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GROSS: This is FRESH AIR. I'm Terry Gross, back with Andrew Solomon, who has written extensively about depression. His article about pregnancy with depression was published in Sunday's New York Times Magazine. His 2001 book, "The Noonday Demon: An Atlas Of Depression," was just published in a new edition, which has a new chapter about the latest developments in the treatment of depression. Solomon has also written about his own bouts with severe depression.

Let me quote something from the new chapter in the new edition in your book about depression. You write (reading) my most recent major episode came when I published "Far From The Tree" in late 2012. The possibility that the book would fail consumed me. I went on TV and on the radio and spoke excitedly, but all the while I felt as though the world were coming to an end. I felt as though the people I loved were going to meet tragic demises. I felt as though I were going to forget how to swallow or breathe.

Now, I interviewed you on FRESH AIR when that book came out. You were terrific. We got a huge response to that interview. If you were depressed then - if you were profoundly depressed then - I don't think I had a clue. So it was very interesting for me to read this and to think, well, were you suffering when we spoke? Were you trying to hide that you were suffering?

SOLOMON: When we spoke, I was depressed. Over time, I've learned how to mask it to a much greater degree than I used to. And, in most ways, that's actually a boon. The only way in which it's a disadvantage is that, then, people don't realize what's going on and don't respond to it. I mean, I was not depressed in the way that I was depressed in 1994 in the episode that anchors "The Noonday Demon," where I was hidden in bed and couldn't get up and couldn't cope with anything. But I was waking up in the morning feeling incredibly frightened and having to force myself to go out of the house and having to sort of go out and take a few deep breaths. And then, once I got the day going, I was sort of doing better. And then, at night sometimes, I would feel myself fragmenting again.

GROSS: You also were dealing with a real physical problem during your book tour in 2012. You were experiencing some hearing loss. You had pain in your ear. Your balance was off. You'd fallen a couple of times. And you weren't sure how much of that was anxiety-provoked and what was actually an ear infection or some kind of other mysterious ear problem. The ear is so full of mysteries. You finally found out you probably had some kind of virus, and you had a real problem. But it wasn't - it wasn't accurately diagnosed initially.

SOLOMON: It was not accurately diagnosed, and it was very confusing. And I think the degree of hearing loss that I suffered, if it had come on gradually, would have hardly been noticeable to me. But suddenly, being largely unable to hear out of my left ear was very, very disorienting. But I feel as though whenever I'm dealing with sickness of any kind, I have to try to sort out what is the psychosomatic element of this, and what is the real element of this. I had the ear problem, and I was depressed. Did I get depressed because there was something wrong with my ear? Did my ear somehow get damaged, or did the damage feel very much exaggerated by the fact that I was depressed? It would be nice if one could sort of sort everything out and say, this is real, and this is not real. But things that are determined through your brain and your body's psychiatry are real as you live them and experience them. And I really felt, during that period, that I was unable to sort of stay standing and to do the ordinary things of daily life.

GROSS: And you went on a book tour feeling that way.

SOLOMON: I did go on a book tour feeling that way. And it was a punishing experience. I mean, I should add that I had worked on that book for 11 years. And I had poured my soul into the exchanges I'd had with the people I wrote about. And I felt that I didn't want to have the experience of everyone laughing at me and saying, really, you spent 11 years, and that's what you ended up with? And I didn't want to disappoint the people I'd included, many of whom had told me very intensely personal stories at obvious great cost to themselves because they believed that I could tell the stories to the world. So people often say, oh, your book's coming out; you must be so excited. And, of course, at one level, one is very excited. But I also was really concerned about whether I could get that message out. It's a long book on a difficult topic. Some people had said it seemed ridiculous to be publishing it. You know, I felt terrified. I felt as though I were sort of dancing naked down the middle of 5th Avenue.

GROSS: So you've had two children since "The Noonday Demon" was published. And you say that you made a pact with yourself, when you became a father, to rule out the possibility of suicide. How strong was the possibility of suicide before you became a father?

SOLOMON: I have never been acutely suicidal. I've gone through periods of being very self-destructive. I've gone through periods of having a lot of suicidal thoughts. I've never made an actual suicide attempt per se. But I felt, if I was going to have children, that I had a responsibility to protect them from the possibility of that loss. I've interviewed a lot of people who've lost parents to suicide. It stays with the children forever. It's not that I think the people who did it were being selfish or did it carelessly. I think they had reached a point of despair at which they saw no other possibility. But I felt that if I was going to have children, it was a responsibility. And I wanted to live up to that responsibility. It's that thing, you know, of having a little bit of your heart that's suddenly living outside your body. You have to be responsible to it.

GROSS: So does ruling out suicide make you feel any more or less secure when you do suffer from depression? Is it upsetting or reassuring to know you can't kill yourself?

SOLOMON: It's some of each. One the one hand, the simple fact that there are children and that I do have an effect on them has been one of the most potent antidepressants that I've ever had. And on the other hand, there are moments when I feel imprisoned by the reality that I can no longer make my decisions just for myself, that I have to consider the interests of others. When I'm really depressed, sometimes I feel like that responsibility weighs on me incredibly heavily.

GROSS: You live with your son and your husband. Do you feel a burden of having to act normal that you didn't feel before you had a family, and is that a good thing?

SOLOMON: I have felt very strongly that I have to protect my children from my depression itself and also from their ability to alleviate it. I don't want them to grow up thinking, oh, when daddy is depressed, I have to drop everything and go up and see him because I make him feel better. That's a burden that I think is inappropriate to place on one's children altogether but certainly on one's young children. So it's a sort of mixed blessing. But I have to say that except when I'm at my absolute lowest - I hear my son coming in, I see my daughter; there, you know, are hugs and kisses and so on. They're 6 and 7-and-a-half now, and it does give me a feeling of being rooted to the world that I did not used to have.

GROSS: You - your college roommate committed suicide in 2009. You had remained friends over the years. Did you have a grasp of the extent of his depression?

SOLOMON: I had no clue of the extent of his depression. I dedicated the final chapter, the new chapter in "The Noonday Demon," to him. He was someone who had an exuberant, upbeat manner. And so, when he occasionally said that he was sort of depressed, I, despite being, in principle, the great depression expert, sort of thought, oh, well, he's having a little bit of a rough day. But I'd speak to him a day later; he would sound all brisk and bouncy. I would think, he's really fine. And I didn't understand that all of that exuberance was being kept up, in the slightly manic way that it was, to cover a terrible emptiness and sense of loss inside of him. And when I found out that he had committed suicide - he lived in Rome in Italy, so I didn't see him all the time - I was not only desperately sad; I was also entirely astonished.

GROSS: Did you experience feelings of guilt for not knowing and therefore not helping?

SOLOMON: I felt enormous feelings of guilt. If I had known that he was that depressed and that he was really at the point of suicide, I would've hopped on a plane. And I would've been in Rome in no time. I don't think that I could have made his depression go away. But I think I might have been able to explain to him how you get through being depressed and helped him to see what was on the other side because he left behind a diary. And in the diary, he's written, in those last weeks, about all of the failures of his life. And one of those failures was that he said that nobody really loved him or cared about him except his partner. And after he died, hundreds of people all came together on Facebook, in person, in conversation, all of us talking about how much we loved Terry and how sad we were. And he couldn't see it. And that's what often happens with people who are suicidal. It's not that they're somehow ignoring, willfully, the damage they'll inflict on other people. It's that they genuinely believe that there is no one there, that there is nothing. And when I read that final diary entry of Terry's - in which he said, all is a failure; except Marcello, there is nothing at all - it ripped me apart. And it so - it so saddened me that I had been naive enough to think that because he seemed happy, he was happy. It's made me look at everyone with a more suspicious eye, in a way, than I did before.

GROSS: Can I ask how he took his life?

SOLOMON: He drove to a mountainside in Italy, not far from Rome, parked the car, climbed to the top of a mountain that there was no reason for people, mostly, to go to and slit his wrists.

GROSS: That is really ensuring that no one's going to rescue you, isn't it?

SOLOMON: Absolutely. I mean, eventually people saw the car. And then they went to try to figure out what the car was doing there, and they tracked him down. But it was not a cry for help. It was a - it was a very definite decision that he had made. And he had seen a psychiatrist the day before he killed himself. And the psychiatrist he saw had been worried about him but had felt, in the name of patient confidentiality, that she shouldn't call his partner or tell anyone that she was worried. His partner was away, traveling on work for a few days. And he said, if only someone had called me and let me know. And one of the lessons that I take from the whole experience with Terry is that we overvalue privacy in the context of mental health. It's important to have privacy, but it's also important not to walk around with too many secrets.

GROSS: He must have been very secretive about the depression to not even talk to you about it, a friend who is also an expert on this.

SOLOMON: When I went back and read his emails, there were allusions to depression. They were all relatively veiled. They would say things like, I haven't really been feeling myself lately; I think I may be depressed - your old subject - but I seem to be doing pretty well, and I'm just about to go off to dance class, which always cheers me up. You know, I read that, and I thought, OK; he's going through a sort of slightly transitional period in his life for various reasons. He's moving. His parents are getting old. You know, those were the sort of concerns I thought he had. And, after all, if he was going to be cheered up by going off to a dance class, it couldn't be so bad. You know, with the sort of curse of 20/20 hindsight, I've looked at those emails and thought, oh, I wish I'd - I wish I'd actually understood what he was conveying. He let it through in tiny, little cracks and in tiny, little pieces. But he never made the open declaration that would have gotten him help. And people are afraid to make that declaration, but I think people are mostly afraid that if they make it, no help will come. And in my experience, some people are so socially isolated that that's true, but not very many.

GROSS: If you're just joining us, my guest is Andrew Solomon, and there's a new edition of his 2001 best seller, "The Noonday Demon: An Atlas Of Depression." He's also the author of the best seller "Far From The Tree." Let's take a short break here, then we'll talk some more. This is FRESH AIR.

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GROSS: If you're just joining us, my guest is Andrew Solomon, and he's the author of the best-selling 2012 book, "Far From The Tree: Parents, Children And The Search For Identity." His 2001 best-seller, "The Noonday Demon," which won a National Book award, is all about depression, how people experience it and how it's treated, and that book has just been published in a new edition with a new chapter.

You have a very interesting nontraditional family. Can you describe your family?

SOLOMON: My husband, John, is the biological father of two children with some lesbian friends in Minneapolis. My very dearest friend from college had got divorced but wanted to be a mother, and I wanted to be a father, and so we decided to have a child together - mother and daughter live in Texas. And then John and I wanted the experience of bringing up a child ourselves, and so we have my son. I am the biological father. John is the adoptive father. We had an egg donor and our surrogate was Laura, the lesbian mother of his two biological children in Minneapolis. So the shorthand is, six parents - really, including the partner of my daughter's mother - six parents of four children in three states.

GROSS: And it's all working out, right?

SOLOMON: You know, it is all working out. And there were a lot of people who said - as we began on the various bits and pieces of it - this can only be a disaster, it's all going to be awful. I've just finished making plans with all of them about who's coming for what parts of the summer and when we'll all see one another. It's turned out to be an amazingly joyful experience - with its challenges, of course.

GROSS: Your children are 7 and 6. So how do the questions change, how do the issues change as the children get older and as they compare their families to other families and as they're old enough to ask questions?

SOLOMON: Well, I've always liked the anecdote about my daughter, that when she was going through the sort of schools process, she was brought in for an interview at the school that she now attends. They asked her various questions which she answered, and then someone gave her a piece of paper and some crayons and said, OK, and now why don't you draw a picture of your family?

GROSS: (Laughter).

SOLOMON: And she said no. And they were quite surprised because she's usually quite polite, but - and they said, no? And she said, it's just too complicated. So you know, they've been aware from the very beginning that the arrangements are unorthodox and unusual. One gets sort of soppy and mawkish saying, but we really love them and love is what it's all about. I mean, love is a lot of what parenting is about, but not all of what it's about. Part of the reason that I've written about the whole experience of having this family is that I would like other people to be able to gain access to the kind of joy that we've been fortunate enough to have. But part of it is because I really want the children not to grow up with the sense that they have a secret. I had a secret that I was gay when I was an adolescent, and I didn't tell anyone and I tried to disguise it. And I want them to grow up having a family that's different that they know is fully acknowledged, that everyone around them knows about. And they seem like really happy kids. You know, my fear of course before we did it all was, what if this situation is too strained and complicated? What if it makes the kids miserable? What if I pass on the legacy of my own depression? So far - much knocking on wood - that doesn't seem to have happened.

GROSS: You've written so much about being different, not just about yourself, but about children who are different in some way, and about depression, which also makes you different in a lot of ways. Children usually want to fit in. Children usually want to be like other children. And they're ostracized if they're not. So I'm wondering if that's been an issue. Like, you know what you've done and you've done it all really consciously and for good reason. You're proud of that ability to have a non-traditional family. Children don't necessarily get that.

SOLOMON: When my daughter was in first grade last fall, I was visiting in Texas and she announced to me that show-and-tell day was Friday and that she was going to bring me in for show-and-tell.

GROSS: (Laughter).

SOLOMON: And I was very sort of taken aback. And I thought OK. I mean, we have had a great time and Blaine is beloved of everyone. But, you know, is there a possibility that questions are going to be asked that will make some parents down there feel a little bit uncomfortable? But she was very insistent that that was what she wanted me to do. And I went in. And they all know that she has a half-brother who lives in New York. They all know that I'm gay. They all know that she lives with her mother and her mother's male partner. All they wanted to ask me about was what it was like to be a writer, and where I had traveled, and what my experiences had been, and what it was like being on TV and so on and so forth. I was really amazed by how little sense there was from any of those children of thinking that the situation was extraordinary. And I was surprised by that in part because you know, it was not a context of people who had all come to hear me speak and who were therefore presumably favorably disposed. I've been surprised by how little the sense of difference seems to have plagued them. It's something they're aware of. George, at one point - my son - was at home when he was in preschool still, I think, and someone was there saying, but you can't have two dads - everyone has a dad and a mom. And George said - because he does call his surrogate Mama and her partner Mommy - he said, I have two dads and I have two moms. And the other kid said, wow, you're lucky.

So there you go. In adolescence, I'm sure people will say, wow, you're unlucky. But for the moment, it seems to be working.

GROSS: Andrew Solomon, it's great to talk with you again. Thank you so much for coming back to the show.

SOLOMON: Thank you so much, it's always a pleasure.

GROSS: Andrew Solomon's book, "The Noonday Demon: An Atlas Of Depression" has just been published in a new edition. His article about dealing with depression during pregnancy was published in last Sunday's New York Times Magazine. Coming up, film critic David Edelstein reviews "Spy," the new comedy starring Melissa McCarthy. This is FRESH AIR. Transcript provided by NPR, Copyright NPR.