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to think it is not acceptable to be repeatedly told antidepressants are 'totally safe' in pregnancy with no discussion of risks or mention of psychotherapy or alternatives?

(65 Posts)
working9while5 Sat 07-Sep-13 13:36:09

I am getting increasingly concerned with this.

I had moderate antenatal/postnatal depression and OCD with my second son. I have been on antidepressants since he was born. Now pregnant with my third, I have already made the decision that I want to come off the drugs by 20 weeks and went to GP to begin taper as soon as I realised I had fallen pregnant. She agreed to support my decision and monitor but also told me sertraline was 'totally safe'.

My decision is based on my personal risks and NICE guidelines.. NICE suggests this is the way forward and supports a switch to psychotherapy for women with my profile.. The risks of untreated depression in pregnancy are low birth weight, prematurity, complicated labour, pnd and some discussion about longer-term delayed development in the baby. I was quite unwell with my son and opted for no medication and he was born at term plus nine at 9lbs in a straightforward waterbirth and all developmental milestones have always been on time. I always ate well and attended all appointments. I was never suicidal or psychotic etc. I am currently well and receiving CBT and doing Mindfulness meditation.

As my previous GP left I went to explain this to the new one. Two minutes into the consultation she said that it was 'safer' to stay on the drugs and there were no risks. She was not happy to reduce my dose further though I had no side effects from taper. Obstetric consultant said, to his credit, not enough data but then went on to say there were no data to suggest there were any risks with my drug, sertraline and 'no need' to monitor a baby after birth despite most research saying observation is needed as 15 to 30% will develop neonatal abstinence syndrome.

I have been referred to the specialist perinatal mh team again but won't be seen until 18 weeks pg at least. Saw them last time and they offered nothing but medication.

This just feels shoddy to me. There are risks. Small but serious risks including a serious and potentially life threatening lung condition in the newborn.

Where is the information about psychotherapy here, where is the guided self-help resources or information on promising alternatives like bright light therapy, exercise, omega threes, support groups, listening visits etc? It just feels that the gun has been jumped because meds are cheap and cheerful. There is good evidence for caution here.

Antidepressants can save lives but aibu to suggest in pregnancy women should be given the information necessary to make an informed decision and appropriate treatment as per NICE guidelines? I seriously hope this isn't just how it goes now in terms of dilute information about serious drugs in pregnancy.

working9while5 Sat 07-Sep-13 20:13:46

And EstelleGetty I agree flat out not prescribing isn't right and women who want or need antidepressants should get them. It is an option for moderate depression but not for me... I would just say the same that antidepressants aren't for everyone but it shouldn't mean a gp won't agree to monitor me coming off or prescribe a lower dose because that just forces me either to take drugs I don't want or taper them without medical advice or supervision which is not ideal.

working9while5 Sat 07-Sep-13 20:29:02

LadyMedea I feel very similarly. I am not prepared to be as unwell again this pregnancy and I will be cautious but want lowest possible dose. I would find neonatal withdrawal very hard because I have obsessions around accidentally harming my children and very badmemories of ds1 screaming continually for days after a traumatic birth. I think it is a big risk for me given how ambivalent I am about the positives of medication FOR ME eg they don't have a great effect.

I just want a professional to help me devise a non-pharmocological plan and supervise it not say 'takr these drugs or get lost and go it alone'.

BrokenSunglasses Sat 07-Sep-13 20:44:03

The cheapest and most convenient treatment available is used for lots of illnesses and medical conditions unfortunately, I don't think your problems are the only ones to be treated with this attitude.

I'm not sure I agree that you should be told about and offered all the things you talk about in your OP on the NHS. I think that in general, people need to take more responsibility for their own conditions and do whatever research they can for themselves. The NHS is already overstretched offering the treatments they do, and when there are so many areas in need of more funding and resources, I just can't say I believe that people who are suffering from post natal depression who have chosen to have another pregnancy are anywhere near the top of the list of priorities.

jellybelly18 Sat 07-Sep-13 20:47:14

Wasn't there a panaroma or some such programme on the bbc about this? Within the last year anyway? Might be worth a Google?

working9while5 Sat 07-Sep-13 21:18:28

Brokensunglasses, you think people shouldn't be treated according to NICE guidelines?

I am sick to the back teeth of poor treatment on the NHS being seen as an excuse to not follow best evidence. I asked the manager of the Mother and Baby Unit for details of private professionals I could approach and was told there were none they are aware of while the consultant psych told me that most in the private sector were ineffective and didn't have proper training.

One of the reasons this concerns me is because last time I became ill I was in no fit position to research anything. Extreme indecision, concentration and memory difficulties etc: when you are in the grips of the illness you have very limited resources. I was seen for very long appointments, some 2 plus hours, by the perinatal team and offered nothing but medication and told anything I sourced in terms of private provision might be very poor. He shook his head and tutted a lot about how shoddy it was and sent me off saying I would feel no better before the birth. Some well-timed clear leaflets on alternatives or even just a clear summary of recommended treatments would have given me much needed hope at a vulnerable time. I think it's a disgrace that vulnerable women are fobbed off with not so much as a whit of information on nationally agreed guidelines for their condition
Which I know now because I am much better and CAN research it but that doesn't mean it is right that I am expected to basically do it all without people who are paid to do it even chipping in with a bit of advice or willingness to monitor and.supervise.

Going to ignore your comment about choosing to be pregnant again as if having had a resolved episode of mh should mean someone should never have a baby again hmm. Bit unnecessary, don't you think? The time it would take to prepare a few information leaflets, disseminate national guidance and listen and support someone who has not chosen to experience mental distress is well within basic care provision and not at all removing good care from those in greater distress. It's about taking the time to do the job right first time and preventing people like me from bouncing around the system from appointment to appointment trying to find someone to be straight and give good guidance based on evidence.

justaboutreadyforbed Sat 07-Sep-13 21:22:27

You seem to be getting a really nasty and ignorant bunch of responses here, working. I think you are right to be concerned. I would personally just go private, get a BCSS-registered psychotherapist or counsellor, and see how you go.
The meds - ultimately surely it is your own decision - you can taper yourself and change that if you feel yourself worsening?

Coffeenowplease Sat 07-Sep-13 21:38:26

No really just meds have to be tapered in such accurate small quantities that I imagine it would be difficult to do without being perscribed a smaller dose/liquid form.

Coffeenowplease Sat 07-Sep-13 21:38:41

*not

EstelleGetty Sat 07-Sep-13 21:52:09

I really do sympathise, working. I've read so many different accounts of depression in pregnancy on here, and all the different things women have been told by GPs about ADs - stop, don't stop, taper.

There absolutely should be a legally required practice in place wherein women are talked through all the available options sympathetically. When you're depressed, you need as much assistance, gentleness and understanding as possible. And you need those tenfold when you're pregnant. I hope everything's going ok for you.

Spikeytree Sat 07-Sep-13 21:54:58

Can you not just slowly lower your own dosage if you feel that strongly about it? I came off sertraline cold turkey which made for an interesting couple of weeks but it was fine in the end. What dosage are you on? You could split the pills or take every other day.

Psychotherapy made me much much worse depression wise.

pianodoodle Sat 07-Sep-13 21:57:12

I feel frustrated to have so many conflicting opinions from doctors as it does stress me out - not great when you're pregnant and worried about depression!

working9while5 Sat 07-Sep-13 22:03:46

Exactly Coffee. Such a pain. You would say something if I wanted not to treat but I just want a bit of monitoring from a medical professional to treat it and have a relapse prevention programme that isn't drug focused.

I've had nearly 30 sessions of CBT (some NHS/some private), done two Mindfulness courses, several mindfulness retreats, am doing Bright Light Therapy for 60 mins every day within 10 mins of waking (which means getting up at 5.30 to beat the kids' waking time), taking fish oils, doing yoga, daily CBT exercises etc... the NHS has not been taxed very much by this illness at all, it has cost me a small fortune. All I need is medical supervision to get off the drugs and monitor me in case I start to slip. This doesn't have to be time intensive, it could be done with a decent GP but it does require professionals to know their guidelines and have a fair handle on the evidence and be able to judge what's what without me having to plead like a baby just to be prescribed a lower dose.

working9while5 Sat 07-Sep-13 22:11:45

Spikey I stopped cold turkey about four months ago for a week. It wasn't intentional. I was on holidays and had the chance to stay on a week and didn't even think. After four days I was very nearly suicidal. Apparently stopping cold turkey can cause greater and more severe symptoms than what caused you to go on in the first place. I am down to 50 officially and I tapered my own to 25mg when I couldn't get a GP to help with advice from a psych nurse friend. But attempts to go further just not good... need a liquid dose to taper much more slowly. To be honest as I had no issue tapering before 25mg I will stay on it if needs be but I do need medical supervision... I shouldn't have to do it like this and am uncomfortable about it.

Spikeytree Sat 07-Sep-13 22:14:43

It is different for everybody of course. I have come off all sorts of ADs on my own as the GP wouldn't let me, so I do appreciate how you feel. Going cold turkey isn't recommended, and if you don't want to taper further on your own you could try a private GP appointment.

BrokenSunglasses Sat 07-Sep-13 23:29:41

Working, I get what you are saying in your reply to me. I really do. But change a few words and you could apply it all to many other things that that NHS has to deal with that are equally deserving of attention.

I think we just have to accept that the NHS is limited. You have clearly taken a lot of responsibility for your own illness and have been proactive in treating yourself, so because of that, I agree that you deserve your GP to give you some credit and support your choices.

I just don't think the NHS can be expected to offer everything.

I'd either look for another GP, or pay privately for one while you go through a change of medication.

emblosion Sat 07-Sep-13 23:50:13

I dont think YABU op, in relation to yourself and to your own treatment. Everyone is different, everyones depression is different.

Thing is, nothing in life is without risk, no medication is without risk, its a matter of weighing up the pros and cons.I had severe pnd after ds1 was born, just as I was feeling better I got pregnant with ds2. Nothing terrified me more than the thought of going back into that dark place. I was on sertraline throughout pregnancy, ds2 was 6 weeks prem (for unrelated reasons - I had a uti that caused prom) but completely fine now.

All medical professionals I came into contact with were v open about the potential risks to the baby, which are small, but undoubtedly exist. For me the benefits outweighed the risks, I would do the same again. I absolutely could not have coped without ad's (im still on a waiting list for cbt, nearly 2 years later)

NotYoMomma Sat 07-Sep-13 23:59:17

I feel like everyone on MN today has suddenly become a doctor. confused

PrettyFlyForAWifi Sun 08-Sep-13 05:23:48

Op, yanbu necessarily but you do come across to me as being a bit overinvested in this. I'm wondering if your anxiety levels are creeping higher than you realise? You mentioned previously that you have ocd and as a sufferer myself I know how insidious the illness can be.

working9while5 Sun 08-Sep-13 05:52:24

And you know what Broken, I agree the NHS can't offer everything... but my problem with it is that it tends not to discuss what it can't offer. I know this from my own area of work in the NHS. ABA is one of the most evidence-based treatments in early intervention for autism but it is wickedly expensive. I can see why it isn't offered... but I can't see how it is ethical to pretend it doesn't even exist, to give misinformation on it, to deny its research is robust but pretend interventions with much less evidence (including speech therapy which is my job) are better even when offered at incredibly dilute levels.

It's the Emperor's New Clothes approach that irritates me.... pretending that offering nothing or a very limited anything is any good at all. I also have to disagree with my NHS hat on that somehow people have to prove themselves worthy of better treatment through their own research and expenditure. Many people really don't have the resources for a variety of reasons to do that kind of research and ultimately we pay taxes to have people share this information, it is not a gift. If you can't get clear, accurate information from your healthcare providers what is the point of having NHS treatment at all?

working9while5 Sun 08-Sep-13 06:16:04

PrettyFly... not really sure how to respond. I'm pissed off more than anxious and I'm not sure how I sound overinvested, it's important to me right now because I think it's sensible to have a GP to support my decision to monitor me. I think I've made a very reasonable informed decision and I am comfortable with it.

I am not comfortable with making medical decisions on medication in pregnancy without supervision. I grew up in a system where I paid for healthcare and I find some of this really hard to understand... this is not OCD it is common sense you do this with a healthcare provider and in most countries where you pay for treatment that wouldn't even be questioned. There's a real 'put up and shut up' attitude with the NHS and it isn't on really. That's partially what this AIBU is about.

I also don't see mental wellbeing as never having a strong opinion again and hell, there are a lot of whacky obsessive posts on AIBU that people tear eachother' s throats out over that are a lot less relevant perhaps to their current day to day lives. Chatting about something does not equal obsession and it concerns me on principle that mentioning a diagnosis means having an opinion or a whinge is clinically symptomatic. I think that's half the problem I face. The doctor said 'you are clearly a planner and want to have certainty but sometimes it's best to go with the flow and deal with problems as they arise'. No. I am not and never have been a planner, in fact I've spent my life avoiding planning healthcare. I was ill for a year, I have made an informed decision to come off medication and I want to take sensible supervised steps to be well as anyone in any country where you pay for healthcare would view as absolutely the norm.

I think the NHS is an amazing idea but it is struggling and from working in it, I can see how it is struggling more and more and this is sometimes used as an excuse rather than a reason for poor care.

To be honest I hadn't thought of a private GP, I know nothing about the private system and it just never entered my head. I think it's a bit sad it has to be like that though... because a lot of women can't afford it. I'm not sure I can!

working9while5 Sun 08-Sep-13 06:22:59

Emblosion that is awful that you are still waiting for CBT sad
Two years! That's an eternity. NICE says that pregnant and breastfeeding women should be prioritized for treatment but that doesn't really seem to happen. In general services for PND are very weak.

Montybojangles Sun 08-Sep-13 07:25:49

Sorry, but I think it might behave been sensible to have addressed this BEFORE conceiving really. You should have been talking to your GP and making a comprehensive plan before hand.

Retropear Sun 08-Sep-13 07:31:46

Yanbu

I had PND and was lucky enough to get counselling,a course and support group alongside ADs.The former was far more useful (then and beyond) than the latter of which I came off v quickly.

BlackholesAndRevelations Sun 08-Sep-13 07:53:11

There is no offer of counselling or any kind of behavioural therapy where I am; when I suggested it, I was given a phone number for a private therapist by my (very lovely) gp. Yet friends of mine have had counselling on the nhs. Rubbish.

I came off sertraline cold turkey unintentionally (a holiday, too) which was horrendous but I chose not to go back on them as we were ttc number 3. I've had dark days (currently pg) and I'm just keeping an eye on myself. That panorama programme was about medication causing birth defects and it terrified me and made me really anxious that I'd caused defects in my unborn child. Luckily all looked ok at scan.

I'm horrified at broken's suggestion that you or I would be less deserving of treatment because of the fact that we chose to get pregnant again despite having had pnd. sad

working9while5 Sun 08-Sep-13 07:54:22

Monty, I have been at this for months. I am 12 weeks pregnant and have been trying to address this on and off since about January. I tried to organise a plan with the specialist Mother and Baby Unit before they discharged me. I have a report where this 'plan' is outlined. It basically consists of them saying that I am high risk for recurrence and may wish to stay on sertraline during pregnancy and should be given information about sertraline in pregnancy when I get pregnant. Nothing else. This is what is on offer. When I first got this condition (which I couldn't have planned for) this is what I was offered. Medication... or nothing.

I have done most of my own planning using a book called 'What am I thinking? A guide to pregnancy planning after PND' because I wasn't getting anywhere with services really. I discussed it at CBT and agreed to take the approach that I would not engage in non-productive worry or excessive research about it but would formulate this plan and communicate my wishes and the rationale for them to healthcare providers when I got pregnant.

I went to the GP before becoming pregnant to discuss my plan saying I wanted to give coming off meds a go. As it is in the NICE guidelines, I really didn't anticipate that it would be such a struggle, not least because basically it is my right, as it is everyone's, to choose to come off medication and the first GP was supportive. I was delighted with her but sadly she was a locum and left the practice by the time I was pregnant. The next two I saw were not so much so. It doesn't help to have to be starting afresh, I wish I could have continued seeing the first one but I can't get her back! I'm trying again with another one on Wednesday.

Honestly I've done a lot in terms of being proactive. More than is really ideal when you have OCD where really the best approach is to get a productive plan in place and then stick to it without doubting or second-guessing it. I just want a basic level of care provision here, one that recognises me as an autonomous person with a right to make informed decisions. I shouldn't have to be going in waving guidelines about and proving I have done 'enough' to warrant a particular decision. People wonder why so many people are like self-appointed doctors to themselves in this country, you should be able to go to a professional, explain your symptoms or lack of them and get treatment or at least advice on it based on that information combined with the nationally agreed best practice. It's sort of been a farce.

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