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)
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.
Maybe ur doc doesn't think you're ready to come off at the mo?maybe they're worried you may get sicker and pose more risks to you and baby. Im opposite, iv never found therapy helpful. I used to dread the sessions immensely. Did you find the light therapy helpful?i was under the impression they were used solely for seasonal affect disorder?i would never come off pills cold turkey without doc approval. Did that 9 years ago, was fucking suicidal a week later.
remember as you come off them your appetite will drop, so try too keep up the food intake as you're going to need it but your body wont be telling you as much as normal.
I know what you mean, OP.
I was hoping to go off my medication for when I was pregnant with my daughter last year. I got down to 50mg from my initial 150mg and then began to take every 3 days, but that made me very depressed. I was told that being depressed and panicky gave me a higher risk of problems with my baby, so didn't want to risk that happening, especially considering I was around 14/15 weeks so she was still at a real developmental stage.
In the future with my second, will I come off antidepressants? I will certainly try. I will see how it goes and give it 2 weeks to see how I really feel, as it might've just been worries about the baby in general amongst other things. If it wouldn't be better then, I may go on the lower dose. I stayed at the lower dose though, as they said the lowest the dose I take, the safer it is for my daughter. I am still on only 50mg at the moment.
I too take Sertraline. I think ultimately, you need to do what you think is best for you and your baby. If you think it's the right choice, then it's up to you to make it. Doctors can advise, but they can't tell you what to do.
I wish you good luck with your pregnancy and congratulations.
Yes, I've definitely been caught up in that trap too - being a hcp has done me no favours insome regards but has brought me better treatment in the long term.
However, in the here and now, what I would say is that you're doing as much as you can at the moment. You're off sertraline, you're keeping an eye on yourself, you're linked in with the perinatal team, you've made your GP aware of where you're at - there's not much else for you to do until you're further on. You could ask your GP to refer you back to CBT though, for a top up?
Also: you might be ok this time. I'm not being glib, it's just when things have been so terrible, you forget that hope exists.
Incidentally, I don't disagree with your AIBU! Have wandered way off topic.
I work in a medical school and am amazed how little training there is for medics on reading research evidence and evaluating it themselves. They are taught in a categorical "this is what we do" fashion which obviously helps them learn the vast quantities of knowledge they need but doesn't help with nuances of evaluating individual circumstances and evaluating whether treatment is worthwhile when the evidence for and against is mixed. Add into that the patriarchal attitudes towards pregnant women who just need a little pat on the head, dear, and you get the situation where it's almost impossible to have a conversation with a doctor as equals where you weight up risks and benefits of anything, be it depression or birth choices, in pregnancy.
I really feel for you OP and agree with everything you are saying. If its any help I know a (properly trained) CBT therapist in the Brighton area who specialises in perinatal mental health so PM if you are anywhere near there and I can put you in touch.
(Oh and did she transfer me to CMHT? Did she heck....).
I guessed you weren't PrettyFly but I wasn't sure, it's been used to fob me off a bit e.g. oh you just want a plan because you are anxious/oh you are just worried about the risk as because you are anxious etc. No, I just want a plan because I think it's a good idea and I just want off the meds because I don't think they've done much anyway.
I am a HCP too and to be honest I have sometimes found this a problem. The CPN I had after having my ds2 spent a lot of time not doing things she said she would and then being all 'oh well at least I know you know what it's like'. Things like not sending prescriptions on time, suggesting onward referrals to this that and the other and never doing anything and to be honest I was caught in a good girl trap and just smiling and colluding and saying how I understood etc.
It all came to a head because the CPN had been reassuring me about ds2' s failure to thrive and saying it was just my anxiety blah blah but actually he was nearly admitted to hospital at 20 weeks as he had dropped from 91st centile a birth to 0.4 and hadn't gained in eight weekss .. and then they backtracked and implied they had been monitoring it etc when the Health Visitor pretty much said they all thought he was fine and I was just being anxious. I made a complaint and the manager said she felt that boundaries had been blurred a bit because they didn't really take responsibility for monitoring it and then kept trying to say it was my fault. Luckily CBT therapist was seeing me weekly at that point and backed me up in multidisciplinary review when they were trying to suggest that I had disengaged and they couldn't have been expected to realise there really was an issue as I was refusing all help. This was based on missing one appointment at six weeks postpartum which I rearranged... was going to therapy weekly, always there for cpn fortnightly, went to all well baby checks etc.
The CPN never contacted me again after I got cross with her on the phone one evening when she called at 5pm and was trying to ask why I wanted a review as I'd said I had lost trust in her. I had mastitis and was literally in from docs and trying to make tea and she said the fact I did want to talk to her ahead of a review was avoidance. I lost my temper and said I felt she'd let me down. This was in November and she never came to the review or contacted me again, though she rang HV to say she would transfer me to CMHT for support on returning to work in February. Honestly the whole thing has been so chastening, I had no idea it could be like this for service users. I was so incredibly lucky to have CBT at that time, I would have sunk without it. Thankfully ds is alright but it was a very difficult time. I think my dealing with services made me more unwell than the condition itself!!! Hence my frustration at not being able to sort GP care now. I just want to get on with it and forget about it.
I had the opposite, was on sertraline for anxiety and panic disorder, and when found out I was pregnant I was advised to come off as soon as possible (within a week) and stay off until I stopped breastfeeding (!)
This was abroad where the attitutde to ads was that they should be avoided at all costs during pregancy and lactation, unless the mother is very suicidical.
Coming back to the UK, I had the standard 'totally safe' attitude by two different GPs.
Not to be given individual assesment about mental health issues in pregnancy is just wrong, as there is clearly no consensus but the risks invlolved either side can be serious.
Good luck OP, I do hope you continue doing well in this pregnancy.
You sound a lovely, strong mum!
It's meant well, I'm not on the attack or judging. Just raising it as a possibility, that's all. Your support certainly sounds lacking. For example, I give birth in 2 months and I have the peri natal team as and if I need them, my GP is happy to check in with me every 2 weeks and the health visitor knows I'm worried about how I might feel. Psychotherapy has been offered too. However, I must add that I am a hcp and therefore an 'assertive' patient.
Oh and sghtly off the point, but if it helps to know, the increased blood volume in later pregnancy actually acts a dose reducer without actually reducing the dose iyswim.
Good luck with it btw.
You seem to have looked at all the options, taken a very informed decision (thanks to your own work, not the HCP that should have given you all that info, incl following the NICE guidelines that are there for a reason).
I really hope that the CBT you got/get will do the trick.
A good friend of mine used acupuncture when she had PND as she was bfing and didn't want to use any ADs. It worked very very well for her. Maybe worth a try too?
more and more professionals are starting to speak out about the use of ad's how as a nation we have dependable on them when for many their are alternatives to try but the money is not there
I had PND with my first and then just after AND when I got pregnant with my second. (very close together).
I had no support with PND which meant no ADs and a dismissive GP&HV.
When I started with AND, my GP clearly decided that the safest way was to do nothing. She only told me to go on ML asap but didn't even mentioned AND (She did so after the birth when I was felling well ).
completely agree that AND treatments are talked very little and I think each GP is doing what they think is best. One of yours is happy to reduce ADs, the other think it's the safest
or is it easiest to deal with with less risk of the mum suddenly taking a turn for the worse?. Mine thought it was best not to take anything, regardless of the effect on myself, the unborn baby but also my first child (major attachment issues linked with the untreated PND and then followed on by the AND).
I also lost my job from that....
Blackholes I wish I had seen it through with coming off but I wasn't able for it sadly. I am glad your gp gave you a good contact. I actually have been really lucky with NHS CBT because the guy I got was really good, the best therapist I've ever had and I've had a few over the years. I did try some private while on the waiting list but having had the comparison the private one wasn't really doing CBT at all, she spent more time going on at me about her own decision to have an elective section than doing anything useful and though she was lovely and it was nice to have her listen when I got 'real' CBT there was just no comparison. There are so few properly qualified CBT therapists where I am, it is a pain. I would pay oodles to have been able to have had more sessions with my NHS guy. I just don't have that option.
It's very difficult. I appreciate that in terms of NHS provision the scale of PND is just huge with one in seven etc but where are the self-help resources, the leaflets sign-posting people to reputable websites and self-help books, information on support groups etc? I've found all of these things now but I think I have been very very privileged and its not good enough that there is so little out there. In my local Waterstones there isn't one single book on PND. That seems nuts when you consider how common it is and how potentially devastating.
Working, I think yanbu. There is a very therapy friendly psychiatrist who may be able to offer monitoring or contacts on www.goodmedicine.org.uk
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.
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.
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.
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.
Emblosion that is awful that you are still waiting for CBT
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.
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!
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?
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.
I feel like everyone on MN today has suddenly become a doctor.
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)
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