Note: Please bear in mind that whilst this topic does canvass opinions, it is not a fight club. You may disagree with other posters but we do ask you please to stick to our Talk Guidelines and to be civil. We don't allow personal attacks or troll-hunting. Do please report any. Thanks, MNHQ.

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.

JesuslovesmethisIknow Sat 07-Sep-13 15:41:49

YANBU

YABU. If you're pregnant are you supposed to come of ads immediately and wait for all these therapies to become available? Carry on with pregnancy while the black darkness gets worse? Most people who are on antidepressants aren't stupid, by the way.

Arnie123 Sat 07-Sep-13 16:28:29

I did not read anywhere the op saying people with depression are stupid. In fact for someone who I am assuming has no medical or nursing training she seems very bright. There are 3 options for depressed women in pregnancy antidepressants, psychotherapy or nothing. Unfortunately the psychotherapy option is not available in most Nhs trusts as even an urgent referral can take months and you have to be extremely unwell to get one. So the op has two choices ad or nothing unless she pays private which will cost £150 an hour.

All I can advise op is that if you do choose to come off the meds you should taper the dose and take high dose omega 3 as this has proven ad effects. If you relapse you will need to restart meds immediately.

Depression can cause changes in blood cortisol levels as this is a stress hormone. High maternal cortisol does far more damage to an unborn child and I would recommend you stay on the meds unless you can pay for private psychotherapy

Arnie123 Sat 07-Sep-13 16:31:09

Try demanding a referral to a perinatal psychiatrist as they have them in the larger teaching hospitals but I doubt you will get it unless you have been very unwell. It is worth a shot

Arnie123 Sat 07-Sep-13 16:32:50

I knew a woman who was on antidepressants and they monitored her baby after delivery. I am pretty sure it was sertraline too

SoThisIsHowYouNameChange Sat 07-Sep-13 16:37:45

OP have you looked into cbt?

orangeandemons Sat 07-Sep-13 16:40:28

I saw a perinatal psychiatrist when I was pregnant. She said there had been loads of studies on amitriptiline and Prozac, both of which were safe in pregnancy. You can obviously cope without the tablets, otherwise I'm not so sure you be that keen to get off them.

I was crippled with terror when pregnant so had no choice

Saffyz Sat 07-Sep-13 16:48:01

There is no "one size fits all" whether this is medication, therapy or alternative treatments. Psychotherapy, CBT and alternative treatments don't work for everyone. For some people the only thing which helps is antidepressants, and for them these are essential, not "cheap and cheerful" hmm

Different doctors will have different opinions, it happens all the time. Unfortunately they only have a very small amount of time for each consultation and so yes you may get different opinions from different GPs. Why not try a different GP if you're not happy with this one?

Edendance Sat 07-Sep-13 16:50:19

My sister had great sucess with Rob Kelly's Thrive programme. She had previously been on antidepressants for bipolar but has come of medication completely and trained as a Thrive therapist herself. Sorry I can't help with more direct help but being seen privately will mean you get treated straight away and her sessions were under £100 with a free initial consultation. Good for you to be looking at other options of help!

specialsubject Sat 07-Sep-13 17:54:46

nothing is 'totally safe' and 'no risks', and no medical professional should say that.

NHS resources and GP time are limited. Try a different GP.

good luck and good health to you.

OnTheBottomWithAWomensWeekly Sat 07-Sep-13 17:57:32

YABU. Don't generalise.
I need meds every few years to reset my brain chemistry. When I need them, I really need them, and when I don't, I'm fine. I don't need psychothlerapy, I don't need to talk.
I'm not the one.

nobody ever says that anything is totally safe in pregnancy, I don't believe for a moment that numerous health professionals have said that to you.

OnTheBottomWithAWomensWeekly Sat 07-Sep-13 17:58:14

not the only one like this, that was meant to say.

LovesBeingOnHoliday Sat 07-Sep-13 18:04:40

Op I hear what you are saying, I refused them when pg because I don't take any drugs whilst pregnant. Did it do me any good no not really. Would I do tge same, probably. I was in not state to listen to anyone.

My me wanted me to take them and basically said to ignore tge risks as tge benefit was more important.

My baby was underweight, loads compared to his sister who were born at tge same point in relation to my due date.

If you have it about you to want alternatives Tgey should be available

working9while5 Sat 07-Sep-13 18:41:07

Oh yes they have said it is totally safe.

Strange responses here. Nowhere did I suggest meds shouldn't be available to anyone who needs them wherever they need them.

I don't think it is acceptable for them to be the frontline or only option for treatment and for the information about other options not to be shared.

When it comes to mild and moderate depression (and moderate is pretty debilitating. . I was in terror during that pregnancy but I chose, as was and is my right, not to use drugs when they are not necessarily any better in terms of efficacy than placebos not to take them).

I don't think it is okay to dumb down the risks because someone is depressed. I don't think it is okay to not state clearly that the medication isn't a quick fix. I don't think it is ever okay to offer it as the only treatment for depression (even if some don't find therapy useful). There is very limited evidence that any depression is solely down to brain chemistry.

What is the point of having NICE guidance if it isn't to be followed?

working9while5 Sat 07-Sep-13 18:46:46

And really I am just saying evidence based individualised treatment should be available and that will be different from person to person, not sure how anyone reads this as 'no antidepressants should be prescribed in pregnancy'. NICE is clear they are recommended for severe depression and mental illness... and are an option for moderate cases.... and so it should be. But not the only option because cbt is 'too expensive'.

neunundneunzigluftballons Sat 07-Sep-13 19:21:16

Op I am really surprised by some of the responses here. My reading is that you are referring to your own situation and not extrapolating your believes out to include every one in similar circumstances.

I believe all medical care should be specific to the individual patients needs. I believe your current situation involves pure risk benefit assessment because yes there are risks associated with all drugs but there are obviously huge benefits too. I would expect a doctor to involve me in any discussion detailing what is best for me and my baby. That said and I could be wrong but more drugs seem to have their worst consequences, even these that are minimal risk, during early pregnancy and by 20 weeks will the risks really outweigh the benefits? The reason I ask this is because under advisement a close family member gave up her medication during pregnancy and then had an episode immediately after the birth which can be high risk due to hormone changes. It was very tough for all concerned.

That said I would appreciate in your situation not being patronised, there are obviously reasons why all of these doctors see the medication as the lower risk option I just wish they would share these reasons with you.

working9while5 Sat 07-Sep-13 19:39:02

Thanks neun.. yes this is about me and about wishing I wasn't being treated as a label instead of a person. And hoping all women are treated according to their circumstances, preferences and best guidance.

The issue for me is that antidepressants really didnt do an awful lot for me. I had a period before and after birth with the illness and went up to the maximum dose without much effect despite me being totally compliant etc. I stuck it out for a year.

CBT is the recommended treatment for OCD and you can't actually take quite a lot of OCD meds in pregnancy so sertraline is the best available but often doesn't make a difference except in very high doses which increase the risks to the baby. The biggest risk is of pphn this potentially serious and even fatal lung condition and though it is small it is a lot greater than listeria etc. So it has to be worth it in an individual's case. Also the risk of neonatal withdrawal... not harmfulbut very distressing for mum and baby and not something I want if it can be avoided.

I think that it is about the resources and not having time to talk this through. On to my third gp this pregnancy now in an effort just to be heard. None of these gps know me.

working9while5 Sat 07-Sep-13 19:40:54

Sorry I meant risk of pphn is when meds taken after 20 weeks also withdrawal.

Pilgit Sat 07-Sep-13 19:51:00

Psychotherapy on its own is not a solution for a lot of long term depressives. It is one of a basket of treatments. In my own case coming off the meds was a complete no no. My brain chemistry simply doesn't work right and I need the drugs to be stable. During pregnancy with DD1 I halved my dose. It was a living hell. I was clinging on by my fingernails at the end. I have had a lot of therapy and know what I'm doing and all the things to minimise the impact but, quite frankly, only drugs will do it. I actually found the OP rather smug and sneery - that people like me are somehow 'less' because we can't manage without our AD's (I probably am being a bit sensitive here!). With DD2 I didn't reduce my dose at all. I am cogniscent of the risks and did A LOT of reading prior to both my pregnancies to ensure I took the most appropriate decisions. Yes, there are risks in taking AD's - but the risks in NOT taking them for me were far higher - I was suicidal at the end of pregnancy 1 and actually in a pretty bad place when I got pregnant the second time. So the risks of not taking them were far higher. Talking therapies take a lot of time to work and are difficult to access if you have to rely on the NHS - in an ideal world every depressive would get the care they need. Unfortunately we don't live in an ideal world and the stark reality is that if you can't pay for it and have to rely on the NHS treatment goes to those most at risk first.

As to withdrawl - DD1 had it and went through it. For 36 hours she slept and had the junkie jitters as she withdrew. It was quite scary but we stayed in hospital and it didn't seem to bother her at all. DD2 - whilst I was on more than double my dose with DD2 - barely had any symptoms (in fact had they not been observing her they said they wouldn't think she needed it as what she was doing was normal behaviour).

SomethingOnce Sat 07-Sep-13 19:52:48

From BBC news: The risk posed by some popular antidepressants in early pregnancy is not worth taking for women with mild to moderate depression, an expert has warned

I'm sure this isn't a new concern either because I remember reading something about it (or similar) years ago.

pianodoodle Sat 07-Sep-13 19:54:41

Every medical person I've seen so far seems to be giving me conflicting info on this and it's making me worried.

I'm 24 wks with DC2 and taking 10mg citalopram daily. This is half the dose I was on before getting pregnant again.

First GP and hospital doctor said this was fine but on recent visit to different doctor she wants me to taper off and stop taking before baby is born.

I'm not happy about it and don't know what to do. Initially I thrashed out and weighed up risks with the first doctors and came to conclusion that me being in a healthy mental state was very important etc... and history shows I am likely to get PND.

Now it's changed to "stop taking and monitor for PND after birth because I'll be breastfeeding again"

That's all very well but I don't want to have to get depressed again before something is done and the medication keeps me on a level.

Sigh sad

EstelleGetty Sat 07-Sep-13 20:02:45

It's a difficult one, OP. Yes, you're right, guidelines on ADs in pregnancy should be made transparent. I do know women whose GPs have flat out refused to continue prescribing their ADs through pregnancy. To me, that's worse than failing to offer talking therapies.

As anyone who has suffered depression knows, it's terrifying. No amount of talking therapy on the NHS (I can't afford private) has ever helped me. ADs have, mindfulness has. I know 2 women who've been on ADs throughout pregnancy, with no ill effects on their babies but those women are not sure they'd have made it without them.

You are right that all the facts need to be communicated, absolutely. But it's so important to bear in mind that talking therapies just don't help everyone.

working9while5 Sat 07-Sep-13 20:08:25

Pilgit where is the sneering? I want NICE recommended treatment for my profile as someone without severe depression and with OCD. Someone who doesn't do well with the available meds.

It isn't about anyone else. It's about medical professionals not using the guidance available to them and treating the person as an individual.

For anyone saying 'well I get nothing from therapy' it is only the reverse. The meds don't do it for me but I am offered nothing else despite my preference not to take something with risks that do naff all for me anyway.

There is a lot of evidence that antidepressants are not brilliantly effective for mild to moderate depression. I just want the right treatment for my condition not to have a pill flung at me that isn't right for me. Is that really too much to ask?

LadyMedea Sat 07-Sep-13 20:11:11

YANBU to want to have options and make an informed choice for yourself from decent advice from health professionals. Only you can make the decision on risks vs benefits.

ADs in pregnancy are a difficult topic. I came offnCitalopram (titrated down from 40g from TTC, off completely from about 8 weeks). I felt that I wanted to try without meds. Anxiety kicked in about 16 weeks which ended up with 3 weeks off work and making the decision to go back on. Now just on 10mg and using (self taught) CBT to manage remaining symptoms. I was reassured from my research that there is absolutely no evidence of birth defects from SSRIs but I am aware of the neonatal affects, but they are dose dependent, so I'm minimising the risk by keeping the dose low... I might even considering stopping it at 38/39 weeks.

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.

kayjayel Sun 08-Sep-13 07:55:01

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

Good luck.

working9while5 Sun 08-Sep-13 08:05:36

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.

working9while5 Sun 08-Sep-13 08:06:23

Kayjayel: thank you so much!

PartyOrganisor Sun 08-Sep-13 08:17:16

YANBU

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 hmm).

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....

FreudiansSlipper Sun 08-Sep-13 08:20:29

YANBU

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

PartyOrganisor Sun 08-Sep-13 08:20:35

working
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?

PrettyFlyForAWifi Sun 08-Sep-13 08:29:20

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.

RSVP Sun 08-Sep-13 08:38:04

Working, YANBU

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. confused

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!

working9while5 Sun 08-Sep-13 08:54:19

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.

working9while5 Sun 08-Sep-13 08:56:38

(Oh and did she transfer me to CMHT? Did she heck....).

thing1andthing2 Sun 08-Sep-13 08:59:13

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.

PrettyFlyForAWifi Sun 08-Sep-13 09:14:30

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.

AintNobodyGotTimeFurThat Sat 14-Sep-13 13:38:24

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. smile

Sinful1 Sat 14-Sep-13 17:36:26

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.

kali110 Sat 14-Sep-13 20:09:35

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.

Join the discussion

Join the discussion

Registering is free, easy, and means you can join in the discussion, get discounts, win prizes and lots more.

Register now