Prescribed sertraline but nervous about taking it

(16 Posts)
AtrociousCircumstance Sat 04-Jan-14 14:14:11

I have to face the fact that I have pnd and I'm finding it hard. I keep coming back to the idea that it's just a heap of difficult RL stuff all whipped up into a frenzy of not coping due to prolonged sleep deprivation....which makes me wonder if I should take ads or not.

I'd love to hear any experiences of sertraline. ( breast feeding so doc said that drug was the best option).

Also just to connect with other women with pnd would really help.

I have a 2.4 year old and a 4 months old. They're amazing and I love them. But I get no sleep (DS2 wakes at least 10 times a night, we cosleep). And I have money worries, problems with workplace (have to go back FT when baby is 9 months).

Maybe I should just stop agonising and take the ads. I feel alarmed by the thought of my mind being affected though, and the side effects.

Gah.

CunningAtBothEnds Sat 04-Jan-14 15:19:39

I could of written your post. literally word for word! I started sertraline when DS2 was circa 8 weeks.DS1 was 3.4 DS2 is now almost 13 months. Each week from about six weeks in has been better! I started on 50 mcg and am currently and steadily settled on 200. I had no real side effects, although there were periods of euphoria, when upping a dose, and this made the times when teh dose started to fail a lot more noticeable.

Now it has steadied out I realise I was depressed since a MC before DS1. My only regret is not taking them / getting help sooner. My doctor [put it best when she said It is a chemical imbalance. that sums it up for me.

CunningAtBothEnds Sat 04-Jan-14 15:21:18

(also to an extent you are right the RL stuff doesnt help, but once my meds kicked in I was so much more able to deal with it all and see it for what it was - I.e what was really a problem and what was just me being anxious. We had work issues, and had a rental house with damp etc. DS1 was query ASD.. Ive dealt with it all much better, and our relationship has improved)

working9while5 Sat 04-Jan-14 15:47:21

Hi

I took sertraline for a year after ds2, was diagnosed with moderate-severe depression and OCD mid-pregnancy. I took 100mg. I came off them at 12 weeks pregnant (now 29 weeks).

I still don't know how I feel about ADs. The research evidence for mild-moderate depression isn't great to be honest, it's not much better than a placebo for most. From what I've read, basically it sort of "flattens out" the feeling a bit, so if you are feeling acute distress, it sort of smooths it over. You get this sort of very mild feeling of being in a bubble or cotton wool. This can be an immense relief and there are times I do believe that relief is really necessary e.g. if you are not functioning... so I am not "anti-AD's", I think they have their place.

There isn't any actual evidence that depression is a chemical imbalance, sadly (would that there were, it would make the whole thing WAY easier!). They've really, really tried to prove it is biological but they haven't as yet found any proof it is mainly chemical or biological (though like with anything, how you feel/think/act/behave does result in changes to your brain chemistry, but then so does dancing or waving your hands in the air).

My current feeling is that I won't take them again if I get PND this time unless it is severe. Why not? Because I have the experience of having been depressed/anxious in pregnancy (when I wouldn't take the medication) and after it (when I did), I can't really remember things when I was medicated as well as I can from any other time in my life. I have had quite a bit of depression in my life and I bloody well hate it (as anyone would!) but being on the medication was the first time I have experienced not really remembering things. Some of this was a blessed relief... it was good for the terror to go and the negative thinking to reduce... but it also means I don't really remember my son's first few months at all.

The psychiatrist would say this was part of the depression but I don't buy it, because I know on at least two other occasions I was much, much more depressed (unable to sleep at night, sleeping all day, suicidal etc) and I do remember those times. I also had a comparable level of "untreated depression" after ds1 (though I didn't recognise it as that at the time). I'm just not sure that the relief was worth losing those memories as I do cherish mine of ds1, even though I was also at the same time fairly miserable.

This was my first time seeking serious treatment for depression - have had bits and bats of short-term counselling and been signed off for a few weeks in the past. My most serious depression was in my teens when treatment just wasn't even considered by me or my family (apparently this is weirdly common for people with clinical depression - they reckon only 20-30% seek treatment despite its disabling nature!). They just thought I was "ill" and that it was "viral" hmm. I missed half the school days in my final year at school!

I can't tell you for sure the ADs didn't help.. but I believe that the CBT which I had every week (30 sessions) and the Mindfulness courses/practices did MUCH more good. I really do believe that thinking patterns and how you relate to your thoughts really trigger and maintain depression and whether you choose to take ADs or not, if you don't tackle this, the evidence says that you will be very highly likely to relapse in the future. I think ADs are a crutch.. and I don't want a crutch, I want to avoid relapsing.. so they're not for me.

I have every respect for the fact many other people feel very differently about it though.

CunningAtBothEnds Sat 04-Jan-14 15:52:37

Working Did you lose your memory then? I have no memory loss, Although if I did then I would probably try another AD before writing them off completely. Also re the chemical imbalance. sertraline is an inhibitor..it stops your brain dumping too much of its own natural happy drug... hence the classification of a hormonal imbalance. I suppose we each react differently to chemical interjection. Did you try varied or one?

AtrociousCircumstance Sat 04-Jan-14 16:00:15

Thank you cunning and working. Two very different accounts but still helpful. I guess it is different for everyone - how these drugs affect us.

I'm signed up for a course of counselling via my GP and am going to attend a pnd support group soon, too.

I'm so torn about the ads. But I guess I feel as if they might well help - there is a chance. So maybe I ought to investigate them.

cunning if sertraline has a similarly positive effect on me as you experienced that would be so good, such a relief...

working I truly believe that a month of intense work related stress experienced recently (during the blizzard of sleep deprivation that comes from ten wakings a night) has changed my brain chemistry. I was kind of coping until then. Now, when I get low, it feels like a crazed 'abnormal' low IYKWIM.

Am also concerned about cosleeping and taking the drug. Will it make me extra sleepy and less responsive, I wonder?

CunningAtBothEnds Sat 04-Jan-14 16:03:18

Have never co-slept since ive been on them, as I was paranoid so cant say for sure, but it did make me sleepy to begin with? I truly would hope they would work for you, its only since ive been on them ive realised how long ive been just living with it..the feelings of anxiousness etc

working9while5 Sat 04-Jan-14 16:18:27

Not memory loss as such. They're just not there. I didn't lay them down in the same way. I will say normally I have a spectacular memory... I am the sort of person who can tell you what I ate for dinner on NYE 1998 and I tend to have very specific and vivid memories. My dh doesn't - it's just not how his mind works - so a lot of the things I wish I remembered now he wouldn't remember anyway.

I took sertraline as bfing.. but I'm just not convinced on the science of them. I suppose for me it's a bit like aspirin... it masks but doesn't reduce what's happening underneath, so you get symptom relief but the actual cause isn't being addressed? That's true of all ADs from my reading.

This isn't to say I don't think they can't save people's lives and they do have a very important place in supporting people in distress so I would NEVER suggest they are not worth while taking for anyone who wants to take them or who has found them helpful.... but from my own perspective I do see them as a crutch, not a cure.

I did a lot of cognitive neuroscience as part of the MSc I never finished because I got depressed! and my understanding of it is that in the main, the relationships between neurotransmitters arise out of a subtle combination of our genetic predispositions and behaviour learned in our environment. There's really so little known about it, it's unfunny.. there are literally so many millions of connections governing the whole thing and some of it is happening in uncharted waters, in parts of the brain they just can't study yet. They know that SSRIs do something to this whole process by inhibiting serotonin uptake but they're actually not entirely sure how or why ADs work as many of the original theories haven't been well supported (e.g. serotonin levels in depressed people are often similar to those who are not depressed, even though theoretically if the drug works as they imagine it should there should be a difference). As of this point, there's no definitive theoretical account of what they do.

I think what the evidence tells us now is that it probably gives some people good symptom relief. For some of these people it will be the chemicals achieving this, for about the same amount of others it works with a placebo effect. The difficulty for me is that the evidence that it actually deals with the underlying depression just isn't there... and that people who are treated only with ADs tend to relapse when they come off. While that doesn't mean they have no value for symptom relief, my own (very personal) perspective is that I'm just tired of piddling about with depression and I prefer to work on the cognitive aspects with Mindfulness as I think there's better evidence they will lead to a future without depressive illness for me e.g. more curative vs like a crutch. Horses for courses and all that!

working9while5 Sat 04-Jan-14 16:23:59

Sorry xpost.. if you want to take them, definitely give them a go. There are times when you just need the headache to lift so to speak.

If you can, I suppose, the best situation is to get relief for the acute phase of the depression and at the same time deal with the underlying mechanisms too.. so when it's all over and you come off pills you are not trapped into a cycle of recurrent depression as happens to far too many people who experience depression (whether they take ADs or not).

Learning about depression and how it works really helps I think - as does learning skills and strategies to keep it at bay. I had never even contemplated this stuff before I got a diagnosis. I didn't even know I was depressed just thought I was a stresshead and was engaged in all sorts of unhelpful thinking styles that I just assumed I shared with everyone!

CunningAtBothEnds Sat 04-Jan-14 17:32:17

ah working that makes sense. for me there aren't specific causes, just things that enhance the feelings, so relieving the symptoms leaves me. clear headed to rationally address any issues, this applies to big and small which pinpoints my issue I think..my reaction to something a normal person would find trivial would be the same as my reaction as something major ie bereavement. add to that a dose of extreme paranoia and that was me in a nutshell.

some of that was my personality and im realistic, I dont intend coming off meds any time soon if ever, thats was another reason I like sertraline, you can take it whilst pregnant etc afaik.

I do think you are right though, in an ideal situation ADs are a crutch whilst you solve the cause if your depression.

in specific terms of PND I have found that as I became more rational my confidence soared and I now have no shame in saying I have PND, I take x, which is liberating.

AtrociousCircumstance Sat 04-Jan-14 17:51:38

Thanks for your thoughts. I know I have some very negative thought habits and I also know I usually have good coping and rationalising habits, too. At the moment the negative patterns are running rampant.

So hoping the ads might help redress that - although cunning I have to cosleep due to all the wakings, so not sure where that leaves me....

working9while5 Sat 04-Jan-14 18:13:17

Oh I coslept all the time with ds2. If anything it made me less anxious.

The issue with an episode of depression is that once that propensity is there as part of your behavioural repertoire so to speak then the next time there's a trigger for it that negative thinking style will come back. So in between you may well be your coping, rationalizing self but just having had a depression makes it more likely that when stressed in the future those thoughts will come back. It's basically like the doorway has been opened. The ADs can certainly dial it down in the acute phase but unfortunately they can't bolt the door for the future if you come off them (and for a proportion of people they stop working after 1-2 years).

I can see this doorway analogy well right now as pregnant again. I'm not at all depressed and all my anxieties are just pretty normal pregnant lady ones. Yet when I can't sleep or have that heavy third trimester tiredness it does feel quite triggering in a different way to before.. there's a memory of the depression and it can bring up those moods and thoughts, though I recognise it from the work I've done pretty easily.

The key for a proper recovery and relapse prevention seems to be to learn to recognise and 'decentre' the thoughts when they reoccur and to expect, accept and allow that inevitably at some point they will reoccurring because they're part of your learning history. Learning to not follow or buy in to the thoughts as well as good stress management and self-care is sort of where you want to aim for. Of course when you're acutely distressed you just want it to stop and some of this sounds almost academic. I'm grateful for having learned it though, it has been a game-changer for me.

AtrociousCircumstance Sat 04-Jan-14 18:39:57

Ah so you coslept whilst on sertraline working? The drug didn't impact on it in any way?

AtrociousCircumstance Sat 04-Jan-14 19:07:08

I'm concerned about being in a stupor and less sensitive to DS2's position etc!

working9while5 Sat 04-Jan-14 20:15:22

It made me sleep less initially which was quite useful first few weeks! By time it regulated I certainly didn't feel sleepy. I never coslept with ds1 before 4 months as I was paranoid about sids/overlaying... a lot of that anxiety was tuned out by the ad's so I just didn't worry as much!

AtrociousCircumstance Sat 04-Jan-14 21:10:31

Thanks working.

Having read your very in depth posts I have to say I agree with you concerning the notion of ads dealing with symptoms not cause, and the need to equip myself with new and more effective ways to combat my propensity to think negatively - which I know I have.

I recognise that I have a tendency to get very low (pre PND, just in 'normal' life) but the ability to drag myself back from that low state pretty effectively. It's a bit of a see-saw. So I do think I need to look at avoiding falling into the initial trap of negative thinking, even if my bounce back-ability is usually strong (certainly very weak at the moment).

How has your pregnancy been?

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