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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.

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


manchestermummy Sat 07-Sep-13 15:57:41

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.

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