Getting the timing right (long, sorry)

[Gentleness]

I'm an old hand with depression, handled with alternative therapies mostly and PND which I've used Citalopram for, twice. I can tell I'm on the way down and feel torn about how to handle going back on Citalopram and the impending birth of dc3. I'm looking for some experienced guidance or anecdotes that might help me decide. I have a very supportive dr, husband and friends and no qualms about acknowledging I'm dipping back into depression. But in the end, it's my decision about how to proceed now and you know how hard it is to make decisions when the symptoms start to kick in.

I'm fine on citalopram as long as I go on and off carefully. I was on it for 8mo from ds1 being about 5mo old. Then got pregnant at the same time as coming off. I went on again for 7-8mo when ds2 was about 6wks old and have been off for maybe 10mo. We are really happy that baby 3 is coming, but kind of shocked it happened so fast this time. I expected an age gap of over 2 yrs, but it is 19.5 months again. And it's been a harder pregnancy, with more vicious exhaustion and a bout of sciatica as well as spd. I feel quite old for the first time ever.

I've been managing just on the edge for a couple of months at least now. I talked to the dr, and made sure the midwives knew and so on. But these glum nights and darkness are starting to tip me into feeling like I need to take action. So my options are:

1. start back on citalopram now, low dose that might be all I need. I need to start low to avoid headaches. I've another 7-9 wks before the baby arrives (tend to go late) so the pros are that I'll be most likely settled by the birth, and it will take a lot of pressure off me, dh and the kids. So we'd get a nicer run up to becoming a family of 5. But I'm unsure about being on it for the birth. It could feel too much like a plateau and I'd rather baby didn't get introduced to the world with a drugged up mum. I accept I need citalopram sometimes, but I don't like the even-ness of life on it.
   
   
2. really concentrate on using the SAD lamp, meditation, time alone and other strategies that help me through usually. They've worked so far though I'm still get really low energy/mood days and don't feel that's fair on the kids. Plus, in real life I am a fairly busy SAHM, with a lot to get done before baby arrives and dh is low himself. So though he wants to be (and is) supportive, he's not the most practical of blokes and it is still down to me to "manage" what needs to be done. I'm not getting through it all with these down days pausing progress so often and I'm getting so frustrated. But postponing citalopram for another 2-3 months would mean having a proper start, connecting with baby, without feeling at all medicated. And after baby arrives, I can hopefully start getting in more exercise which really helps.
   
   I can't think of any other options and in writing this it sounds so selfish to me that in my heart I really want to go for option 2 when option 1 is clearly better for the family unit. I do have to do something.
   
   If you have bravely waded through all that, any advice? I promise that even if I seem to argue back, I will be taking it on board.

[Gentleness]

bump

[Crawling]

Right i have walked this path with anti ds and anti pyschs i would say it depends on two things one will you be breastfeeding as i am sure you are aware early intervention means lower doses which overall would mean baby gets less.

2 How much guilt are you going to put yourself through if you take them. Personally i waited as long as possible but if i were to do over i wouldn't wait as i feel i missed out something irreplaceable by being ill for dc3s first year when really there is a very insignificant risk of medications harming her HTH.

[jetstar]

Didn't want to read and not reply. I have PND and take sertraline. I don't really have much experience but if you really want to do option 2 could you try for it and then have option 1 as your backup plan if it doesn't work out? It's a really hard situation to be in and you can only really make the best decision you can here and now and then change it if you need to. Lots of sympathy and good luck to you :)

[Gentleness]

Thanks to you both.

Crawling - I hadn't thought on about maybe being able to maintain a lower dose throughout and therefore baby getting less through breastmilk. I'm intending to bf again so that is significant...

I think I won't feel guilty about taking them, just disappointed if it evens out the whole birth experience too much. I did hypno-birthing with ds2 and the experience was amazing - I don't want to feel afterwards like that immense explosion of emotions when you first see them was somehow dimmed. It was such intense bonding and I would easily feel like I'd denied dc3 that, like they'll know! Hmm - yeah so maybe I would feel guilty in a very odd kind of way. But my more serious guilt mainly comes from feeling my sons are getting a rough ride when I lose patience and shout or haven't the drive to do something fun with them.

Jetstar - I think that's my inclination, but having not been proactive about managing option 2 I'm kind of losing faith in my ability to keep it up... Dh is going to help me get the SAD lamp set up by the bed now so maybe that's a start.

[Crawling]

Can I ask what do you mean by you don't want to feel evened ? Because I have never felt funny on anti ds. So maybe you should try a different anti d.

[Gentleness]

I'm not sure really and probably making too much of an irrelevance. After I've been on citalopram for a while (talking maybe 3mo), I become aware that although I'm much calmer and recovered my equilibrium, I've not got that fire in me that makes me who I feel I am. Or at least it isn't as intense. Given that it is one of the reasons I get depression in the first place, I can see the value of dampening it down for a while. I just miss it on the few occasions when I notice it's gone. I'm making far too much of that on reflection aren't I?

[Crawling]

No i don't think you are but honestly anti ds should not make you feel numb like you have lost your spark i think you should try a different anti d maybe seroxat ?

[LittlePoot]

I think I know what you mean about feeling a bit dulled somehow. I had the same on Citalopram. I've only taken it once, for PND after my son was born, and i've never tried any other ads. But although I felt fine on it, it does slightly take the edge off-I think that's what you mean. But I think its only the edge you loose, if you see what I mean. Do you really think its likely to take so much away that you wouldn't still feel something amazing at the birth? I can't really comment. I sadly didn't get that bonding at birth and it took me a couple of months to get there. Personally, I would go for a slight dulling over the intense nightmare of PND I had, but it is definitely a personal thing so I don't want to tell you to do one or the other. What I would say though is that parenting is a marathon not a sprint, so if the instant of birth isn't what you expect, you know you've got all the time in the world to celebrate your new edition. So maybe weigh that against how much you think your behaviour without ads might affect dcs and the new arrival, if that's your main worry with option 2. Either way, I think you're very wise to your situation and I hope I can learn from that if I have a second pregnancy. xx

[emblosion]

I had very bad pnd after my ds was born and am on sertraline. Have just found out I'm pre gnant again (DS not quite 6 months old - eek) and have made the decision to stay on the meds because for me, the though of being in the state I was in is way worse than the small risks of being on anti-d's while pregnant.

As others have said, have you thought of trying another type of anti-depressant? I don't think that 'evened out'/dulled feeling is inevitable - I don't have it.

Good luck with everything!