18 weeks pregnant with poor mental health. Should i start citalopram?

[Deborah543]

Hello,
A bit of background. I'm 26 and I've been with my OH for 10 years. We've been married for one. Beggining of our relationship was not great, but it got better. In June 2016, after living together for 2 years my OH went to hospital for acute psychosis and I was off work for mental health problems for a few months. In the meantime I stayed at my parents, built a better relationship with my family, especially my mum.

HERE I GO OFF ON A TANGENT.
I was very supported going back to work (NHS) however, since then I have become very disheartened at work as I was about to go for a promotion and was doing a canulation course and all that was stopped or delayed. Lots of colleagues with less experience have got promoted. I went to one interview and didn't get it(someone with more experience got it) The most recent vacancy, advertised when I was pregnant I didn't even apply to as I felt I had enough going on. There was only one applicant, a colleague who started when I was off in 2016 and she got it. Lots of people have been doing the canulation course but I've stopped being proactive at work about it.

BACK ON TRACK
I feel guilty that I'm not working to provide a good future for my baby. In January 2017 I came off all medication, felt great and came off contraception as a if it happens I get pregnant thats a good thing as I'm not really going anywhere at work. My husband earns less than me as a school assistant and we agreed to try for a baby in October. Now I feel like this was irrisposible and feel incredibly guilty about bringing a life into an instable family.

When I first fell pregnant I immediately went off work with stress and went to the GP and went on setraline dispite being originally against meds. It was really bad, gave me insomnia, made my thoughts run and at the end I started speaking in a different voice to my husband (before the test) I went to the GP asking for some sort of sedation for the insomnia but we agreed a break from the medication then to try the half dose before giving up. At 4am I decided to take the half (logic being I'll be strong at get through the tough 2 weeks before it gets better) instead of taking a break. Early hours is never good decision making time! A few days in I got my positive (before my head got really weird). I know my family would have taken in to hospital when I started behaving so weirdly but my husband just went on work mode (he works in a special needs school). Anyway he left briefly to walk the dog and I stuck a leftover olanzipane we had in the cupboard which is a sedative and I slept for 12 hours and it was all uphill (sort of) from then. Taking the olanzipane was not my choice, it was the strange voice but it was the right choice as I needed it. I've not been on any medication since.

I told my family a few days after the test as they had been supporting us and I thought they had a right to know early that hormones was one of the triggers. The thing about my family though is that they are excellent at crisis management but my general low mode and communication in the months following has not felt the most reassuring. And I sound selfish.

At the same time as the setraline I self referred to healthy minds and was diagnosed with high levels of GAD and moderate depression (I think I didn't take note as I don't find labels very helpful.) I signed up to silver cloud online cbt and did some of that while I had my insomnia but found it a little inpersonal and patronising so gave up. My mum said she was disappointed I'd given up on the cbt but it's my choice. This evening I've been tearful and writing that makes me cry. Me and my mum don't cry in front of each other.

Also occupational health referred me for counciling and face to face cbt. I've not heard back about the cbt and like everything at the moment I'm not proactive. I have had a few weeks counciling but I struggle to really talk. I'm finding writing this much easier. I might actually print off what I've written here and take it in when I see a professional. She did last session give me a technique for stopping negative thoughts. To repeat a mantra of 2-3 things like 'I am positive. I am strong.' even if I don't believe it. I did that I bit tonight, wrote a few positives in my diary (caring, compassionate, organised). Organised is a big one as I've always defined myself as disorganised (I'm dyslexic and was teased as a child for losing and forgetting things). Since being pregnant I've put little effort into origanistion (or anything) but know as I mum it's important to be organised and more in control.

I've also seen my midwife twice and physically everything is well and she referred me for mental health support. I've seen a consultant and a specialist mental health midwife who gave me a bit of a reality check by saying 'is this the right choice for you now' and putting the option of abortion at the front of my mind. I had an abortion once before, not traumatic, but this is different as it is planned and last time I was at uni. When I told my husband he was angry that she would try to pursuade a vulnerable woman to have an abortion but it wasn't like that. She also encouraged me to research citalopram and that me being strong is the most important thing for starting a family. Due to my previous medication experience and the fact the baby could get withdrawal I decided against it. My husband is 100% anti. He thinks I should work on a good diet, excesize and hobbies but really I'm struggling for motivation.

I'm sure I'll get negative comments as I think my getting pregnant I'm being selfish, irrisposible and I'm very immature and I feel not ready to have a baby. This evening I was thinking about how my core values of caring are no longer there as the emotional burden of keeping our reptiles and a dog as well as bringing a baby into this world is too much. I already feel like I don't give the animals the best but my OH won't sell them as he feels like they are his responsibility.

[Deborah543]

One last thing, I've been referred to the adult mental health team but I keep pushing back the appointment (work) then last week I got the time wrong and turned up at 11:20 for a 9:30 appointment. Feel so guilty as working for NHS I know how annoying DNAs are and mental health is stretched. Anyway, got a week off then an appointment next week so I'll have time to write some things down. There are so many agencies I'm under, does my head in but gives me empathy for my patients:
GP
Midwife
Antinatal team
Adult mental health
Healthy minds.
And healthy minds referred me to two other charities including pandas for antenatal and post natal depression.

Just gonna move on from my missed appointment and keep repeating 'I am organised. I am in control'

[Afternoon]

Could you ask your GP to suggest another medication? There are various others you could try, it definitely isn't just Sertraline or nothing.

Did you tell your GP about the "strange voice" and feeling it made you take olanzepine? It could be relevant to which medication will suit you best. The GP may refer you to a psychiatrist for clarification of your condition and the best way forward.

I would also chase up the occupational health CBT. Was this via the NHS, and if not, can the GP put you on the list for NHS therapy too?

Things can get better, so don't give up! Are you eating well, getting fresh air and exercise, sleeping enough? How about downloading some relaxation or mindfulness to listen to? These things are unlikely to solve all your problems but may take the edge off a little.

You might find these links useful:

Anxiety UK
www.anxietyuk.org.uk
They can offer reduced price therapy and have a community online message board.

MIND
www.mind.org.uk/

Moodzone
www.nhs.uk/conditions/stress-anxiety-depression/

Anxiety in Pregnancy (Babycentre)
www.babycentre.co.uk/a25016207/anxiety-in-pregnancy

[Afternoon]

Also do not let other people knock your confidence. You are 26, in a long term relationship and this is a wanted pregnancy. You also happen to need some additional support at the moment due to mental health difficulties which are not your fault. Keep on finding as much help as you can, as you and your baby deserve to be happy and healthy.

[Deborah543]

Thank you afternoon,very helpful. In October I saw gp A. He prescribed and monitored setraline but after the voice I couldn't get an appointment with him so saw gp b and talked about being pregnant. I didn't tell her about the voice just that the effects were bad. She referred me to midwife and recommended no medication. I was keen to come off. I told my key midwife in my booking appointment that I took setraline then one olanzipane so it's in my maternity notes. She referred me to bucks mental health antenatal team and they prescribed citralapram which I've not collected or taken yet. That is what I'm concidering. I've also been referred to Oxford mental health team and I'm seeing a consultant next Tuesday. So I've got lots of support but all these different agencies and professionals (5 listed) are doing my head in.

My husband is keen that I eat and excesize well but I've had too much sugar recently and less excesize. I'm sleeping well. He is completely against medication as he thinks I'm hoping for a quick fix and doesn't want anything that could potentially harm the baby. Currently visiting my parents in the Peak District and its lovely and sunny so going to head out soon.

[Afternoon]

Medication is definitely not a "quick fix" so it's a shame your DH currently sees it that way. If someone needs medication to control some other condition such as diabetes or low thyroid would your DH say that was a "quick fix"? Even if therapy helps in the long run, many people still need medication during that time, and others need it for the long term or a lifetime. Would your DH come to an appointment with you at some stage so he can ask questions about how he can best support you?

Is the Citalopram ready to collect? I'd say give it a try as it can work on both depression and anxiety, although it takes a few weeks to achieve the full effect. (Obviously I'm just a random stranger on the internet though!!)

I hope your appointment with the consultant goes well. There should be a lot more time to talk than with a brief GP visit or midwife check. Have you sussed our a plan for that day? Hopefully once you're settled into a suitable treatment you won't need to see quite so many different people!

The Peak District is fab, hope you enjoy the sunshine

[NameChangeCuddleBums]

All the best for your future and your beautiful new baby. I have no advice but I can sympathise being pregnant and working in the NHS is hard enough without any other concerns.

[Deborah543]

I do have anxiety around taking medication and am not keen on psychoactive drugs but am not stubborn and open to options, which is why I took setraline but couldn't tolerate that. I've told people I don't want to take medication and my husband says he is supporting this decision. But I'm allowed to change my mind. I'm indecisive and my Councillor has talked about 'gut choice' ignoring other people's opinions and my gut is uncomfortable with ruling out medication.

[Katyx3]

Probably not what you want to hear, but citalopram can be very harmful to baby
As soon as I fell pregnant they took it straight off me
I have borderline personality and now have weekly therapist appointments
They have given me 50mg sertraline but I'm trying to not take it, and think of the positives eg baby
I have taken 200mg sertraline a few years ago, and I find once in my system it becomes the norm and not effective.
Wishing you well hugs x

[Deborah543]

Nice to hear of someone in a similar situation @katyx3. I researched citalopram and it's mostly harmful in the first trimester and I was prescribed it in the second. However the newborn can get withdrawal symptoms. I don't want to take it really, esspesally after talking to people. My first thought was no, but then when I posted this I was doubting and thinking I should follow medical advice.

I'm worrying about my appointment next week which is an assessment with a psychiatrist to see how best to support me. I'm worried I'll have to justify why I don't want meds and I just need to convey that I'm, not perfectly fine but also managing and in control, unlike when I trialled setraline. I should be grateful I've been offered so much support but... I'm easily overwhelmed right now.

After talking to friends and family I know I'm overthinking things and meditation treats the symptoms but councilling and lifestyle changes are better.

Just been feeling quite tearful today. Yesterday I wrote a positive letter to my baby and that I found helpful.

Just feel like my relationship with my husband is not strong enough for a baby and I brought up a recurring argument we've had about our reptiles (I want to sell them). Just got to the point where communication is just perceived as me whining and I know I am 'playing the victim' and there is lots more I could be doing to help us/myself including housework.

[Deborah543]

Also kaytx3, congratulations. When is your baby due?

[Katyx3]

You've got this girl
Try not to worry, although I know it's not easy
You're going to have massive positive to focus on soon and I know you can do it
All the appointments etc are scary but worth it and they are there to help you
Thank you you too!
Baby due 8th July hoping to find out sex a week today!
What about you? X

[Katyx3]

Ps men don't like change! Why do you want to get rid of your scaley friends? We have a dog who is like my baby, and our brother in law said we should consider re homing her. Not at all an option for me, feels like a complete cop out, for me it's like already having a child, getting pregnant and getting rid of the first born!
No one knows what to expect there's no instructions but everyone copes!
When I worry that I can't I remind myself smack heads on Jeremy Kyle manage to have babies and keep them alive! X

[Deborah543]

How annoying, my message has gone before I posted. My baby is due the 11th July. I'm feeling positive today, set some lent resolutions to set myself small goals every day and take baby steps in planning for the baby. I also drew out a mindmap and wrote some notes for my appointment. I feel less overwhelmed now I've broken things down. My priorities are to sort out finances, health and pets.

I agree with you about dogs. I have one myself and wouldn't rehomed him. The reptiles however are an emotional and financial burden as I don't think I'm looking after them as well as we could. They don't form emotional bonds like dogs so it would be for their benefit as well as mine. It's not something I'd take lightly. Bearded dragon is the one I feel worse about as she has the most character, is most difficult to care for and rehomed as they are overbred and neglected.

[Deborah543]

I'm Not sleeping well for the past few nights. I'm focusing on organising and planning and feel like I've switched from mainly depression to more anxiety. However anxiety is better right now as I need the motivation. Feeling more alive. But fixating on negatives. I felt like I needed to cry after viewing a house we didn't like. Relationship with husband feels really strained right now. I want to declutter and am trying to persuade him to sell some things but I don't feel like I'm getting anywhere and oh gets defensive. He always talks about cars and computer games which I'm really not interested in right now so just zone out. I feel like he needs to grow up. Also feel incredibly guilty for the way I've treated him during pregnancy but he just takes it and says it's the hormones. Didn't cry until after my husband fell asleep. I know going on my phone at half midnight is not good but I've been sticking to my little daily goals. We've got a long drive tommorow, husbands driving which is good with my lack of sleep. Hopefully I'll sleep on the journey. It'll be good to see the psychiatrist next Wednesday. I still want to stick to no medicine.

Thank you again for your kind comments. Just need to remember to think positive and take baby steps.