Therapist won’t work with me anymore unless I take drugs

[TinaTeaspoon54321]

I am 5 months pregnant so this feels particularly unfair. I know people can and do take SSRIs in pregnancy and that it’s a risk/benefit analysis. Yet I personally would prefer not to and feel confident that I can get by without. Surely that should be my decision and being able to receive support from the person I’ve already established a rapport with shouldn’t depend on this?

It's very bold of you to attempt to backtrack, when your original comment is still up. I can see straight through it. You've changed from "it's likely" to "I was making suggestions". The OP didn't ask for your opinion on whether their perception of reality was wrong.

Firstly, physical health meds are often reduced if possible in pregnancy, including pain medications. Secondly, there is little research on long term effects on children who have been on psychiatric medications growing up and thirdly, many carry the risk of neonatal abstinence syndrome which can look scary and, despite being treatable, is unpleasant for the baby and can require a NICU stay. It’s really not that simple. My first pregnancy I was too unwell to consider not being on meds, my second I managed to avoid it. However, it’s not a black and white issue. There’s a lot to consider and psychiatric medications are complex. Not everyone responds in the same way, the OP could take it and find that she feels worse or no different and yet the baby has problems which complicates her own symptoms further after she’s gone through labour and is in early parenthood. It’s not like antibiotic.

There’s mention of coming off meds before a pregnancy here, or not starting meds during a pregnancy because it’s not ideal to take anything that can be avoided, but it’s more nuanced than that.

I had pre and postnatal depression with my firstborn and had little to no support. It took months for HV to pick up and for me to then be referred for the care I needed. Going into this pregnancy, I chose to try anti-anxiety meds well in advance. This was backed up by the fact SSRIs are considered safe and have been taken by pregnant women since the 80s. So it’s not black and white.

I was very much anti meds in the past but they’ve supported me this time around, and therefore my family. I say this as someone who is also on aspirin, clexane and had to take steroids and others meds to support this pregnancy. So the decision to have more medication wasn’t taken lightly.

I’d just hate for anyone to read this and think taking meds is wrong or unhealthy because, for some, the pros far outweigh the cons.

I hear you. I wouldn’t want anyone else reading this to think that either. I believe there is certainly a place for meds. I‘m not convinced they are right for me at present though. I am disappointed that my therapist is insisting on them as I’d honestly been feeling like we were making good progress without them.

She's not a good match for you. Find another therapist who will work with you as you want them to. Coercing someone into taking medicine, whether they are pregnant or not, is unacceptable under almost any circumstances (perhaps with the exception of when someone is sectioned). She sin't even qualified to prescribe them, so she certainly isn't in a position to be so insistent. But you can't change who she is, so change who you see.

I think these are very valid points. I’m aware too that SSRIs are not a silver bulllet. They take two weeks to kick in and it often takes a while to find quite the right one at the right dose. By the time I’d done that, my pregnancy would be almost over anyway and my fears about premature delivery would be much less of a concern.

But we’re talking about ssris here and at a very low starting dose. If she can’t function enough for therapy it’s not great!

@MagpieSong I think you’re thinking of different types of antidepressants. There is a wide range.

No attempt to backtrack, I'm owning it!
If the therapist doesn't want to work with her that's her perogative. She's said that she would like to refer her to someone for medication (probably). OP has point blank refused to consider this treatment option.
The debate isn't whether or not she has to, she should, or it would be better if she did. The point is the therapist does not wish to continue to work with her. ...and that's fine.

Agreed. And the therapist is the one who knows the story, not the posters on this thread.

I’m a therapist (and hopefully no more batshit than average 😆). I’d never tell someone to take - or not to take - any medication. All I’d advise is that the client consults a registered medical professional before making any drastic change to medication prescribed for them.

Aye but antibiotics are treating a biological change inside the body. What does this medication do to the body? Nothing as depression isn't biological.

The therapist is out of order.

You need to find someone else.

Even meditation and breathing exercises might work better than a therapeutic relationship that is only adding to your stress.

Im a therapist and don’t favor medication in my therapies—but I do work with people who also have a psychiatrist and who are medicated for a variety of reasons. If I don’t feel that a patient is safe because of over medication or undermedication that is something the three of is should discuss and come to an agreement about. It is a natural feature of some therapies. I think there is some confusion about this for some commenters here. Talk therapy is not sufficient for all patients: bipolar, schizophrenic, highly suicidal or self harming patients may need more than one session a week, more than outpatient therapy, or more than just talk therapy. Not every therapist has the training or the support staff to support every patient and manage the patient’s risk appropriately.

I would never demand a patient take or not take medication or be hospitalized but I do reserve the right to decide what risks I will take as a therapist with some patients. I don’t see patients in private practice that i would have seen in my agency days Because the wrap around support for the patient and the close monitoring of their pharma needs cant be done by me in solo practice.
OP disagrees with her therapist’s formulation of the case which requires (in the therapists professional opinion) some pharmacological support. If patient and therapist don’t agree the fit is not a good one. Maybe the therapist is over reliant on medication, or maybe they see some risk the OP doesn’t in the unmedicated therapy. Whatever: its not a good fit and the OP needs to find another therapist.

This

I'm a mental health nurse and I totally understand your concerns. They are likely to be safe, but any clinical trials have been incidental eg women already on them, fall pregnant accidentally and maybe don't realise until the pregnancy is advanced. No drug company will dare do full clinical trials on pregnant women.

You can't compare a painkiller or a course of antibiotics, which are taken short term. Antidepressants are taken for the whole of the pregnancy.

Of course there will be times when the mothers mental health is so fragile the benefits of remaining on the medication outweigh the possible risk to the unborn baby, but in your shoes I think you are right to look at alternative ways to manage your low mood.

I would ghost the therapist - wouldn’t bother explaining - therapists who give ultimatums aren’t worth your time or energy.

you could post on here every time you feel worried instead.

You're right in that no specific clinical trials have been carried out. But cohort trials have been completed, and they do show a small increase in birth defects when other variables are accounted for. If we don't inform women of these risks, they cannot give consent.

I took sertraline in pregnancy FYI, so I'm not anti medication by any means. But when you look at the efficacy of SSRIs for mild/moderate disease and the risk, it's no wonder many women choose to decline.

I don’t disagree but therapy takes time. It’s changing the way you think and breaking through (often) long held beliefs, as well as potentially addressing lifestyle changes. It may well be the OP can and will get through with just therapy, but hasn’t had the time to get to that point yet. It’s obviously dependent on the SSRI, but there’s plenty to consider and valid reasons to not take medication (as well as very valid reasons to take medication, which can obviously be helpful) depending on how that specific person feels after weighing up pros and cons. An antibiotic is a relatively straightforward medication that acts on specific pathogens. An SSRI is complex and may or may not be helpful depending on several things, including the reasons behind Depression and/or Anxiety, the specific make-up of that person and their hormonal response and any other conditions the person has. A psychologist can ask the patient to see someone who is qualified to look at these things, but an SSRI isn’t matched to the situation in the same way an antibiotic is and cannot be relied upon to work in the same way.

Although a therapist can refuse to work with someone, several therapists on here have mentioned they would not insist someone takes medication because it isn’t in their expertise (that’s a psychiatrist or, in some cases, a GP).