Ads and pregnancy

[GracieLoo]

I'm prescribed duloxetine by a psychiatrist as I'm under a cmht. But due to the cmht being crap recently, I had to see a GP to ask whether I can carry on taking them safely as I've found out I'm pregnant. I'm on 120mg. The GP looked in a book and basically said all ad's are the same during pregnancy, and to half the dose.

This isn't right is it? I thought there were safer ads to take. She said there are no studies done to show what effects there could be. But surely there are cases of babies born with defects due to the mum being on meds. Been trying to get hold of cmht to double check this but haven't got hold of them yet.

I've halfed the dose but feeling the change this wkend. My sleep is awful, my skin feels like it's crawling with bugs and the itchiness is driving me crazy, and I feel more tearful and irritable. Doesn't help this wasn't planned and I'm feeling confused by the whole thing.

im on sertraline and that is safe during pg. Have you googled? I dont often recommend that but your GP sounds like they have been shit. could you call nhs direct?

Re the pregnancy the fact that you are already thinking of thr babys needs shows that you are doing great, how far are you?

Know nothing about duloxetine - as it is a newer ad then there is less evidence and testing about it. Ones that have more advice on are sertraline and citalopram. Ask your care co-ordination to book you an appointment with the CMHT's psychiatrist. They are the specialists and can give you correct advice. They need to assess the risk to you of not being on a relevant dose and the risk to the baby of you taking certain medications. They may change your ad's.

If you are under a CMHT you have access to specialist advice even if you have to wait.

I've looked it up and it says not to take it, unless the benefits outweigh the risks. It also says not to be taken if breastfeeding, so that sounds as though there could be risks.

Well with breastfeeding that is not an issue yet so plenty of time to get expert advice on that. I think the risks at breastfeeding are different to pregnancy due to how it is passed to the baby (forget the science bits!!)

Have you had your booking in apt with the midwife yet (here it is around 8weeks pregnant). If not, why not ask her to contact the local mental health midwife that will be part of her team. She can then liase with your cmht if your team not responding to you about medication. Or refer you to an appointment with a peri-natal mental health psychiatrist if that is how they work there (here no referral to peri-natal until after birth and in fact no referral to peri-natal if already under a cmht but their usual psychiatrist can seek advice from a peri-natal mental dr).

It is one of the newer ad's around so I personally would imagine they say that due to lack of evidence and data. Only a psychiatrist would know whether it is safer for you to stay on it or whether switching to another (and known to be safer) AD would still help you. Much would depend on your diagnosis, what medications you have had in the past if any and what is known to treat your condition. Only your cmht can really advise on that.

Why not phone your cmht team on Monday and ask the duty worker for advice on what to do if you do not have an appointment coming up. They could talk to a psychiatrist or book you a medication review with a psychiatrist.

Sorry this pregnancy is a shock to you. Have you had an opportunity to discuss this with your gp or midwife and the options available to you? For continuing/not/for support for medication when pregnant and extra support you may need? Do you have a cpn? If so can you book an appointment for next week to share your news of pregnancy if not already and ask for support regarding medication.

Some areas have support groups for pregnant mums with mh issues - may be worth asking your midwife to be asked to be referred to such a group, as maybe more knowledge gained there?

Had a call today to say they are waiting to hear from a pharmacy, but as you say it's a new drug so they don't know much about it.

Just had a horrible meeting with my cc. Was basically told to have an abortion, that it wasn't fair on the dc. They could be taken away from me, and she had concerns about me coping. I feel worse than ever now, she didn't suggest anything that was supportive at all, I told her I wasn't sleeping, she didn't suggest any alternative meds or additional support. I didn't cry in the appt, but drove home sobbing.

Sorry just want to add. I get the impression they think it's all my fault, that I want to be like this. That I chose to have depression, and sh, get suicidal, cry lots and find it hard to think rationally and make decisions. I don't want their involvement anymore if they aren't treating me as though I have a mental illness, just blaming me and not even being there in a crisis. They've messed up a lot recently.

I would keep showing them your cheerful side.

Thanks that's helpful

Did they advise about medication? If not go back to the gp

Sorry they were not supportive. You can choose to not see a cc I think. As long as not under a section.
Their job ultimately is risk assessment. Or rather it seems to be!! When someone under a CMHT is pregnant I guess they change their focus. Perhaps they could offer you a support worker to help you cope when the baby is born?

I spoke to a GP because I was in a state. She was so much nicer and she made an appt for Friday. I don't expect anything from the cmht anymore, they weren't supportive in a crisis, and they won't be if I carry on with something they disagree with. Still no advice about the ad's.

What support do you have from the CMHT? If the gp supportive they can liaise with the psychiatrist re: medication for you? My psychiatrist when pregnant had to contact a specialist pharmacy service to check medication and it did take a few weeks to get an answer so maybe gp can do the phoning for you?

Why not tell the gp about what the cc told you this week regarding the pregnancy and the lack of support you have from the CMHT - they may have other resources they can offer you through the gp?

I hope you get some answers soon, GracieLoo

I know I've been stupid, everyone's going to be angry and disappointed in me. I want to be happy about this, I hope it all works out like everyone does when they're expecting. But this wasn't planned, I've got lots to think about and the last thing I needed to hear was it'll be selfish to carry on with the pregnancy and to risk both dc being taken off of me.

I know I've struggled in the past few years, meds and therapy haven't helped a lot. But I love dd loads, and I didn't want to get as low as I have done, or tried to end it. But I want to try to turn things arounds, with support. And if my mh does take a turn for the worse, I want to feel I can be honest and ask for help. Not be terrified of ss, and be made to feel I've made the wrong choices and it's all my fault.

I am scared, but dd is happy and everyone says I'm a good mum, so I can do it again. Not saying it's going to be easy. I'm hoping I can discharge from cmht, I'm not sure it's a good idea as it's a tough time, but maybe the GP and midwife will be more supportive in this situation. Crying again though, I don't know what to do.

Also I don't want this shitty bpd to rule and dictate my life. It's not going to disappear so I need to try to push it away.

Have they offered you DBT Gracie?

Hi Gracie. Am not too sure how often a midwife sees someone with a healthy second pregnancy but they do not see them as often as a CMHT can - would that be enough support? My midwife was not brilliant - saw her at 8 weeks, 16 weeks, 24 weeks and forget after that. Nor was she equipped to deal with MH issues, just a ten minute check of baby, take blood and give out more bits of paper for me to read.

A gp can be supportive and I hope you can be really honest on Friday and tell them your worries, fears and concerns and sort out medication for the coming weeks. Ore medication that some people have for prn is not usually seen as safe in pregnancy, such as diazepam and sleeping tablets so be worth talking about any Prn medication you have. Also if you feel suicidal and take od's that can also affect the pregnancy so maybe work out a plan witht he gp about what to do if you take an od when pregnant - ie when to go to hospital etc and what to tell them etc. being prepared may take away some of your worries.

You say you want to ask for help and get it. Can you tell your gp this and what help you are expecting to get so that you know what you have got when you get it and they know what to give you.

Sorry meant to say you told your cc you were not sleeping and you say she did boy offer additional meds or more support with this. I think that may because no sleeping medication is safe in pregnancy and definitely not something a cc can prescribe. If you already have a cc then there is little extra support they can provide apart from refer to therapy groups, to therapeutic communities ( where you live for 6 months). Or use crisis team. The only other support generally available is a support worker to help people with day to day activities of they are unable or unsafe to do isctivities alone. If this is the support you want do ask for referral for a support worker. They are not nurses but assistants who can come for a few hours to help you get out to appointments, do shopping, attend important meetings etc.

I was trying to think what else they offer patients with bps where I am based and those are the options: group therapy; be part of a therapeutic community up to 6 months; day hospital; crisis team when in crisis and support workers.

If I did get so low as to od again, or had thoughts to, I think I'd be too scared to tell anyone. I'm too worried to say anything at all now, I know it's all about the risks to the baby and I should be honest, but that terrifies me atm.

I have never been offered prn, and I know I can't take sleeping tablets but I wanted to discuss the sleep as it's panicking me. I'm already dreading going to bed and not sleeping. She changed the subject.

I don't think I'd even be able to ask for day hospital or crisis team anymore, I feel the focus has changed, and if I did, it would be instant ss referral.

Apparently dbt isn't available in this area, and I've tried googling peri-natal care, maybe specialist mh midwives, or even a support group, but there seems to be nothing.

I think deep down I know I should have a termination, but I'm already thinking if this as a baby, and picturing myself getting bigger, and dd being a sister. I've got myself into a bigger mess than I was, I don't think I've been well or thinking rationally for a long time, so I know it's my fault and my problem. It doesn't stop me having feelings and being terrified.

GracieLoo I have followed your previous threads and saw what you have been through.
unfortunately it looks like you couldn't get the support you needed long time and I don't think you will find it n the future.
but you gained lots of experience and maybe along the way you learnt how to handle yourself in difficulty, but don't seem to be there yet.
and along the way you found it hard to look after your dd.
If you have 2 dc how will you handle it, you are not well yet.
and till you give birth or after they may be telling you your baby can be taken to care, are you strong enough to handle this?
also how will you handle pregnancy without ads, I'm expecting it will be really hard.
why don't you wait a bit more till you feel a happy, strong person then have baby if you want again?
and the baby and your dd can have a stable life away from fears of going to care and etc.
best wishes.

Since halving my dose and missing a couple I can feel my mood dipping. But I've a lot to deal with so that's to be expected. If I feel worse I will ask for an alternative, we'll known ad. Re the pregnancy, I'm feeling positive, I think I'll cope. I want it to work out and be ok.

It's really hard having so many different opinions and advice thrown at me, here and in rl, but I did come here looking for advice. Think I need to take a step back a bit and think for myself, and make my own decisions. There are many more expectant mums out there who will be far worse mums than me, yes I'm ill but with support and meds I'm hoping it will be ok. It's hard fighting mental illness at the best of times, I know, but I've got more support and awareness now.