PND, therapy and medication

[captaincake]

I've had pnd since DS was about 2 months (now 9m). I actually think it's reactive depression from long term lack of sleep, long term stress and DS being very difficult and in pain and discomfort a lot. My GP was horrible and I've recently changed so don't know the new one well - have only seen her once. I've been under perinatal and they haven't been able to help. A 2 night stay in a mother and baby unit was a disaster and I came out feeling worse. My CPN was lovely but couldn't help it seemed like all she did was come round, remind me my life is shit then left again leaving me very distressed after each visit, so she doesn't visit or call anymore. I have tried sertraline and paroxetine. The paroxetine was a disaster I had an instant really bad reaction so only took the one. The sertraline gave me not very nice but bearable side effects but did nothing to lift my mood or anxiety or very sudden uncontrollable lows.

I have just found a private therapist and have an appointment in 2 weeks. I have the option of trying another mother and baby unit but I'm very concerned the same will happen as last time. I can also take venlafaxine. The venlafaxine I did take a low dose for 2 days but I started with the same side effects as the sertraline and started to feel even lower again and unable to cope alone with the suicidal plans and thinking that it would go the same way with not helping but making me feel bad so stopped that. My concerns with taking them are that and not being able to get hold of them once I'm on them. My last gp practice consistently got prescriptions wrong. I know that I'm at a new one now but I'm paranoid. DH is very supportive but is too at a loss at what we can do to help me.

I suppose this is a little bit of a WWYD? I know you can't answer for me but was wondering if anyone has been though anything similar and might have some advice?

Anyone?

Hi. I had pn depression twice. The first time was far worse because I genuinely thought I might never come out of it (I bet you fear the same ). The second time was more bearable because I deep down remembered that it does get better.

I was on anti depressants both times. I was very afraid to take medication initially and for the first 6 weeks it didn't seem to work and I felt 'odd' - distant and apart from the world, if you know what I mean. I was so ready to flush them down the loo. But I had a good doctor. He told me to hang in there and grit my teeth as my body would adjust and they would start to work. They did work amazingly in the end and my anxiety and lows began to get under control. Please be brave and stay on the drugs. You really do need them and they will help you. It's not a good idea at all to go without medication.

I understand your anxiety about not being able to get hold of the medication once you're on it. I had so many fears and anxieties. Day-in-day-out. It was relentless. So very tough. But sometimes you need to step outside of your situation. What would you say to someone else who was afraid they'd not be able to get their medication? You'd reassure them that this would not be the case and that all would be ok? (Obviously your GP sounds a bit crap so there may well be hiccups, but on the whole it'll be ok).

It's horrid for you right now. I really really empathize with you. But to encourage you, it's 9 years on for me. I got better relatively quickly (about 9 months, but we're all different and so don't put any pressure on yourself). It's 9 years on. Me and the kids are great together. I would NEVER have believed that back then. You will be ok too. Be strong. Get yourself on medication as soon as possible - it will help you.

Wishing you all the very best

I didn't want t read and run [flower]

I don't have words tonight, but I'm thinkingn of you. It takes ages for sertraline to kick in. I'd try the mother and baby unit again if you can. It might be very different to the other one. Sending hugs x

Forgot to say, they will be able to sort out your medication much sooner if you're on the unit x

I feel for you. Massive hugs.
For what it's worth, I like posters know what you are going through.
I had it too after both my daughters. Unfortunately I (no one else) recognised it for what it was so you being aware of having PND is great You can deal w this and be

Not sure what happened with my post (trying to type on phone) ....here's the rest...
and will be 'you' again.
The mother baby unit is worth a try isn't it? At worst it will not change anything, but the possibility is that it will actually help. The meds too. A friend of mine is on Sertralin and it has helped her massively. Good luck. x

Thank you so much for the replies. The mother and baby unit was a disaster and I came out significantly worse. I'm trying to draw a line under it and move on but I still feel guilty I put DS through it and my problem is what I need is what a unit should be but that's not what it is and not being able to find a solution is reminding me of what happened there. I can't go back to the unit I went to, the next available one is quite a drive and doesn't even have any therapy available so I just can't see how they would be able to help? I might have missed something? I want to go because I could be in a safe place to get on meds fast but on the other hand I could very easily get very worse being dumped in a room to look after DS on my own again without DH's help like last time.

I was on sertraline for a few months and just got worse in that time. Although that had a lot to do with the unit. I took it consistently but all it did was give me side effects, but from an anti depressant perspective it was like taking a sugar pill.

My worry is if I don't get some help this will never get better but if I do try to get help it will make me worse and I won't be able to control my suicidal desire. I've heard good and bad things about venlafaxine and from the 2 tablets I took I definitely had not very nice effects again. I know I'm being paranoid about not being able to get hold of them from what happened with the last gp - the new one's seem fine but I really really think they'll make me worse. Even if that is in the short term before they would help in the longer term I don't think I can get through being worse in the short term - especially as 'short' is more like a month or 2 it would seem.

Is it possible that this is something that will just get better on its own over a rather longer period of time?

Captaincake I would urge you to go and talk to someone. By the sounds of it, you mention suicidal thoughts, you really, really need help. Is your DH aware of how bad you are feeling? Is there anyone else that can come and be/stay with you for a while? Someone that can go with you, DH or other supportive person, to see the GP?

I'm sure there a lots of women that get better on their own. I am not one of them and am still not feeling great, but am dealing with it (therapy and St Johns Wort).

Yes DH is aware I tell him how I'm feeling all the time. The cpn i had till last week I said pretty much what I've said here only in more detail and she just said well we're stuck then really and said i can call back within the next month if i decide what will help me but other than that they'll close my case. She's right. We are stuck but surely there's something they can do to help? I'm even more upset I asked for help in the first place now all they've done is made me worse and dumped me

They have not dumped you. I suspect you are just feeling like that due to the PND.

So, you are scheduled to see a private therapist in 2 weeks? If you do go to the mum/baby unit how long would you be there for?

I have no idea. I'm not going to go. What is the point in rotting there even faster than at home. I'll just sit there alone with no help with the baby and no access to therapy at all. They have suggested potentially I think a fortnightly session for the next 8 weeks with a therapist, would it really be worth doing given there's no support in between and every time I used to see the nurse she'd just make me feel horrendous then leave me beside myself? Obviously with it ending so soon after beginning too? I can't see how I haven't been dumped I'm worse than I was and they've said they can't help me, won't be ringing or coming round anymore and will be discharging me.

Thanks for the advice everyone. I've decided to risk starting the tablets and ask family to be around as much as they can in case they make me worse and go with the private therapy which I've already got booked in because I can carry on with that rather than being dumped off it after 8 weeks. I'm very very concerned about not knowing what to do if it gets worse. I feel sure I'm going to have some awful lows and just don't know what to do to get through them. When I was with perinatal they did give me 12 2mg diazepam but all they did was make me a bit tired and I've used them all anyway.

Captaincake I spent 14 weeks in an m&b unit after DD2. Yes it's boring and there is limited therapy but they can keep you safe if you are having suicidal thoughts and they can increase the dose of your meds much faster so you feel better faster. I have reluctantly accepted despite hating it at the time that it probably saved my life at the time as I was having constant suicidal thoughts. Please consider giving it a longer go.

Also mine had 24 hr nursery nurses to help with the babies so you can get enough sleep which is really important for quick recovery.

Thanks Ivy unfortunately I got no sleep whatsoever when I was in the mbu and both DS and I were safer at home. I won't go into detail but there were massive failings and pals are investigating. I don't feel I can go to a new unit, where I think they would be able to keep us safe, but have my therapy taken away and replaced with nothing. This unit doesn't have access to any therapy at all they've told me. It's frustrating because if they did what they should it's exactly what I need - somewhere to safely start this medication, to get me some proper sleep, some therapy and help me with DS. But it's not that at all. It's sit in this room with DS on your own, DS bored so screaming all the time, no help with DS, no therapy, absolutely no sleep whatsoever and medication always wrong.

I started the venlafaxine yesterday morning. I was up vomiting about 10pm last night and was unable to get to sleep at all till sometime after 3am then woke up about 5:30. Now just have a headache and feel dizzy. I have taken this morning's dose against what I think is a good idea. I'm hoping these side effects wear off. Anyone used it, does it get better?

I was on venlafaxine before I got pregnant again. I didn't have any side effects and I found it very effective but it did take around 8 weeks to kick in and it was a very gradual improvement whereas I started on imipramine for this new pregnancy and it kicked in overnight at 3/4 weeks. Sorry you had a bad time in your m&b hopefully PALs will sort them out as definately doesn't sound like you got the support you should have got.

Captain, my heart goes out to you because all your messages above are filled with a greyness and a sadness....and I sense that you don't really believe that anyone can help you. You are messaging, but you aren't really present. I recognise this because this was me for so much of the past 9 months (my baby son is also 9 months, PND started at 4 months when I stopped breastfeeding).

You sound to me that you are at the stage I was last November when I tried and failed FOUR times to get onto an SSRI...Sertraline, Venlafaxine, Prozac and Escitalopram. I didn't do more than 4 days on any of them, felt sick as a dog, suicidal, and believed old me was never to return.

I wasted another 3 months believing ADs weren't for me (even though I had fantastic experience with venlafaxine before pregnancy), that I was broken, and maybe having a child was the end of my life.

I had some hormonal treatment (oestrogen gel) in January which certainly helped my mood somewhat, just enough to get my ass back to the doctor, and to say I would give some ADs another go. That was a month ago, and I am finally recovering. I happen to be taking escitalopram as my doctor prefers that, but prior to pregnancy I had insomnia that led to mild depression, and I had a wonderful experience with venlafaxine. Forget feeling better, I felt BETTER than better on venlafaxine....I was the best, happiest, most motivated and energetic version of myself and I am envious that you get to try it for the first time!

I am convinced that the tougher your starting point, the harder the start up side effects and anxiety. Your worst side effects will be gone within two weeks, and from that point I believe you will start to slowly feel better. My recovery this time around is much slower as my starting point was much worse than my pre-pregnancy version....so I accept that it is taking longer but nothing will stop me from taking my pill each day.

I will stick with this, and have suffered through the start up period because while I dreaded the process, I finally accepted that living the way I was is unthinkable. I am bloody well coming back, and if it takes me another 4, 8, or 12 weeks to find the right drug or dose, I am going to do it. The status quo is not acceptable.

If you stop your venlafaxine in the next 6 weeks, you have to start all over again. Please don't do that. However bad you think the side effects are going to be, is it so much worse than your current place?

Keep telling us how you feel each day...starting SSRIs is CACK. But it can make you better, and then your posts won't be sad anymore.

Thank you for your message La. I really appreciate everyone taking the time to write back to me. You're right I don't think anyone can help me anymore. I feel like I've tried so much and everything I try just leads me one step closer to everything having failed. I guess now I'm scared to try because if I don't there's a chance it might work but if I try then I'll know that it hasn't worked. Not sure if that makes any sense. It took a lot to try the venlafaxine. The dr said to stop taking it. I'm upset about that I was hoping (again) that I'd have some success. They said it's quite a strong one and people have great success on it so I'm really unhappy I can't have it.

I went to pick up my urgent diazepam prescription to find they hadn't sent it to the pharmacy with the others - apparently you have to collect it from the dr's separately which no one told me and I didn't go to the pharmacy till they closed. I called 111 and the doctor made me tell her the whole story and then said "right well we don't prescribe that over the phone". She knew what I wanted so why didn't she tell me that at the start Now I feel sure I can't start a new antidepressant as my anxiety that I can't get hold of medication I need has been proven. Dr was planning to give me escitalopram on Monday. I don't want to do the wasting months thinking I can't have them then end up finding one that works though. Very very luckily I thought I had used up all my previous prescription of diazepam but I double checked as I am extremely forgetful now and I had one left so I did get some sleep last night. I'll have to drink tonight. I try to avoid that as I know it's a step in a very wrong direction but I need to sleep even if it's crap alcohol sleep it's better than nothing.

Do you think the side effects (they were pretty naff) would go away? The dr said they might well do but it would take weeks of feeling that awful even if they did which i'm unlikely to cope with and they might not go a way but by the time we know that it would take ages to gradually withdraw from it and I would just feel dreadful for ages so it's not worth the risk.

So you took escitalopram and it didn't work but you tried it again after taking the gel and then it was ok? Maybe I could try the gel and then the venlafaxine again?

Captain. Am going to come back to you in much more detail later today (alone with baby until mid-pm). You are exactly where I was in November, that feeling that there are no options available to you, and dear god, is this me forever more. I promise you there are places for you to go to.

Regarding the gel....after a terrible Christmas of crippling anxiety, insomnia and lowness, I still was too scared of ADs, but started to research a bit.

See Professor John Studd's website...specifically re PND. He is a right cocky old fashioned Harley Street guy, and loaded me up with 3 pumps of estrogen gel a day, plus a small dollop of testosterone gel (yes, very sexy). Within about a week, while my anxiety and insomnia was not better, my mood and energy improved enough to make me realise that I wanted to get even better and I had the motivation to do it. I marched back into the GP office, ignored her opinion of my hormone treatment, and said I wanted to try the best SSRI she would recommend, and it MUST address my anxiety and insomnia too. She proposed escitalopram, I said fine. And yes, that was one that I totally failed to get past day 3 on back in autumn.

The first two weeks were painful, but because of the hormone treatment I was mentally stronger, got up to 10mg after a week, and pressed on. I expected it to be SO awful, it ended up being not so awful. The best thing is that I am sleeping again and slowly (slower than I want) the other issues are passing.

Captain, starting and stopping multiple drugs every few days is going to really hurt you. Please stop. I also do not think diazepam is anything but a very short term answer to sleep and panic attacks. That stuff is so addictive. You are not addressing the actual problem with that at all.

If you were advising anyone else you would tell them not to worry about access to your drugs. When you get a prescription for escitalopram on Monday ( is that your plan?) you must get a proper supply, and stop worrying about getting your hands on your drugs. That is your PND and anxiety speaking, not a rational argument.

I am going to think about what other options you could consider and come back to you later. I sense you need to feel you have options, as right now you feel very cornered.

Thinking about you today, as I would love to help you take the right step forward. Xxx

Captain, some more thoughts, and ideas for you...

I think you are saying that you won't consider starting the escitalopram without diazepam to combat the start up anxiety. Fine...personally I didn't use any benzos to get mine going, as I cannot stand the sedated, zombie, drug addict feeling that benzos give me. Instead I sat shaking with anxiety on the sofa in the morning, and then felt a bit better in the afternoon. By evening I felt more optimistic. I could just about cope with the baby at the bad times.

This start up anxiety at its worse only lasted about 4 days in the first week, and then another 4 days in the second when I upped the dose. I am not saying that is the end of the start up effects, I am just saying that you are ONLY getting as far as the worst of it, and never getting anywhere close to the benefits. I am only a month in and I am still not at maximum benefit ( which is good, because I need to get even better than I am now).

I am personally surprised your doctor said to stop the venlafaxine after what I think you said was just a few days. Did he/she say that because you weren't coping with the side effects? Because whatever you take, the first week will be hideous (but your life now is hideous...you cannot stay the way you are).

I would like to know who is helping you. After all my messing around towards the end of last year, my boyfriend got very frustrated with all my self diagnosis, online research, and deciding to start and stop things (my doctor is private so I can get my hands on pretty much what I want). When I started the hormone treatment and then the escitalopram, my boyfriend went through it all with me, and he and I decided it together. He was firm about us making a plan that we would both stick to. He would support me only if I did exactly what I said I would for the next 3 months. Right down to the time of day I would take a tablet, and what I would eat with it. I felt very committed to my promise to him and this has helped. He would text me during the day to say 'have you taken it? How are you feeling?'. He came home and understood I didn't feel like talking, and just rubbed my feet on the sofa. I felt both supported, but also that I owed him my commitment.

Alcohol: no judgement from me here at all. Until recently I regularly used it to relax in the evening, and to drop off to sleep faster. Annoyingly my post pregnancy insomnia problem has been very early waking (like 2am), and booze made that even worse. However I still drank, and enjoyed the process. I just accepted it was also a depressant, and since getting the escitalopram going I don't drink nearly as much. I just don't feel like it as much, the feeling isn't as pleasurable, and I don't need it to get to sleep anymore.

Forgetfulness: dear god I was awful. I walked into a room and couldn't remember why I went there. That definitely will get better when you deal with this.

Captain you need a plan...a plan that you write down, that you tell your family about, that you know will be tough but you make a big commitment to. Stick a big calendar on the wall and tick days off for the first 2 weeks which will certainly be the worst, and then the next 4 weeks as you reach maximum therapeutic effect....commit to not stopping whatever you decide to take for that long, you will NOT stop or change the drug until that point. You have felt like shxt for 7 months now, is 6 weeks such a long time?

What do you think? What kind of plan do you think you can face?

Thank you so much again for very kindly taking the time to talk to me.

I know I shouldn't have to worry about accessing the medication but I've had problems getting hold of them before - for both myself and DS, now i've been left without what I was expecting for over the weekend and I'm so scared of taking something like venlafaxine that you really can't miss a day of and being left without any. I guess I could go to A&E if that ever happened and refuse to leave without it but I don't want to live my life with the anxiety of running out. I did take sertraline for a few months so I think I should have felt a benefit but didn't. I was surprised and really upset when the dr said it sounds like venlafaxine isn't going to work stop and try another on Monday. I really wanted to stick with this one I was so hopeful it would help. Do you think I can insist on trying it for a month? Or is that a good idea? If I still get all the side effects like the Dr said I might will it be really awful to come off it though? But then now I've taken it for 2 days, then several days off over the weekend and till I can get an appointment I'm just messing with my brain even more. DH said he's worried if I take it for a while then have to come off slowly and I vomit daily that entire time things will get awful - I agree with him. I completely agree with you about a plan and sticking to it but I keep being told to try different ones and I have no idea what it is we're waiting for to know we've found the right one. Everything just seems to make everything worse. I'm finding it seems like no one will tell me anything/knows anymore than I do and I have no idea what to expect or what to do. The dr Friday on the phone gave me the choice between citalopram and escitalopram - basically said they're all very similar it's pick 'n' mix and we're just plucking each one out of the air each time there's no 'we'll try this one because...' but then surely if they are all very similar none or all would work? But I need to get an appointment next week to get the prescription. Is moving to another one so soon after trying venlafaxine messing with my brain too much? It's all such a minefield I just wish I knew what to do.

No the diazepam is something I wanted because I'm not coping with the lack of medication/plan and I'm finding my sudden lows intolerable knowing there is nothing that is going to be making this all any better for what seems like forevermore. Also I'm really struggling to sleep. I'll go to bed about 9-10 but won't be asleep till the early hours then I wake up every hour or two. There is no plan of action for my lows. I have no one to call if DH is at work and nothing to take to help me calm down. A&E is my only option and the last thing I'm capable of doing when i'm feeling at my lowest is getting DS ready and driving 30mins away. Diazepam is not something I've had consistently. I had one prescription for over a weekend in January once and this was the second time that was supposed to happen but didn't.

At the moment I'm thinking, as you say it helps with anxiety too, that trying escitalopram for at least 2 months along with the other things I've got going/planned and maybe ask DH to take some annual leave if he can during the first fortnight. Do you think that sounds like a good plan? Ticking it off on a calendar is a great idea I think that might really help. I can put a circle around the end of 2 and 6 weeks.

Captain how are you today?

I think you are at a very sensitive stage and whatever SSRI you take you are going to have bad side effects initially. So your doctor encouraging you to stop one and try another again and again after just a few days on each (exactly what happened to me last autumn) is not a good plan as far as I am concerned. With hindsight I am convinced my psychiatrist just wanted me to go away, and offering different drugs was a way to do this.

Regarding escitalopram or citalopram...if that is the current choice then I suggest escitalopram. Not because that is what I am on, but because I have done my reading on this and escitalopram is a newer drug, believed to be a more targetted SSRI, with fewer side effects. Lots of mumsnetters refer to not being able to get it prescribed because it is very expensive. That is my view...I have never heard anyone say that citalopram worked great for them but escitalopram did not.

If you can get some good support for the first two weeks I think that is a great idea. You might not even need the full two weeks!

What is your plan for tomorrow?

I've been to see the gp this morning and have now started 10mg of escitalopram. I go back next week to get more/maybe higher dose. I have agreed with DH that whatever the dr says next week we're carrying on with them for a minimum of 2 months (unless I have some sort of very rare dangerous side effect of course). Unsurprisingly having taken 2 venlafaxine then stopping and not having the diazepam i'm not doing very well at all. Suicidal thoughts are almost constant and my memory is ridiculously bad.

Captain how are you tonight? Side effects from first tablet yet? Feeling good about your decision to stick with this?

I am impressed you have got on with 10mg...I did first week on 5mg, and that just slowed things down, I'm sure. Grit your teeth and get on with it. If doctor encourages moving to 20mg, then definitely do it. I might increase too if anxiety still the same in 2 weeks. I would like to know how you find it.

Keep in touch!

I still feel the same but I've had some good news. The Dr phoned perinatal today and they are coming back round to see me soon. I've also about bloody time, I needed it Friday got the diazepam so feel less anxious that it's there if I need it. I don't seem to be having any side effects so far from the escitalopram. I feel good about the decision and DH is fully behind me. I'm going to put an alarm on my phone to take it and will ask DH to try to remind me too in case that fails. Hopefully if I can manage my memory will come back a bit soon. Is it a month now you've been on them? Are you finding them helpful other than anxiety?