More children please

[SparklePopRampage]

I wasn’t entirely sure where to stick this - thank you for reading 😊

My husband and I would love more children, we have 1 DS(6) but I’ve been advised not to on my current medication (mirtazipine 45mg/day).

Im gutted as I’ve come off all my big time medication and feel like the mirtazipine is such a minimum compared to where I have been in the past.

Ive been through the mental health wars and have OCD and depression because of, and including CPTSD because of my childhood. Despite this, my OCD and depression are managed now and I can have trauma therapy soon and we are great parents.

Im feeling really low at being told by the doctors that id totally have to come off meds to have more children. I know it would ruin me and the relationship I have with current DS.

Any thoughts appreciated. Especially if you’ve been in a similar position. What did you do? How did you cope?

I’ve been advised not to on my current medication (mirtazipine 45mg/day).

I have no thoughts aside from follow this

Sorry but this.

When you already have a child(ren) you always need to do what’s in their best interests when deciding to have more children.

You make the most of the progress you have made,
embrace the relationship that you have with your child,
don’t jeopardise everything you have by coming off the medication that you need

Is there hope to come off it in the future?

I think if not it may be better for all your family, including yourself to be stable and as mentally well as you can, so that you can be a good parent to the child you have.

The risk of becoming mentally unwell so that you can have another child is a very large one and the biggest risk is to your current child and any future one.

You say you have PTSD from your childhood - so you know how important childhood is to establish healthy functioning adults.

It is difficult and you may need help to deal with how you feel about this reality.

Has the GP said this? Because I know various different people who have been on mirtazapine whilst pregnant so I wonder if your doctor is not well informed. I would ask to be referred to a Perinatal mental health team for pre conception counselling. If one is not available ask for a second opinion from a psychiatrist. If a psychiatrist gave this advice ask for a second opinion from another one.

It is the pharmacist at the gps - this was the person I was triaged too. But this is interesting as I’d looked into the research as well and there seemed to be no contraindications - thank you - I might go back to the psychiatrist who did the CPTSD diagnosis and ask there.

I know everyone is right, but I can’t help but feel massively saddened by this situation. It is not my fault that I have had to go through all these things and we are really involved, caring parents. Probably even better parents because I make such an effort to make my DS’s experience so much better than mine was! I feel totally bereft that my decision has been taken away from me. Like my upbringing has stolen something else from me aswell as everything else it has done.. I see all these people who don’t even think about having kids or being amazing parents having kids all over the place and I am devastated that our home can’t be more of a home. ❤️

why were you at the doctors? was it you wanting a chat about beginning the fertility journey? or was it something else?

might go back to the psychiatrist who did the CPTSD diagnosis and ask there.

this

I see why others are saying to follow the advice, and I wouldn't tell someone to just ignore their doctor's advice, but not all doctors are well-versed in the current state of knowledge around every drug and its use in pregnancy. Understandably, many will tend to err on the side of caution if there's any doubt at all. And there's almost always doubt, because for obvious reasons, they don't like to test drugs in pregnant women.

Bumps (a service provided by the UK's specialist organisation for the effects of substances in pregnancy, and funded by governmental health departments) don't seem to mention any major known risks, on an initial glance. https://www.medicinesinpregnancy.org/leaflets-a-z/mirtazapine/

But in your position, I'd want to talk it through with someone. Is this your GP saying this, or a psychiatrist? Can you ask for a referral to a psychiatrist, or to a psychiatrist who specialises in perinatal mental health, so you can drill down into what is and isn't known, and make an informed decision?

Yeah I am very conscientious and wanted to make sure any decisions were supported medically. Although I realise now they will always err on the side of caution. I would want to prioritise the child.

Please get a second opinion. Maybe even a third and a fourth.

Unfortunately I don’t see this as a complete option at the moment - I have clinical depression due to everything and when I have tried to go meds-free in the past this has just made coping really difficult.

Although I would Compromise or do some of the time off it if it was for a purpose which would carry me through. The research suggests mirtazapine is untested in the 2nd trimester but safe in the 1st and 3rd and breastfeeding. I could do this knowing it was temporary - but this option wasn’t even discussed with me. It was a blanket no.

I mean, pharmacists are highly trained professionals with a strong focus on pharmaceuticals, and they're obviously going to be very focused on the risks. A probably tiny but technically unknown risk is still a risk, and someone who's focused on drug risks isn't going to tell you to take that risk when you could just… not take the risk.

But people routinely take thousands of risks, pregnant or not, and there's so much more to any decision on risk than a blanket "We don't know for sure that it's 100% safe so don't do it".

Did the pharmacist let you discuss the big picture with him? the potential effect of having or not having more children on your mental health and wellbeing and your partner's mental health and wellbeing, and on your relationship with each other, and the effect of the health of that relationship on your DS's wellbeing? what your feelings are on your DS growing up as an only child vs with siblings, or your ability to cope with another child with or without medication? your likely ability to handle regret at not having children, or your likely ability to handle having a child who was affected by medicine exposure (and realistically just how high the risk is and what those problems might plausibly consist of)? your relationship with your own mental health and trauma history, and how you'd feel about yourself if the treatment for your mental illness ended up limiting your life choices? your prospects of becoming drug-free in the near future and whether it's a genuine possibility? your feelings about balancing risk to a potential child against risk to the existing members of your family, including you…?

There's so much important stuff goes into making important decision, and drug risks are right up there, but they're part of a fuller story. Deciding not to have more children when you desperately want more children doesn't seem risk-free to me, so unless he was able to explain why taking mirtazapine in pregnancy is risky enough to outweigh all other consideration, I don't think the issue has been sufficiently explored to determine the overall optimal course of action. In your position I'd want to discuss it with a knowledgeable medical professional who can help you navigate this in a holistic way.

You might still come to the conclusion that taking mirtazapine in pregnancy is a risk you don't want to take, but at least you wouldn't look back and say to yourself "I wish I'd looked deeper into that decision".

Thank you so much. All of you. I’ve decided to go back to the previous mental health team I was with and ask there, with the hope of getting some more detailed information and that they will entertain my query even though I’m technically not under them anymore. I’ll also ask for the GP surgery to take my query more seriously and escalate it to a mental health professional.

I was so disabled by the blanket no, not even a discussion around reduction, risks or ‘safer’ trimesters. It just really hit me hard.

Good luck — I hope you can get to see someone you can talk this through with properly, or at least get some clarity on the recommendation.

I would make an appointment with the GP and ask them to write to the local perinatal mental health team to review your medication wrt pregnancy. My gp did this for me prior to conceiving my first child and they said my medication was safe in pregnancy. I didn't have to see anyone the GP just wrote to them with the medication I was currently taking and the dosage. I was about 7 months pregnant when my pharmacist suddenly twigged I was pregnant and they were going to withhold the medication from me as they deemed it unsafe for pregnancy. As soon as I informed them I was under the perinatal team they let me have it. My medication was only able to be prescribed in pregnancy if the risks off it were worse until 2018 when there was a big meta data study (comparison of all good quality research available) and it was now classed as safe. It can take time for this to trickle down to prescribing practice

I have just spent 8 months overhauling my medication ready to try to conceive number 2. This has involved coming off mirtazapine however it was dropping my mood stabiliser that triggered this rather than the mirtazapine. I'm at risk of mania if on an antidepressants without mood stabilisers. My psychiatrist was happy for me to stay on it whilst trying to conceive and only stopping it if my mood started to go up but I requested stopping it before waiting for that to happen. As it was stopping my mood stabiliser did result in some symptoms of hypomania so it was the right move. I'm still on quetiapine

I would ask for counselling specifically regarding the risks of conceiving on mirtazipine, how much the risk is increased and what it is that you’re risking. It’s not always wrong to accept risks, after all I wouldn’t say someone who’s 40 shouldn’t try to get pregnant just because the risks for them are greater than those for a 20 year old. Even a quick google for reliable sources suggests that pregnancy on mirtazipine is not a complete no https://www.nhs.uk/medicines/mirtazapine/pregnancy-breastfeeding-and-fertility-while-taking-mirtazapine/#:~:text=Mirtazapine%20and%20pregnancy,breathing%20problems%20in%20the%20baby.