Anxiety/intrusive thoughts and starting sertraline in 3rd trimester, advice please?

[squashie34]

Hello,

Just looking for some advice/stories from anyone who has been through the same. I'm currently 33 weeks pregnant and have resigned myself to the fact that I really need help with my anxiety after breaking down to the midwife at my last appointment. Long story short, I was on 50mg of sertraline for anxiety prior to pregnancy and this was working really well. However, when I found out I was pregnant I just stopped taking it as I wanted to ensure I wasn't doing anything to harm the baby.

The anxiety has always been around (the wait to the 12 week scan to find out viability, then the 20 week scan for abnormalities etc) but I can feel it getting much worse. I was diagnosed with obstetric cholestatis around 28 weeks and that has set my anxiety into overdrive too as I'm convinced she will now be still born. Because of this I have developed tokophobia about a vaginal delivery and I'm also having OCD type intrusive thoughts such as 'what if my partner isn't the father' 'what if the baby comes out a different race?' (I haven't slept with anyone else, but then the thoughts say but what if you just don’t remember) ‘if you pack the sleepsuits in my hospital bag you are jinxing it and she won't be alive to wear them' etc. I'm honestly at my wits end and spend each day in an anxious bubble because I feel like being happy means I’m going to make something go wrong .

My midwife referred me to Perinatal MH who basically just sent me a letter saying they don't think I'm severe enough to be seen by them so to self refer to my trusts IAPT which is essentially the general way to refer yourself for any anxiety etc. In the meantime I spoke to my GP who talked about the sertraline but mentioned about the risks to baby in the third trimester such as withdrawals at birth and problems with hypertension etc. This really scares me as I don't want to put my baby at risk (as that's why my anxiety festers on) but equally I don't know how to go on feeling like this. I just want to feel excited. I also worry about how this continues postnatally.

Has anyone started sertraline in the third trimester and what were the outcomes for baby at birth?

Hi, I could have written this. Also OCD diagnosed and came off sertraline when we were trying to conceive. I didn’t go back on the medication yet as I am trying to breastfeed, but I am also struggling to cope with the intrusive thoughts now my babies are here. I don’t have any real advice, except that I tried CBT last year and it gave me lots of coping mechanisms, I just haven’t been implementing them, so I definitely have to start putting some work into that, even though, as you know, the easiest way to calm the thought is to do the compulsions!

Sorry not to be more helpful, but you are not alone ❤️❤️

@ArdoCycle really sorry you feel this way too, although it's nice to know I'm not alone ❤️

Has your HV talked about talking therapies? I know the first response is quite often medication, but may be worth finding a counsellor if you’re worried about taking medication when pregnant?

Hi OP! I'm so sorry to hear you are feeling like this. Anxiety can be such a monster and I have struggled with it too. I am only 17wks pregnant so at a different stage, however I was prescribed Sertraline yesterday as I have been struggling with my anxiety as well. I had previously been on Citalopram before conceiving and came off when I found out I was pregnant, but the thoughts are too much. I worry so much about something going wrong and am convinced they'll find a problem at my 20wk scan! I had a long chat with the doctor yesterday who assured me that Sertraline was fine during pregnancy (I got moved onto that instead of Citalopram as it's safer) and she said it's also safe through breastfeeding. With anxiety meds they always weigh up the risk to the baby versus the benefits to the mother and if you're really struggling, it might be worth considering going back onto it? I'm sorry if that doesn't help, but I hope you're ok!

I can't answer your specific questions but re medication in pregnancy and withdrawal. I asked the perinatal mh team the same question concerning my medication yesterday. They said "they don't use the term withdrawal anymore. After birth about 1 in 10 newborns take time to adjust being out of the womb. Being more fussy, not settling, digestive issues etc. This typically goes over the first week or two without requiring a stay in hospital. If you are taking medication during your third trimester this can go up to 3 in 10 - so still a small chance. When I give birth we will possibly be kept in for 72h to make sure she is adjusting to this new world ol but we will be assessed at 24h to see if this is necessary.
It does vary with medication but this has stopped me panicking so much about withdrawal as the original doctor described as something more likely to happen and something that was unique to my medication and not something that could happen anyway.

It is always a hard decision to take medication in pregnancy but you have to think about your well being too. I have been on my medication throughout my pregnancy and have stayed mostly ok. This has put me in the best position to manage what comes next.

For my intrusive thoughts I find giving myself 20 minutes or so a day where I allow myself to have the thoughts. For me the thoughts need to be heard and if I keep telling them to go away they get more insistent as it is crucial they tell me whatever it is.

I hope things get better for you intrusive thoughts are horrible.

Thank you so much ladies, I'm on the waiting list for some talking therapy so it's just a case of waiting for that. Maybe I will wait instead of starting medication then.

I was referred earlier in my pregnancy for therapy and/or counselling. Unfortunately it turned out what they could offer wasn't right for me. Instead they have said that there is a women's centre in my area that can help with pregnancy related health concerns. It might be worth seeing if you have something similar in your area as an additional avenue to explore. I now have input from the perinatal mh team which I didn't have earlier so its not something I have explored myself but thought I would mention it.

Hi squashie sorry you're going through this. I took sertraline in the second trimester of my last pregnancy. I was told it was considered safe after the first trimester, and the risk to the mother and baby of not treating a mental health problem is far greater than the tiny risks of taking antidepressants. I originally wanted a homebirth but I agreed to a hospital birth so that my baby could be monitored after the birth for a couple of days. I was told the risk to the baby from antidepressant withdrawal could be in respiratory difficulties, although again the risk was tiny. We were both fine. Don't feel guilty if you need to take antidepressants your mental health is really important, it won't be forever, I hope you can get a handle on your intrusive thoughts I've been there myself and it's hellish.

The counselling service had just called me back and said that they think CBT will be suitable for me so they are going to add me to a waiting list and it could be in a few of weeks that I will start. I'll probably likely be almost full term by then so I don't know just how much use it will be 😕