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Mental health in early pregnancy – the first trimester

Disrupting the balance

Little Foster-Pickup waves hello

I’m pretty good at managing my mental health. I know what helps, what doesn’t and how to recognise when I need to take better care of myself or ask for extra support.

But early pregnancy disrupted this balance. I’m nearly 17 weeks now and finally ready to write about the first trimester.

Awareness of perinatal mental health is increasing. Most people know about postnatal depression but I’ve seen more conversations about antenatal depressionperinatal anxiety and postpartum psychosis too. I’ve heard less about how to prepare for the way dramatic physical and psychological changes can interact with existing problems.

Taking antidepressants, managing eating problems and dealing with depression and anxiety

It turns out I’ve got a lot to say so I have separated them into three blogs.

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Antidepressants (Sertraline) and pregnancy

Pregnant and taking Sertraline

I’m 17 weeks pregnant and still taking the SSRI antidepressant Sertraline. I thought I was pretty firm in that decision. An attempt to stop taking it last year ended badly.  But we had to try, if only to help us work out where we sat in the endless risk/benefit balancing act.

But I was still thrown when my GP (a new doctor who didn’t support me through withdrawal, relapse and re-prescription) told me I should try to come off – “You could just stop immediately on that amount – or you could take it every other day for a couple of weeks and then stop”.

She seemed convinced the main reason I found it hard to come off them last time was because I was anxious about trying to conceive. In the time we had it was hard to explain that it was considerably more complicated than that.

Mental health agendas vs. pregnancy agendas

When you are pregnant and also manage mental health problems you have lots of people telling you what to do. Different authorities often have slightly different agendas, follow different recommendations and suggest different things. It feels like an extra layer of disempowerment and it’s hard not to get caught between what’s best for your mental health and what’s recommended in pregnancy.

I have:

  • personal experience that strongly supports staying on antidepressants
  • a well considered and discussed (with a doctor and my husband) decision to start taking them again
  • an awareness of the power imbalance implicit in a doctor’s consulting room
  • access to – and knowledge of – a lot of relevant research that emphasises the importance of maternal mental health and the danger for both mother and developing baby of coming off when it isn’t appropriate
  • an awareness that the ‘risk’ referred to here is pretty small and that everything has risks and benefits – I shouldn’t take the fact that something has a risk associated with it as an automatic reason not to do it
  • an awareness that doctors are told to advise women to stop as there is very little safety info but this is a precaution and for some women, it can be better for them and their baby to remain on medication

Questioning my decision

But despite ALL this, I still walked away from the doctor feeling pretty wobbly and thinking “maybe I should, the doctor is telling me I should after all”.

It took another discussion with Alex and some more reading and research to help me feel confident in my decision again.
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Eating problems and early pregnancy

Recovering from eating problems

Over the last year, I’ve been facing up to eating problems that have dogged me my entire life. This became particularly important as we tried (and for a long time failed) to conceive. It was really hard going but I got my cycle back and my hormones balanced – by the time we conceived my levels were fine. I gained weight until my BMI settled in the mid/high normal range that seems to be where my body naturally wants to hang out. I preferred being smaller but I was (slowly) teaching myself to feel positive about the changes.

This is what recovery looks like for me. After 24 years with these thoughts and feelings, I’ve pretty much accepted that I’m never going to be completely free of them. But I’ve learned to manage them in a healthier way, enjoy exercise and let myself eat without feeling too guilty (usually).

A naive hope for eating problems and pregnancy

I had nurtured this (naïve) hope that during pregnancy my muddled relationship with weight and eating would somehow vanish. Or at least become a lot easier as I nurtured my amazing baby growing body, forgiving weight gain and enjoying my new curves. HA. Load of bollocks.

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Depression and anxiety in the first trimester

A toxic mix

I had some very low periods and dark thoughts during the first trimester of pregnancy. The myth of pregnancy as a calm, exciting and enjoyable time is still pervasive – but there were times when I felt unable to take pleasure in anything, distant from Al and scared I wouldn’t be able to feel anything for the baby either.

  • Nausea and exhaustion were draining and left me more vulnerable.
  • Pregnancy was constantly pushing all my eating and weight ‘triggers’ and making that much harder to manage.
  • I couldn’t do almost anything I used to enjoy or that helped me manage my mental health – challenging myself with long runs, tiring myself out with speedy bike rides in the hills, skiing with friends, winning races, revelling in that gorgeous post-exercise feeling – even drinking tea and having a long steaming hot bath.
  • Nowhere felt like home – my supercharged sense of smell means that the smell of the house made me sick. It’s exhausting to have nowhere comforting to retreat to.

All of these are manageable individually but they made a toxic mix when combined with existing mental health problems.

One big anxious thought

I have a diagnosis of clinical depression and anxiety – but it’s tended to be anxiety I’ve struggled with over the last couple of years. Anxiety get’s its claws into whatever is going on and warps it out of all proportion. In the first trimester, there is a LOT for it to hook onto. Al always tells me to try not to think ‘big thoughts’ when I’m anxious but for a lot of those first 14 weeks or so I just felt like one big anxious thought.

But I also felt that dark, flat, stifling darkness of depression again. It was actually pretty scary at times – mainly at night when things often feel the most overwhelming. I’m certainly glad I kept up the Sertraline.

Referrals and support

I’m feeling a lot better now. I have a referral to the obstetrician who specialises in mental health – but my appointment isn’t until June. In the meantime, I spoke to an amazing midwife who really seemed to understand and agreed that 27 weeks was very late for starting any additional perinatal mental health support. She referred me to see a psychologist a little earlier. I’m not sure how (or if) these appointments will help but I’m keeping an open mind and making sure I have as much support in place as possible in case things get harder again.

Read my other blogs about the first trimester:

Signs of change and coping with cheese – how my eating disorder recovery looks now

vd9j4ghMental health problems have a way of taking over. I’m lucky enough never to have been hospitalised or signed off work. Life has always stumbled on. But moods and behaviours creep in and twist their tendrils around daily life. They trick you into thinking they’re normal, into nourishing them. It’s not until they start to suffocate and strangle even the simplest of things that you recognise their power. And then it’s too late for an easy fix.

This year I’ve started the long process of hacking away at the thicket and pulling up roots that go incredibly deep. It hasn’t been easy. But now I’ve made some space it’s much easier to see what a tangle I was in.

Eating new food

I recently turned 33 and enjoyed a breakfast made for me by Alex without having to purge it through exercise.The day before my birthday last year I was panicking over choosing something nice (and therefore different) for my birthday breakfast. I cried outside the bread shop. I ended up with toast and even then it was a tricky day.

Letting go of control in the kitchen

I no longer have to have control in the kitchen. I’ll eat something made for me by someone else – even if I didn’t see whether they used butter or check how much oil they added.

Reaquainting myself with cheese

I had cheese on toast for the first time in two years last week (cheese has been a scary food for years).
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Recovery is long, messy, uncomfortable and emotional – but i’ll keep trying (and talking)

Glad to have an eating disorder?

I'm not linking... but you can Google...

I’m not linking… but you can Google…

Apparently Liz Jones is glad she has an eating disorder. In her latest piece for the Mail, she tells us that recovery is so hard that it’s easier not to try. She’s lived with an eating disorder for so long that she’d rather take refuge in behaviours that feel safe than deal with the messy and fluctuating business of balanced eating.

She’s lived with an eating disorder for so long that she’d rather take refuge in behaviours that feel safe than deal with the messy and fluctuating business of balanced eating.

Yes, recovery is bloody hard work

She’s certainly right about that.

If you’ve lived with a restrictive eating disorder then gaining weight is quite literally your biggest fear. Recovery means choosing to face it and having the courage to live with it every day. It can be weeks, months or years before it stops being scary and difficult at least some of the time.

Food isn’t just nourishment. It’s both punishment and reward. It’s at once the scariest and the most important thing. Recovery means learning to manage this complex twist of emotions at least three times a day. Forever. It means dealing with other people’s opinions and comments on your changing body.

You’ve probably developed tests and checks to make sure your body is ‘right’ – restricting or purging until you ‘pass’. Recovery means ‘failing’ those tests without spiralling into self-doubt and recrimination. Hundreds of times a day.
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Unwanted pregnancy far outweighs any side effects of contraception? How dare you say it’s that simple!

Women on hormonal contraception are more likely to be treated for depression

fullsizerender-1Recent research has shown that women taking hormonal contraception are more likely to be treated for depression. And we already know that those with pre-existing depression may have their symptoms worsened by the pill.

Tell us something we don’t know.

I’ve avoided hormonal contraception completely since a devastating experience in my teens. Mood changes are the top reason why people discontinue using the pill.

But some of the responses to this research have made me pretty angry. I’ve been trying to make sense of why for the last couple of days. Maybe this is really obvious stuff. But maybe it needs to be said again and again until people start to listen.

Unwanted pregnancy far outweighs ALL side effects?

The worst comment I‘ve seen is “avoiding an unwanted pregnancy far outweighs all the other side effects that could occur from a contraceptive”. That’s the sort of thing someone who hasn’t experienced depression might say. I wonder if an equally debilitating (and potentially life threatening) physical health problem would be treated so casually.

I was prescribed the combined pill in my teens with no guidance, no discussion of side effects and without being offered alternative options (I wrote about it in an old blog post here).

The causes of mental health problems are complex and under-researched – but I’ve always felt that the six months of desperation, confusion and trauma I suffered before realising the pill was to blame was the start of long term problems with depression and anxiety. I still occasionally have nightmares where I’m trapped in that time and those feelings.

I had an abortion in my twenties. Unwanted pregnancy can be awful (and can be associated with an increased risk of mental health problems too). But the mental health consequences of getting medication like hormonal contraception wrong can also be devastating – and can last a very long time.

When I posted these thoughts online, others immediately agreed – “Yes, yes, yes! I’ve had both an unwanted pregnancy and a termination and long-term mental health problems aggravated/caused by the pill. And it wasn’t the first one that was more traumatic and terrifying”.

I feel the need to clarify that I’m not suggesting people have terminations instead of taking the pill – but that I need to do this at all just shows how reductive the discourse on this topic tends to be.
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A letter to Incognito about OCD

Hey Incognito,

screenshot-2016-09-18-11-38-21You probably haven’t thought it through – and I’m sure you don’t mean to cause offence – but I wanted to highlight some of the problems with your OCD Hand Sanitizer product and the accompanying text.

OCD is an incredibly debilitating mental health problem. So much so that the World Health Organisation ranks it in the top 10 disabling illnesses (both mental and physical) in terms of lost earnings and diminished quality of life. Yet it remains one of the most misunderstood and trivialised of conditions.

I’m so OCD” or “I’m a bit OCD about that” has become shorthand for “I like things to be clean” or “I like things in the right order”. Comedians joke about it. We’ve all seen a picture on social media of some slightly misaligned objects with the caption ‘This is sending my OCD crazy’. Products like this perpetuate those myths.

Jokes and misunderstandings trivialise OCD

OCD gives people constant negative, repetitive and intrusive thoughts, combined with an ongoing feeling of doubt or danger. These are the obsessions. Compulsions develop to try and quell the thought or quieten the anxiety. They can be things like repeatedly checking a door is locked, repeating a phrase over and over again in your head, checking how your body feels, cleaning or repeatedly asking for reassurance. The relief caused by completing a compulsion is usually short lived and before long the anxiety and mental discomfort caused by the obsessions and doubts rises again.

You can get stuck in an exhausting cycle of rituals and often choose to avoid places or people that may trigger their obsessions. Your day to day life is disrupted and relationships may be strained to breaking point.

Intrusive thoughts can be graphic, violent or scary. You may be very ashamed of these thoughts and spend a long time checking whether they might still be there and how you feel about them  (for example ‘am I still appropriately upset by them?’). You may feel the thoughts mean there is something ‘wrong’ with you as a person – and don’t feel able talk about them or ask for help for a long time.

Every time someone says “I’m a little bit OCD” , shares an OCD joke on social media or sells a product that makes light of it, they add to the impression that OCD is trivial – even a bit comical. This makes it much harder for people to seek help or even open up to their friends and family – and for research and support services to get their share of limited funding.

Imagine if you had to explain to friends and family what cancer really was, how it affected you and that it wasn’t an amusing or comical condition. Imagine how isolating it would be if they still didn’t really understand or made conscious or unconscious judgements about what it ‘really’ was based on jokes and viral pictures on social media. Imagine if shops sold joke ‘cancer hats’ which you could put over your own hair to look as if you were having chemotherapy.

Misinformation stops sufferers seeking help

It already takes an average of over 10 years for people with OCD to seek help. Often that’s because they don’t realise that they have a recognisable condition with potential treatment options. If you’ve always been led to believe that OCD is just a quirky approach to being clean and organised then you might not realise that the intrusive thoughts or crippling doubts you’re constantly fighting are also OCD.

Language is a powerful thing – even small everyday comments, ‘funny’ product descriptions and cheeky ‘likes’. Let’s use it to learn more, to support others and to fight stigma and misunderstanding rather than perpetuate it.

Please consider reading a little more about OCD and removing this product from your shelves.

Thank you,

Clare

The next step in recovery – letting go of clothes that don’t fit

Too small

img_3546I’m selling some of my favourite clothes. Some of them are definitely too small. I bought them when I was at my lowest weight last year. Fitting into a smaller size was an unhealthy but irresistible boost to a fragile self esteem that had narrowed to focus only on my weight and ability to exercise to exhaustion.  They hang in my wardrobe now and remind me, daring me to go back there. It would only take some long runs and a few weeks of restriction. They are better off living with someone who is naturally a smaller size.

Close fitting

Some of them still just about fit. They’ve always been close fitting, that’s just their style. As a result they are often barely worn – rejected because my muddled mind translates their constant pressure on my skin as a sign of being too big.

But now I’m working to reduce my exercise without restricting my food. My body is softer and larger. Getting dressed is one of the most difficult times. Tight and restrictive clothes risk triggering an avalanche of recrimination, irritation and anger. Yesterday I threw a banana at the wall. It’s funny now but at the time I was so angry at my mind for telling me I had to choose fruit over toast until I had run (on a day when I wasn’t supposed to be running at all).

My favourite clothes are a tangible reminder of change that doesn’t always feel welcome. I’m trying to learn to like a softer, curvier frame but it’s hard. I’m scared of losing control.  I’m fighting to stay away from unhealthy patterns of thought that started carving deep grooves in my mind when I went on my first diet aged 9. It will always be much more comfortable to let go and slide back into them than to resist and live day in and out in a body that feels heavy and uncomfortable.

It’s easier if I don’t risk it, if I say goodbye to those clothes and that time and look forward.

Letting go

I can’t afford to buy a whole new wardrobe but I’ve bought a few larger sizes, baggier clothes. They help me forget the discomfort and move my focus to all the other brilliant things in my life – work, family and friends I love.

In the past the fact I KNEW they were a bigger size would ruin this comfort. That disordered inner voice would keep reminding me that wearing a larger size meant I’d failed. That I wasn’t in control. Ridiculously I would rather be uncomfortable and sad in clothes too tight than admit I am bigger and be happier in clothes that fit. But this time I’m determined to make real change – for my mind, for my body and for the hope of conceiving.

In her brilliant memoir of anorexia and bulimia The Time in Between, Nancy Tucker writes about a pair of shorts…

“One of the most painful things about this period is The Shorts. I have a pair of denim shorts whose label bears the glorious declaration ‘Age 6-7’ and they become one of The Voice’s favourite instruments of torture…. eventually it is a panting struggle to pull them on and when I take them off I have crusty sores on my skin where the denim has rubbed me raw. I don’t know whether it is because I need reassurance that my body is still acceptably small or because the pain of wearing them serves a hair shirt, self flagellation purpose, but from the time I hit my lowest weight to three, four, five months afterwards, The Voice insists I wear these shorts every day”.

Her anorexia was far far worse than any disordered eating I have experienced. But her words show the incredible power that the warped voice of eating disorders can give to clothes and clothes sizes. After 23 years of letting buttons, zips and waistbands rule my life, it’s time to start letting that go.

 

Writing a blog about your mental health – why and how?

Blogging about my mental health

A few weeks ago had an internet date. Of sorts. Not a romantic first date (thank goodness) but a face-to-face meeting with someone I met online. Someone like me in lots of ways. Someone who could be a friend.

We knew a lot about each other’s vulnerabilities and fears before we set eyes on each other. And that made things much easier. The conversation could get right to the good stuff. We could be open and honest. We chatted about medication, work, diagnoses, panic attacks, weddings and how our dogs help with our mental health. Not really first date fodder.

social anxiety blogIt’s all down to our blogs. Claire writes WE’Re AlL mAd HeRe about social anxiety (she’s also been asked to write a book about anxiety based on her blog – wow). She got in touch a few months ago and suggested lunch. I’m so glad she did. Meeting inspiring new people is just one of the things that blogging has done for me.

I’ve had a number of  readers get in touch with me recently about starting a mental health blog – overcoming those demons of uncertainty that whisper ‘what’s the point, who cares what I have to say?’

I know the feeling – I have it about writing fiction. But I thought I’d share a little about what blogging has done for me – and a few things that helped me get started.
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