Tag Archives: medication

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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What I’d tell my 2015 self about dieting, body positivity and accepting medication

One year on...

One year on…

Yesterday we celebrated our first wedding anniversary. Our wedding was a magical day but, in the two years since we got engaged, life has taken some unexpected turns.

My mental and physical health has taken quite a bashing.  I’m not fully recovered – and I’m working hard to challenge and change thought patterns and reactions that have been deeply ingrained for many years. But I’m gaining more perspective with each month that takes me further from the trickiest of times.

So what would I tell the Clare who said ‘yes’ under that tree on Hampstead Heath in 2015.

You can’t control a wedding diet – change the dress, not yourself

I thought I would be able to diet just enough to feel comfortable in a gently corseted dress – and then stop afterwards. But my disordered eating lurked much closer below the surface than I realised. It wasn’t long before my eating, exercise and emotions got horribly tangled. I thought I would never go back there but I slid into militant calorie counting, restriction and purging through exercise with the excuse that it was ‘just for the wedding’. The dress was too big, I spent our honeymoon struggling to find a manageable balance and it took my periods stopping to shock me into making a change.

You need medication – and that’s fine

“You were so proud of yourself,” my mother in law said. And I was. I had been fighting my medication for years, trying to cut down and come off. Stopping was the hardest thing I’d ever done.

And when I finally fought through the initial withdrawal symptoms I thought things would get easier. Instead they got harder. More chest pain. More tears, panic and anger. Suicidal thoughts. More running. More fighting my body. It took three months to realise I couldn’t do it. That nothing was worth the destruction those months had wreaked on my body, our health and our relationship.
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We need to talk about mental health and trying to conceive #takeoffthetape

Find out more about Mind's campaign here: http://www.mind.org.uk/get-involved/take-off-the-tape/

Find out more about Mind’s campaign here: http://www.mind.org.uk/get-involved/take-off-the-tape/

Mind has been asking people to #TakeOffTheTape and share something that makes them anxious. Something they haven’t spoken about before.

I thought I would use the opportunity to write about something that’s hardly spoken about at all.

I’m finding it incredibly hard to balance trying to conceive with managing my mental health.

We don’t talk about this. We don’t even talk about the first twelve weeks of pregnancy much (as I’m well aware from my work with the Miscarriage Association). Trying to conceive often happens in almost complete secrecy. I didn’t realise how it would interact with my fluctuating mental health and I wasn’t prepared.

It’s taken a while to get to this stage. The doctor who removed my coil last year strongly implied that it would be best to continue with my efforts to come off my Citalopram. She moved me to Sertraline (it’s considered safer in pregnancy) and told me to try and reduce my dose completely over the next month.

Coming off medication

In fact it took me three more months. I’ve been trying to come off anti depressants for a while anyway (after a muddled fifteen year relationship with them) and trying to conceive gave me the strength to make it through a hideous withdrawal period. It was probably the hardest thing I have ever done. Alex didn’t have much fun either. I’ve written about it here.

I’m more vulnerable to hormonal changes now. I still have very dark times when everything seems hopeless and I can’t see a way through the next ten minutes let alone the rest of my life. Difficult images and ideas jostle with an endless repetition of fears and doubts. Sometimes the same phrase over and over again. They whisper just below the surface of my consciousness. They’re loud enough to wear me down and shrink my focus to a single point of constant worry – but not quite conscious enough for me to recognise what’s happening in a way that helps me stop.

One these days I’m separated from the world by thick glass that bounces every negative thought straight back at me, infinitely magnified. My attention is forced inwards but my mind is everywhere but present, infecting all it can with worst case scenarios. I can’t look up and out, can’t see the variety of the world and my place in it, can’t take a long deep breath. My chest physically hurts and I feel constantly sick with the fight or flight chemicals flooding my poisoned body as it tries to deal with the powerful threat of my mind.

The inevitable uncertainty and lack of control

These times are getting further apart and each one adds detail to our understanding of the best way to manage them. But trying to conceive has made my anxiety worse. It’s given it another peg to hang its hat on. Issues with eating and body image are often about control (with an emphasis on control over your body) – and anxiety hates uncertainty. But trying to conceive is a very uncertain time. What my body does – and doesn’t do – isn’t completely under my control.

I was managing my mental health to the extent I felt I was in a position to come off medication – in order to do something that has made the problem worse again. The irony isn’t lost on me – although on bad days it just makes me  want to cry.
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The Regret Tape and the I’m Not Good Enough Mix – new metaphors and thinking tools for managing anxiety and depression

I’ve recently come off Sertraline after 15 years on various SSRIs. It’s been a long and tricky journey but I think I might be almost there. I’ve written a bit more about that here.

Using metaphors to identify, share and understand my mental health

Mix tapesDuring this period I’ve found two metaphors very helpful.

I love a metaphor when it comes to managing my day to day mental health. Metaphor helps me identify and pin down my experiences. This is a step towards understanding and managing them. It helps me regain perspective and use the language of shared experience to transfer and talk about some pretty intangible feelings.

Getting my nose away from the oil painting

I haven’t had much perspective recently. Feeling anxious seems to magnify individual moments. It’s as though I am living life too close up. I don’t have the capacity to see beyond the worry I’m experiencing right now.

van goghMy nose is right up against the canvas rubbing in all the tiny flaws and bumps. From here they look huge and distorted. But we all know an oil painting looks better from afar. The swirls of dark colour and the lumps of paint add texture and depth to the bigger picture.

I’m not saying that this kind of anxiety is necessary or important to make up the picture of a life – it really isn’t. BUT I have found that whispering ‘remember the oil painting’ to myself has reminded me to step back and question whether the worry that’s causing overpowering anxiety right now will matter at all in a year (or even a month or a week). It’s helped stop those tricky surges of panic become uncontrollable.

My anxiety and depression have a tape collection

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Coming off anti depressants – withdrawing from Citalopram and Sertraline

Day six in Foster’s brain and all is reasonably calm…

trainers and pillsAs I write I’m on the sixth day without any form of SSRI at all. This is new territory for me. I’ve taken them every day for 15 years (with terrible healthcare making it much trickier).

Three months ago I moved to Sertraline. Two months ago I was down to 1/4 of a tablet per day. Then I started alternating days. One month ago I moved to one day on and two days off.  Over the Christmas break I’ve been attempting one day on and three days off.  This time round when it got to day four off I decided to keep going.

It’s been a LONG time coming. I’ve been bobbing around the 20-30mg mark for years. I tried to come off them in 2008 but didn’t get below 10mg Citalopram before an abortion and a move to London meant I needed more support again. I tried in 2012 but again couldn’t drop below 10mg. In  2014 I got to 5mg before it became unbearable and ended up slowly and frustratingly working my way back up to 20mg.

Dealing with withdrawal symptoms

My chest sometimes feels uncomfortably tight and I’m still welling up at the slightest thing but I haven’t had any big uncontrollable surges of irritability (horrible), anger (scary) and panic (painful) since before New Year. The worst day was the first time I got to three days without. That afternoon there was little to be done except pick my sobbing self up off the bathroom floor and breathe deeply in showers as hot as I could bear. I would lie completely still in bed hoping for sleep but fearing the threat of my mind building, rushing and slipping away into a place of panic and pain that felt unknown and terrifying. It’s really scary to feel genuinely out of control of your mind. Luckily there was only one afternoon that bad.

I only feel completely safe when I’m exercising and in the calm and blissful hours afterwards when I’m myself again. I’ve ran hundreds of miles. When my knee gave out I cycled hundreds more. I discovered spinning. I’ve been chaining Kalms and I haven’t had a good coffee or a glass of wine in weeks (interestingly when you’re recently married and of a certain age people tend not to push alcohol on you, even at Christmas!). But I’m nearly there. I really think I might be.

Luck, love and incredible patience

I’m  very very lucky to have such supportive and loving friends, family, work and (most of all) my husband Alex. My family love me unconditionally even when I’m unforgivably difficult. My friends make me feel myself again just by being in their company. But Alex is endlessly patient. Those surges of anger and irritability disguise themselves as reactions to things happening day to day. They show their ugly faces in snippy comments, slamming doors and helpless tears. He recognises these as symptoms. He knows that deep down they’re not my fault. He doesn’t react to them as if they are.  This is perhaps the most helpful but also the most difficult thing someone can do to support your mental health. He’s an absolute hero.

(I’ve also written about managing depression and anxiety in relationships here)

New understanding and techniques to manage my mind

There’s been plenty of dramatic lows and a few proud highs in this particular journey. But a lot of the experience of living with and managing this stuff is the day to day mental grunt work. Looking after yourself. Recognising triggers and identifying negative thoughts. I’ve been doing a lot of that too.

I love a metaphor when it comes to managing my mental health.  Metaphor helps me identify Mix tapesand pin down my experiences. This is a step towards understanding and managing them. It helps me regain perspective and use the language of shared experience to transfer and talk about some pretty intangible feelings.

Over the last few months I’ve found a couple of new ways of thinking about my experiences which really help day to day. The tapes and the oil painting. I’ve written about them here: The Regret Tape and the I’m Not Good Enough Mix – new metaphors and thinking tools for managing anxiety and depression.

I don’t know what’s going to happen next and I’m going to try not to beat myself up if it doesn’t go quite as planned. But I’m cautiously pleased and proud to have made it this far. The sun is shining and I’m off out with the dog (he helps a lot too). I might even treat myself to a (decaff) coffee.

P.S – An important extra

It’s worth emphasising that I spent a long time reducing my Citalopram and then Sertraline slowly in 2015. I did the withdrawal and reduction with advice from my doctor. This is a personal account of an individual experience. Mind has a lot of great info on coming off psychiatric drugs which it’s worth looking at if it’s something you are thinking about.

PMT, hormones and withdrawal – treading on mood eggshells

Mood eggshellsIt’s fair to say I’m not compleeetely on top of things today.

The doctor moved me from Citalopram to Sertraline last month (slightly better for any potential pregnancies) and suggested I try and reduce the dose a little (again in preparation for the same). I wasn’t sure whether this was a good idea considering I’ve been struggling more recently – but also felt it was worth another go given a) things have started to be a little easier and b) the doctors are always telling me my old dose was sub therapeutic anyway (pah!).

Hormone smash

It was actually going pretty well until my period hit. Then those hormones smashed into me with a force I haven’t experienced for a while. Saturday was a real struggle, slow moving, anxious and crying on the kitchen floor (poor old confused Watson). Sunday was a little better – I felt exhausted and raw but calmer. We went to the Wildlife Photographer of the Year – it was good to get out of the normal routine but the crowds made me anxious and I cried in the bakery afterwards – overwhelmed by food choices for a birthday breakfast today. At least afterwards Al and I could laugh at some of my more ridiculous tearful utterings –  “I just want some nice bread” (sob).

Mood swings

And today I’m struggling with some serious mood swings. One moment I’m feeling calmer. I’m more on top of things and able to see ahead to all the joy in my life. The next it’s really black. My chest feels very tight, there’s no good memories anywhere and I can’t see a way through at all – the mental trickery of depression taken to an extreme. It seems to take almost nothing to trigger the change. I’m treading on mood eggshells and wary of the world. It’s tricky to trust in any individual moment.

It seems that both medication withdrawal and day to day management of my mental health is massively exacerbated by hormones at the moment. The worst weekend in October was a period weekend too. I need to recognise it and ride it out but it’s hard hard hard. Hopefully the worst will be over this month.

Writing, running and cake

Writing things down has helped – but on days like this I only feel myself when running. So I’m going to run and run and breathe deeply and listen to the world and watch Watson chase squirrels and hope I come back calmer – and ready for some birthday cake.

Pills and Pregnancy – when careless journalism damages vulnerable people

Pills panic

Sitting down at my desk this morning, I opened Twitter for my usual pre work browse. My eye was caught by this tweet, which linked to an article by the BBC ‘Antidepressants ‘could be risk to unborn babies”.

Of course, I clicked straight through. My recurrent depression and uneven support and information from mental health services means I have been on varying doses of Citalopram since I was 17 – almost 13 years now. For most of the last seven years I have been attempting to reduce my dose.

I have a range of support and techniques in place – Mindfulness, exercise, writing being the main ones. Despite these, I haven’t managed to get below 20mg. Above 20, all is well. Below 20, things become a slog, a constant joyless fight against endless rumination and negative fog.

I’m also almost 30 and with a long term partner. It won’t be long until I’m thinking more seriously about pregnancy. Future pregnancy is one of the reasons I am trying to cut down. I’ve been told in the past by doctors that they would always recommend a mother continued with appropriate antidepressants during pregnancy if she needs them – that a depressed mother is a much greater risk to a baby than anything else. But, ideally I’d rather not be taking them – especially given the occasional headlines about the risks. These tend to ‘trigger’ increased worry and rumination associated with depression. It’s not always rational – but depressive thoughts aren’t. Continue reading

Understanding mental trickery – notes from depression island…

The three tricks that a depressed mind can play on you – and how to overcome them.

An ongoing balancing act

I would describe managing depression as an ongoing balancing act. A lot of that is knowing and understanding how my thought processes work and what influences my mood.adore endure

Alas, the mind is a tricksey thing and knowing it is a complicated process. I’ve been thinking about some of those nasty mental tricks a mind prone to depression can play. In the course of trying to make sense of them I have been thinking about depression through the metaphor of inhabiting islands. But I’ll get onto that…

Tricky thing 1: The reverse motivation caused by depression

My Mindfulness Based Cognitive Therapy (MBCT) course spoke about the reverse motivation often present during depression. You can read a bit more about that session in my Mindfulness diary for Mind here – ‘How can I best take care of myself‘.

So what is reverse motivation?

Usually we want to do something and then we do it. When depressed, sometimes we have to do something in order to want to do it. The motivation comes second.  I know that sometimes I end up feeling better by making myself put one foot in front of the other and doing something I initially really do not want to do – often exercise (which I write more about here in ‘Running stops my thoughts running wild‘), visiting friends or getting to work.  However, it can be hard to persuade myself when in a very low mood.

Why? Well partly I think this is down to another sometimes quite devastating trick that a depressed mind can play. Continue reading

Mind the gap – GPs, antidepressants and mental health support for young people.

“I’m not going to give you another prescription”
“What… but I need it.. (panics)”
“Don’t worry, I was just testing to see if you really did still need them..and I think you do”
GP in Fenham, Newcastle

“Just take them when you feel you need to”  – to me aged 17.
GP in Cumbria

“So, do you want to kill yourself then?” – on a routine prescription pick up.
GP in Bow, London

“It’s important you stop taking this medication as soon as possible, we have no idea what impact it can have, especially if you start taking it when you are under 18”
GP in Fenham, Newcastle

“It’s fine for you to take it as long as you need to, even for ever”
GP in Tower Hamlets, London

“They’re not addictive”
GP in Cambridge

“You will get withdrawal symptoms”
GP in Byker, Newcastle


The above is a selection of the contradicting information and advice – as well as frankly bizarre approaches and attitudes I have experienced in the twelve years I have been seeing GPs regularly. 

(2016 note – I wrote this piece in 2011 when I was just getting started blogging – but a lot of it is still relevant)

Personal and practical barriers to getting support from a GP

I’ve spent lot of time supporting young people to take the first steps to support. Their GP is usually the gatekeeper for services.  A lot of young people really struggle to get the mental health support they need, facing a number of personal or practical barriers along the way. As well as support in articles, live chat and on discussion boards, one of the projects I was involved in at YouthNet (now The Mix) was crowdsourcing and discussing experiences in order to create community content to help others overcome these barriers. The project really highlighted the frustrating reality of trying to get the support you need from local health services. Continue reading

How can exercise help depression?

what role does exercise play in managing depression

Earlier this week, when the ‘exercise no help for depression’ stories were published on the BBC and the Guardian, I quickly pulled together some of my initial thoughts and frustrations with the way the research was reported. Since then, I’ve had a chance to think about it in a bit more depth.

The debate on exercise and depression

I watched the debate and discussion throughout the day. Those involved came from a range of perspectives and angles. Many people who got involved had experienced depression themselves. Some were in the middle of a bad episode, others had experienced it in the past or felt that they were ‘managing’ their depression to prevent relapse.

Some had found exercise improved their mood or helped them manage, others not. For some it depended on the severity of the depression experienced. For some, exercise was not considered ‘helpful’ unless it formed part of a ‘treatment’ leading to a cure. For others if it enabled them to manage better on a day-to-day basis this was enough.

What was interesting was that while some were supporting or arguing against the research itself (that one particular form of facilitated ‘encouragement’ to exercise doesn’t help in treatment) many were responding to the simplified message in the headline – that exercise doesn’t help depression.  And many responded with the simple answer, ‘Well, it helps me get by.’ While the Department of Health can conclude that TREAD, in the way it is currently delivered, does not work, the mass of anecdotal evidence that this study has generated should give them pause for thought. Continue reading