Tag Archives: Research

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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Writing to the Information Standard for Mind and the British Lung Foundation

screenshot-2016-11-23-19-14-26If the events of 2016 have told us anything, it’s that people can write any old rubbish and post it online as fact. And people will believe them. Especially if those people are vulnerable or anxious.

And no one is more vulnerable or anxious than when it comes to researching health concerns. The internet is our first port of call for any worry – but news articles can leave us feeling confused and worried about what research shows and evidence recommends. I wrote about this in relation to antidepressants in pregnancy here.

Hundreds of other articles identify our most vulnerable moments and use them to drive traffic to their advert loaded pages.  If you’re struggling to conceive it’s hard to avoid clicking on an article entitled ‘Trying to get pregnant – 10 proven sperm killers!’

On the same search results page I found ‘10 things to do if you want to conceive’ and ’10 myths about trying to conceive’. They were basically the same and no one was any the wiser.

Reliable, balanced, current and evidence based information

The Information Standards recommended search hierarchy.

The Information Standard’s recommended search hierarchy.

It’s really important that people have access to reliable, balanced, current and evidence-based health information. Which is where the Information Standard comes in. Any organisation achieving the Information Standard has undergone a rigorous assessment to check that their information production process generates high quality, evidence-based, balanced, user-led, clear and accurate quality information.
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Strong, powerful, upsetting, thought provoking and with important teaching points – developing Miscarriage Association learning resources for health professionals

Sorry about the picture on the left....

Sorry about the picture…noone wants Trump on their blog…

Skimming through the British Medical Journal, I came across a blog called Breaking bad news in maternity care. It’s a lovely piece about the new learning resources I worked on with the Miscarriage Association.

I coordinated the development of these resources, working with the National Director of the Miscarriage Association, the Media Trust and lots of service users and health professionals. Mary Higgins describes them as strong, powerful, upsetting and thought provoking with important learning points. I’m pretty pleased with that.

The resources are online now although we’re not launching them officially until the new Miscarriage Association website is live. But it’s great to see that health professionals are finding them useful already.

There are six films  – one each for ambulance crews, A&E staff, GPs and booking in staff supporting women with pregnancy loss and two for anyone talking to women about management of miscarriage and what happens to the remains of their baby.  Each one is accompanied by a good practice guide.

Research

  • I created a short survey for women and their partners. It asked them the top three things they would like to tell the relevant health professional about their care – and had a free text box too. In the BMJ blog Mary Higgins writes ‘what I say will be remembered for the rest of their life’. And it’s true. Most women who responded remembered exactly what they were told – good or bad – even after 10 or 15 years. It’s so important to get it right.
  • I also surveyed health professionals to find out what they and their colleagues found hardest about these situations and where they would like more training.
  • I wrote a report on each of these six areas, identifying key learning points and pulling out quotes and experiences we should highlight.

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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

Using the web to provide peer support for emotional health and wellbeing

This is a write up of my thoughts, experience and findings from the In Petto conference  ‘Exploring Online Peer to Peer Support’ in Antwerp. I attended this, along with a volunteer peer advisor last November.

Structures and systems for providing online peer support.

At the conference we were focusing in more depth on peer support and how this could be given online.  Before giving our own workshop, we heard from a range of other organisations, each with quite different ways of offering peer support online. Continue reading