Tag Archives: withdrawal

WRISK – understanding and improving communication of risk during pregnancy

The WRISK project is a collaboration between the British Pregnancy Advisory Service (bpas) and Heather Trickey at the School of Social Sciences at Cardiff University. They are aiming to draw on women’s experiences to understand and improve the development and communication of risk messages in pregnancy.

They asked me to blog about my experience of taking (and trying to stop) antidepressants before conception, during and after pregnancy. I was happy to oblige. I was given conflicting and simplistic advice from various GPs. They failed to give proper weight to the complexity of my experience and used the concept of risk to make me feel guilty and disempowered. This needs to change and I’m glad to support the WRISK project in trying to do so.

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.