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Medication and pregnancy


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Hello, I’m new here so apologies if I get this wrong, but I was hoping for some advice I find it difficult to get in real life. 

I used to be on Fluoxetine and personally found it to be hugely transformative. But due to moving/finding it difficult to get ahold of prescriptions I went off it about a year ago.
 

Now I’m settled and myself and my husband are trying to have a child. At the same time my OCD is particularly bad. I’m feeling depressed, struggle with contamination, ruminations and past guilt to the point of just sobbing uncontrollably or else feeling frozen and unable to do anything. I wake up almost everyday with the feelings hitting me in a way that make it difficult to function. 

All that is to say, does anyone know where things stand with taking fluoxetine while getting pregnant or being pregnant? I was prescribed it by my doctor and mentioned we were trying so they gave me a scary disclaimer about health issues for the child.
 

When I mentioned my concerns his response was along the lines of it being that the parent’s needs is as important as the child’s. The irony being that OCD makes it difficult for me to do this without carrying unbearable guilt for any harm I might cause the child. But equally I am worried about the implications of having a child when my brain is like this. I know from friends there is all sorts you can get obsessive about and I want to be mentally sound for them. 

I have thought that I could put up with 9 months of a bad brain in order to not spend the rest of my life feeling guilty over potential harm caused. But at the same time every day feels like mental torture and I’m already carrying lifelong guilt for various things. It feels often like I’m tainted and so don’t deserve anything good. I can only get around it by living for the purpose of my husband or future child both who deserve good things. 

When I look it up online it seems fluoxetine is safe and there’s nothing conclusive about harm caused. But other sources can be quite scary about the damage done. My husband is hugely supportive and thinks I should take medication if I want to, but it feels like the burden for the child’s well-being is on me for being the one carrying it (all hypothetical at the moment) and I’m really struggling with that. 

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Your last paragraph does not mention the sources. There is a specialist pharmacological service that can answer the question. It is based in London at the largest mental health trust. This service used to be open access and I used it in the past. But access is now restricted to medical personnel as it became too poupulat. So I would ask your GP if he or she could contact the service. Many GP practices nowadays have a pharmacological advice line this would be an alternative route to answer your question.

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Thank you for this - I hadn’t thought about that. And to be honest it’s mostly a bunch of blogs, so nothing definite. I’ll try and approach my GP but I find it difficult to speak to them about mental health. It’s scared me away but I need to be more forthcoming. 

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In the UK if a woman is pregnant who is on an SSRI they usually try and switch you to sertraline if possible, as sertraline is very safe in pregnancy. That's not to say that the others aren't safe it's just that sertraline is linked with less issues in the baby once they're born. The main issue is that babies can be born "addicted" to the SSRI that you're on, but all that means is that they may need a short stay in the neonatal unit to medically withdraw from it. I used to be a neonatal nurse and I've looked after babies who had medication withdrawal. They're normally fine after they've had their treatment and can go home with no issues. This doesn't happen in all cases but it's more likely to happen if mothers are taking an SSRI other than sertraline.

There is also a possible slight increase in risk of other problems too but these aren't completely proven. In many cases not being on any SSRI at all can be riskier for the mothers health and wellbeing, which can cause more stress for the baby leading to other problems, so on balance the best thing is for the mother to continue taking them. Worsening mental health in pregnancy can also lead to postnatal depression/postnatal psychosis after the baby is born which is absolutely horrible.

So in short don't worry too much about staying on your medication whilst pregnant as in most cases it's absolutely fine.

https://www.mind.org.uk/information-support/drugs-and-treatments/antidepressants/antidepressants-in-pregnancy/

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Your post resonates with me so much. I am hoping to get pregnant some time next year but the thought of coming off my medication is a bit of a worry (I'm on sertraline and I dread to think how awful I'd feel if I wasn't!).

I believe this is an evidence based website about medication and pregnancy https://www.medicinesinpregnancy.org/

Ultimately you, hopefully with the help of your doctor, will make the choice that is best for you at the time. That is all any of us can do. Let us know how you get on. 

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Thank you all for the resources and advice. I'm going to see what I can set up with my GP and think I'm leaning towards Setraline if I do go on medication. Knowing that choosing not to deal with my mental health can also be detrimental is actually very helpful as I find it easier to do things for the benefit of someone else. 

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It would be better to treat your OCD before you get pregnant. There are huge hormonal swings that affect OCD. Also, your child is going to be a source of OCD obsession. There are lots of topics on this in the forum, where you have women with OCD who get pregnant. Also, Brainlock has stories about this.  

 

Sertraline rating is C by American Association of Pediatrics. 

Medication is not required to recover from OCD. CBT works just as well.

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Handy I really wish you would be a bit more mindful of the things that you post.

Many women with OCD get pregnant and manage it well, just like with any other health condition. OCD is not a barrier to becoming pregnant or being a good parent. The best thing is to be open with the professionals caring for you about your diagnosis and treatment and they will be able to help you. In the UK there are very good perinatal mental health services who help women with mental health problems when they are pregnant and after they've had their baby. I've looked after lots of babies whose mothers have mental health issues and they have been fantastic parents.

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2 hours ago, Lynz said:

Handy I really wish you would be a bit more mindful of the things that you post.

Many women with OCD get pregnant and manage it well, just like with any other health condition. OCD is not a barrier to becoming pregnant or being a good parent. The best thing is to be open with the professionals caring for you about your diagnosis and treatment and they will be able to help you. In the UK there are very good perinatal mental health services who help women with mental health problems when they are pregnant and after they've had their baby. I've looked after lots of babies whose mothers have mental health issues and they have been fantastic parents.

This.  Entirely this.  It's all very well and good saying 'treat your OCD' first but that's not how it works in most cases and it doesn't have to be how it works.  I don't have anything else to add to what Lynz has said I just want to back up her post because she's correct - health issues are not a barrier to parenthood and making up some stupid rule about what you have to do first in order to succeed doesn't help anyone, especially not someone with OCD.

 

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I am UK-based, so going with advice from those with experience here. I've thought about whether I should have children at all, because of my issues, and have had many an extensive conversation along those lines. I don't approach this lightly. Thank you for the reassurance Lynz and ocdjonesy, I think I have a clearer idea of what I'm going to do moving forward as far as accessing medication and perinatal care. 

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2 hours ago, Catfan said:

I am UK-based, so going with advice from those with experience here. I've thought about whether I should have children at all, because of my issues, and have had many an extensive conversation along those lines. I don't approach this lightly. Thank you for the reassurance Lynz and ocdjonesy, I think I have a clearer idea of what I'm going to do moving forward as far as accessing medication and perinatal care. 

You're welcome, Catfan, and all the best for your future plans 😊

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On 24/11/2022 at 05:01, Lynz said:

Handy I really wish you would be a bit more mindful of the things that you post.

Many women with OCD get pregnant and manage it well, just like with any other health condition.

The ones that post on the forum are not managing it well. Just look at the perinatal & postpartum posts. Perinatal OCD, Postpartum OCD, PMDD, etc. 

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6 hours ago, Handy said:

The ones that post on the forum are not managing it well. Just look at the perinatal & postpartum posts. Perinatal OCD, Postpartum OCD, PMDD, etc. 

Well yes, because generally speaking I would think those that are managing it well probably don't feel the need to post? 

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On 24/11/2022 at 13:01, Lynz said:

Handy I really wish you would be a bit more mindful of the things that you post.

Many women with OCD get pregnant and manage it well, just like with any other health condition. OCD is not a barrier to becoming pregnant or being a good parent. The best thing is to be open with the professionals caring for you about your diagnosis and treatment and they will be able to help you. In the UK there are very good perinatal mental health services who help women with mental health problems when they are pregnant and after they've had their baby. I've looked after lots of babies whose mothers have mental health issues and they have been fantastic parents.

Hi @Lynz,

as someone who is thinking of trying to get pregnant next year, I found your post really reassuring and encouraging. It's a really scary thought but we can't stop ourselves from living our lives or wait an eternity to get better before trying to start a family. Life is what it is, every parent will struggle for one reason or another. You just have to do your best and go with it.

@Catfan, I can really relate to your fears and have been following this thread, but haven't had anything clever to say. I just wish you all the best. I think when we think about the future, it can look much scarier than it will actually be. I'm sure that you will through this and be a fantastic mum!

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7 hours ago, Handy said:

The ones that post on the forum are not managing it well. Just look at the perinatal & postpartum posts. Perinatal OCD, Postpartum OCD, PMDD, etc. 

Wow you want to maybe reel it back in a bit?  Needing and asking for support is not an indication that anyone is handling something poorly and it's judgements like this that put women off asking for any in the first place.  

Way, way, way over the line mate.

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18 hours ago, Handy said:

The ones that post on the forum are not managing it well. Just look at the perinatal & postpartum posts. Perinatal OCD, Postpartum OCD, PMDD, etc. 

I'm trying to respectfully say that you have absolutely no idea what you are talking about, Handy. A large bulk of my professional experience in my job in healthcare has been with mothers and babies, many of whom have had mental health issues (the mothers). Most have handled their pregnancies and newborns well. Whereas the sum total of your experience comes from reading a few posts on a forum, which is only going to feature the small amount of people who aren't doing so well at the moment.

I don't understand why you feel like you know better on this when you don't have any real life experience of this issue. And you also need to tone it down in telling women what to do about having children or not because that is not for you or anyone else to say.

The OP didn't come here asking whether she should have kids or not, she came here to ask for advice on her medication. To then tell her she shouldn't have kids is completely crossing a line.

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11 hours ago, malina said:

Hi @Lynz,

as someone who is thinking of trying to get pregnant next year, I found your post really reassuring and encouraging. It's a really scary thought but we can't stop ourselves from living our lives or wait an eternity to get better before trying to start a family. Life is what it is, every parent will struggle for one reason or another. You just have to do your best and go with it.

@Catfan, I can really relate to your fears and have been following this thread, but haven't had anything clever to say. I just wish you all the best. I think when we think about the future, it can look much scarier than it will actually be. I'm sure that you will through this and be a fantastic mum!

You're welcome Malina 😊. Good luck for the future.

Unfortunately I think sometimes other OCD sufferers on these forums can't look past their own perfectionist tendencies and black-and-white way of thinking about the world, so their advice tends to apply those same perfectionist rules on to other people's problems.

I always try and point out that there is no perfect world and the real world doesn't work that way. If everyone waited for these perfect conditions to exist before having children then nobody would ever have children!

I think also as a man Handy is speaking from a position of privilege that many women don't have when it comes to having children, which is time! In contrast we have a relatively small window of fertility in which to have children, so we can't really faff about for a few years hoping we will get magically better and for everything to be perfect before trying to have kids.

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