27 weeks: pregnancy and medication

I had an appointment with the perinatal psychiatrist recently. I’d recently got discharged from my old mental health team and am now with them and again I have a psychiatrist and a community psychiatric nurse. The first opinion I had of my new psychiatrist was that I didn’t have one. When I told people my opinion of her after the first meeting I said that she hadn’t really left much of an impression – good opinions take a while to form whilst bad ones of someone can take an instant. But I had some faith she’d do the job.

My new CPN  I didn’t much like. She said that everything I was experiencing with my mood was normal when I knew that it wasn’t and she also made me feel pretty bad for not wanting to do antenatal classes. I got invited to some a few weeks back, but I have since been umming and ahhing over whether to do it for numerous reasons but involving the fact that it was at the old youth group centre I used to go to and I didn’t want to bump into the old youth group leaders with their judgmental opinions about a 19 year old getting pregnant. But also another reason is that I had been feeling disconnected to the baby and that I didn’t want to spend an hour or so being reminded of the fact that I was. Plus antenatal classes haven’t always been a regular thing for pregnant women to attend and women have had babies just fine without them.

Another thing she said that annoyed me was that it didn’t matter if I was ill because I could get someone else to look after the baby. It’s true, I have my dad and the father of my baby but if it doesn’t matter whether I’m there for the baby, why am I even bothering to get better? After cooling off from the appointment I realised how she actually meant it but seriously? You work in this profession, you HAVE to know how to word this properly.

But the thing I want to talk about is my second appointment with the perinatal psychiatrist. I get called in and she has basically forgotten who I am which isn’t necessarily bad except when she got things wrong about my life e.g. she said I lived in a studio apartment when I live in a 4 bedroom house with overcrowding issues and I then corrected her, she actually argued with me and told me I was wrong… I have to live there everyday, I know exactly where I live.

She then was reading the appointment notes from the new CPN and she told me that “wanting to cut the baby out” was not normal – which I knew. Then went onto imply I wanted to hurt the baby except I’ve never had any intention of hurting the baby. Hurting myself, yes. Hurting the baby, never. She said if I’m having these thoughts and feeling depressed (and I am but only every so often and I haven’t actually felt that depressed in a while) then I needed to go back on medication whilst pregnant. I’ve always been against it. I don’t judge anyone who does, I really don’t. Every situation is different. But I know that I’m sensitive to side effects, I know I can handle the low moods as they are every so often, I don’t think taking antidepressants (as were the only medication mentioned at the time) is wise for an unborn baby to be exposed to.

But rather than talking rationally about my fears and answering questions she snapped at me telling me I needed the antidepressants and when I said to her about being bipolar and that JUST being on anti-depressants could cause mania or like last time, rapid cycling moods. That would be way worse than what’s going on now. She didn’t really give me much of an answer, just that she’d talk to my old psychiatrist (whom never actually prescribed antidepressants alone) and that if need be a mood stablizer would be added.

To be honest, when medication was mentioned way back in the first appointment, I researched what people said and yes the antidepressants have been found, in recent studies, to have minimal risks to the baby (so not completely risk free like she tried to make out and when I asked about the minimal risks, she had no answers for me) but mood stablizers are very dependent on which ones and even then the research is very split between the risks to an unborn baby even in the third trimester (everyone agrees that no meds of these sort should be taken in the first trimester).

But the fact I don’t like her isn’t based so much on the her different opinion on medications and stuff, it’s that she had very little respect for me. Wouldn’t discuss options, just told me what I had to do and several times implied that if I didn’t follow her opinions I was going to be a bad mum. So when she handed me a piece of paper to take to reception to make another appointment, I just walked out and didn’t make one.

I moaned to my dad; ranted. Then GC phoned me when my dad went to pick up my brother but could only stay on the phone for 5 minutes and once he hung up, I just balled my eyes out. I felt so guilty and bad and just cried. Until I hit this point where I got pissed off. Being  pregnant hasn’t been easy for me – physically or mentally but I’m doing better now. I actually have formed a connection with my child now (which if she actually let me speak I could have said) but even so still experience lightheadedness, feeling faint (up to the point of passing out), nausea – all sorts of stuff that make pregnancy still difficult but I’m doing well with it now and coming out of a perinatal psychiatric appointment feeling worse about myself as a mother is not something I think is good and is kinda the opposite reason why I go.

That afternoon, the CPN called me but it was on an unknown number and I wasn’t in the mood so ignored it, she left a message asking if I could call her back to confirm an appointment for the 6th of May. I haven’t called her back. Partly because I just don’t want to but also because she asked me my preferred method of contact and I said text and she calls me so I’m just waiting to see if she calls me back.

All in all, I’m very underwhelmed by the perinatal team and regret being changed to them.

Science Blog: Why antidepressants cause mania/rapid cycling

Antidepressants and MAOIs both of which increase functional monoamines (contribute to stable moods, and an excess or deficiency of monoamines seems to cause or result from several mood disorders) neurotrammiters (E.G. norepinephrine, dopamine and serotonin), are known to precipitate mania or rapid-cycling in an estimated 20-30% of patients.

There has recently reported a strong association between velo-cardio-facial syndrome (VCFS) patients diagnosed with rapid-cycling bipolar disorder, and an allele encoding the low enzyme activity catechol-O-methyl (controls the degradition of the enzymes for dopamine, endrinephrine and norepinephrine) transferase variant (COMT L).

Between 85-90% of VCFS patients are hemizygous (an individual who has only one member of a chromosome pair or chromosome segment rather than the usual two) for COMT.

Homozygosity (The state of possessing two identical forms of a particular gene) for the low activity allele (COMT LL) is associated with a 3-4 fold reduction of COMT enzyme activity compared with homozygotes for the high activity variant (COMT HH).

There is nearly an equal distribution of L and H alleles in Caucasians. Individuals with COMT LL would be expected to have higher levels of transynaptic catecholamines due to a reduced COMT degradation of norepinephrine and dopamine.

It is therefore hypothesized that the frequency of COMT L would be greater in Rapid Cycling BPD ascertained from the general population. Significantly, we found that the frequency of COMT L was higher in the ultra-ultra rapid cycling variant of BPD than among all other groups studied .

These findings indicate that COMT L could represent a modifying gene that predisposes to ultra-ultra or ultradian cycling in patients with bipolar disorder.