Monday, 27 December 2010

The catch 22 of antidepressants

Over the last few months I have been thinking a bit more about the path to recovery from depression and the catch 22 of taking antidepressants. For post natal depression and recurrent depression the research shows that a combination of medication, cognitive behavioural therapy, excercise and good nutrition can help people to recover and maintain good mental health. But the problem with research is that despite it being very convincing, resources are limited and medication remains the cheapest and seemingly easiest option.

I have had a lot of counseling over the years, including CBT, but I still had a severe depressive episode. At the time I was too ill to do any of the self help techniques I had learned and forget diet and excercise when you are recovering from a cesarean and breast feeding round the clock. So for me medication was the miracle I needed to keep me in the land of the living. Over the months the sense if joy and hope I experienced was something that had been missing from my life for the past decade, as I struggled with what I now recognise was chronic low level depression. It was like I was seeing what life was like for other people for the first time and I finally saw what all the fuss is about. It is decidedly scary that I lived for so long being so unhappy and thought that was an acceptable way to live and that it was my fault. So medication has really been a miracle for me.

But there is a down side to having such a positive experience with medication. It means you are easy to treat and it has given me the false idea if I just pop my pills each day, I don't need to think about my mental health or take any greater responsibility for my recovery. Also at the time of deciding to accept medication it really wasn't the time to discuss side effects, long term issues or how to wean myself off them. So 18 months on I am realising that "mother's little helpers" are not a quick fix and that I am still unwell. Well people don't need medication every day to function. And I do.

I recently changed medication. The drug I was on is Paroxetine. It is the best SSRI to use while breastfeeding as it is not transferred into breastmilk in any large amount. However it is also the most difficult of the SSRIs to discontinue and has awful side effects when you withdraw. I tried cutting down my dose and within three days definitely was struggling. That really scared me. Suddenly I felt trapped rather than freed by this medication and I also felt a bit angry that I hadn't know more about it. It wouldn't have changed my decision to use it but I may not have been so naive and "pollyanna" about it. Thankfully it is possible to make a direct switch from Paroxetine onto Citalopram. Citalopram is not as safe for breastfeeding but Paroxetine has a risk of causing birth defects. There are no plans afoot for number two but I wanted to change so that if and when we decide to have another we didn't have to have doctors involved and there would be no pressure on me to change medication in order to conceive.

Thankfully in New Zealand these drugs are subsidised by the government drug agency Pharmac and so the cost has been nearly zero for me. However, in changing medication and struggling a little with anxiety and accepting I still have depression, I have been comtemplating what I can do to help myself. The next step for me is to see a psychotherapist who specialises in PND. However, there is no funding or services for me because my daughter is over one year. While she was under one I could have gone to a support group and had more counselling. But I thought I was doing so well, and I was. So I was discharged. I have only praise for the Maternal Mental Health team who cared for me. They are operating with limited resources and have to prioritise. But I am a statistic waiting to happen. I know that if I don't do something either I will never have any more children for fear of PND, or I will just end up back in the same position. Or possibly take drugs for the rest of my life when they was a possibility I didn't need to.

Now therapy is expensive. $100-200 an hour usually and most people can't afford that. So for those who suit antidepressants it is hard to afford to do the best for yourself so that you can eventually manage life and depression better. It seems a strange logic to give people drugs but not help them make the long term changes to their lives to promote long term health.

It shows that though there is more recognition that health does not just mean the body but includes the mind and that holistic treatment is the most effective, the money just isn't there to turn knowledge into practice.

Mothering Tank

Christmas has come and gone and the dust is settling. Just before Christmas Ella and I were struck down by a nasty bug and I was busy with finishing off at school. We also had some family worries on our minds. So by the time we packed up for the road trip to my sister's for Christmas I was feeling pretty stretched and like I might topple over in a stiff breeze.

Through all of this my mothering tank had got a little empty. For me it is the sense of having enough to give to my child and the patience and thoughtfulness that a busy toddler needs. Ella has been feeding like a newborn since she had the tummy bug and with the heat I have been feeling a little sucked dry. And the family road trip, though heaps of fun, doesn't leave much room for Mummy time. Throw in time with family who are watching your child and commenting on their development - supportively! but still commenting, it is a recipe for a Mummy breakdown.

What I needed was some deposits in my mothering tank. And they have come just as I really needed them. Watching Ella enjoy family and new experiences while we were away has made me marvel again at how much of a miracle the growth and learning of children is. As she soaks up life and explores it is such a joy and a reward for the hard work I put in each day. Hubby and I also had a great talk as we drove home about how much we love Ella, her quirks, her confidence and even the things that other people may see as not so convenient or acceptable. I also got home to find the first issue of The Natural Parent magazine in my letterbox. Reading about the things which I think about as a mother, provides nourishment and inspiration. And the La Leche League magazine Aroha is full of the personal experiences and struggles of Mums just like me.

I think the holiday season can be full of excitement and lovely time as a family. But it can also be exhausting and a time when the tank runs low. So I hope you find ways to fill your tank as a parent this holiday season and remember that your children want you. Just you. And you need nourishment yourself for that to be possible.

Sunday, 19 December 2010

Christmas Stocktake

My lack of posts recently is really reflective of a general feeling that my life is too full. And adding blogging to my life which seems to already be bursting at the seams, seemed impossible. But as I have been lying awake at night in the awful Auckland humidity I have been wondering how things ended up like this and conducting a little stocktake of my life.

I am not one for New Year's resolutions. They are always made in a fit of idealism and never seem to be achieveable in my actual life. It is also a little depressing when they are the same every year. Maybe 10 years on this year will be different? Somehow I don't think so. They also seem to feed into my tendency for perfectionism and unrealistic expectations for myself. I went through a phase where I just felt allergic to goal setting at all. Now I seem to have reached some sort of happy medium where I want to reflect on how my life is going and what I enjoy and what I would like to change. But no crazy goals which just lead to disappointment and seem to be based on some other version of me who needs and cape and to wear her undies on the outside.

The pre Christmas madness is the perfect time for a stocktake of my life. It highlights my priorities and the imbalances. It also is the time I feel the most strung out it limits what I think I can manage so stops me from being unrealistic. And I tend to be focussed on what is truly important and my values.

So the short version is that I need to take better care of myself and do less. I need to stop thinking of new things I 'should' do and enjoy doing less. If I see a problem around me it doesn't mean it is mine to solve. And that I am an adult and try to deal with my own issues so the other adults around me should do the same and I don't have to try to keep everyone happy.

The practical side of this is:
  •   one day a week as an at home day.
  • work on my fitness and sort out my back pain. 
  • I love to write so make blogging a priority and something I do for me.
  • Remember that I work so I can't act like I am at home everyday and do all the things that Mums who are at home can commit to.
  • Spend more time with my hubby
  • Focus on enjoying now rather than planning the next thing.
  • No more commitments! I have enough in my life to be doing right now.