Sunday, 21 August 2011

No walk in the park ......

This is the story of my experience of depression in pregnancy.

I married in March 2009 and started trying for a baby after the nuptials - a good focus for the honeymoon.  I thought it was going to take a while to conceive, at least a year, given I was already 38.

Both my husband and I were mindful of preconception care before we started trying; exercise, good diet, vitamins, relaxation etc.

Then around a week before my period was due, end of April 2009, I started having the oddest experiences; mood swings (elation and irritation), vivid dreams about little people swimming to a light source (go figure!), tiredness whilst feeling spaced out and floaty, and an interest in make up which was very unusual for me.  I kind of knew at that point I might be pregnant.  I was also taking my temperature every morning on first waking which continued to read high even when my period was due, another indication of pregnancy.  By the time my period was three days overdue I was almost certain especially as my cycle was at the time clockwork regular.

Armed with all this evidence I marched off to the local supermarket and bought two pregnancy tests which both mirrored back a resoundingly positive result.  My husband and I were both delighted but equally shocked that it'd happened so quickly; it'd only taken two months.  We were also enjoying a very happy point in our lives as we'd just married so there were no obvious indicators for what was about to happen. To suddenly go from feeling happy and settled to holding onto my sanity was to be a deeply distressing experience.

I knew that pregnancy wasn't necessarily going to be easy based upon my previous reactions to the contraceptive pill.  I'd had no adverse affect to the pill during my early twenties and took a break from oral contraception until I tried it again on two seperate occasions in my late twenties and early thirties.  Both times didn't go very well as within a week of starting the course I had descended into a tearful depression.  Both times I stopped taking the pill immediately and within weeks was feeling much better again.  I felt certain I had reacted negatively to the pill.  This also made me feel uneasy; as the pill releases the same hormones involved in pregnancy how would I react to the real thing?  This worry lay at the back of my mind for years to come. How would I cope with an adverse reaction to pregnancy?

Week 5 into my pregnancy and I had already started feeling hormonal, teary and irrational.  Like my usual PMS I thought and so far tolerable.  Then this suddenly descended into the darkest depression. Some days I couldn't leave my bed and had to take time off work.  The depression escalated and I cried constantly.  It started to almost feel psychotic in that I was losing sense of myself and fragmenting into pieces.  I just couldn't get a grip on what was happening or my sense of reality.  I ceased to function well, I couldn't cope with anything and would spend hours staring into space.

It's difficult to put into words the depth of the experience so I'll try my best in the following sentences.  I felt cut off from everything around me like I was contained in an impenetrable membrane.  I couldn't escape and no one could reach me from the outside.  I felt deeply alone and sucked deeply inside myself.  All I could hear were my internal cries.  I felt totally overwhelmed and could almost physically feel the birth hormones whirring in my brain.  I felt like I had been taken over (and essentially I had as I was growing a baby), my body hijaked and that I was caught up in something I didn't seem to have any control over.

At the worst point (weeks 6-9 of pregnancy), and for the first time in my life, I experienced unwanted suicidal thoughts continously;  my head filled with painful, vivid imagery of placing a gun at my temple and pulling the trigger. All I obsessed about was ending my life; it was very frightening.  I actually started trawling the web for places I could purchase a gun from - absolute madness. I was literally crawling the walls - I wanted out of my head and body.  It came to a point that I actually thought about terminating the pregnancy - it was the baby or my sanity.  It was very distressing to entertain the idea of terminating a wanted pregnancy.

Not only did I feel alone but so did my husband.  As we'd decided not to tell anyone about the pregnancy until after the results of the first scan my husband felt totally unsupported and lost in the situation.  What was happening to the happily married couple?  Why was his wife disintergrating before his eyes? He felt he was losing me.  There were times he wanted to run to the hills.  He couldn't cope with my breakdown.  Every day he was inundated by my terrified phonecalls and would come home to a sobbing and traumatised wife.  It was very hard for him when I expressed my concerns about whether I could continue with our pregnancy.

Given the acute reaction I was having I felt very sure I was reacting badly to the pregnancy hormones.  In addition the depression also raked up lots of personal material; psychological stuff around my childhood, and ambivlence around having a baby.  I wondered if I was doing the right thing, whether I would make a good enough mother and feared the unknown path my life was taking.  The enormous responsibility of raising a child seemed too much.  This was all compounded by pregnancy fatigue, nausea and sickness.

I also felt upset and angry as my pregnancy should be a cause for celebration.  Why was this happening to me?   I felt pressure that I should be feeling happy as this is what you are 'supposed' to feel at this time.  The myth that pregnancy is one of the most joyful experiences for a woman seems to be perpetuated in our culture.  For some it really is a very straightforward, wonderful and textbook experience but for others its hard work and can be debilitating.  My heart goes out to those women who suffer from acute sickness, hyperemesis gravidarum. This condition causes unrelenting nausea and vomiting often throughout pregnancy, and is marked by rapid weight loss, malnutrition and dehydration. It can lead to complications for the mother and her unborn baby.

So if you are having a bad time it can feel pretty isolating when it seems that all the other mum's to be are really enjoying their pregnancies.  I felt very alone and actually very ashamed and embarrassed that this was happening to me - surely something must be wrong with me?  Fortunately I found some solace in chat rooms on mumsnet where I read about other women's experiences of depression in pregnancy (I wasn't the only one).  I managed to stumble across the only website I could find dedicated to antenatal depression which offered invaluable information and support.

Fortunately I had a very supportive GP.  She placed me on her priority list and encouraged me to see her as often as I wanted.  After weighing up the pros and cons we both decided that a course of antidepressants (citalopram) would be the best way forward - it was certainly the more preferable option to terminating a pregnancy .  I still felt nervous about taking medication and the impact it might have on my baby.  I started taking a low dose at week 9 which continued until a few months after my baby's birth. The medication really helped and allowed me to enjoy the rest of the pregnancy.  Incidentally my baby was fine.

In addition I saw a counsellor; talking through what had happened helped me to understand, process and ground my experience.  I am a counsellor myself but my experience felt so extreme that I knew that just talking to someone once a week wasn't going to be enough in this instance - I actually needed 'chemical readjustment' as well.

I cannot advocate taking anti-depressants and if you are in a similar situation then my advise is to consult your options with your GP.  You need to assess what is right for you.

I also had a very supportive boss.  At week 7 and after being absent for so many days I had to come clean and tell him about my pregnancy and the accompanying depression. He shared that his grandma had once told him that 'pregnancy is no walk in the park' which felt very reassuring.

When I finally went for the first scan I had almost forgotten that I was pregnant;  I had been so focussed on the depression.  When I saw the image of the tiny little thing wobbling around inside it helped me to turn a corner. I began to realise all the hard work my body had been doing for the past number of weeks.  This was my pregnancy and this is the shape it took; it helped me to accept the depression.

By week 15 I started feeing markedly better; my mood and tiredness lifted and the morning sickness ceased.  My second and third tri-mesters felt a world away from the first.

However I sometimes continued to feel self conscious about what had happened. When I talked to friends about my first tri-mester and the depression I omitted describing the suicidal thoughts bit.  At around week 16 I went to a Summer BBQ party and I tried opening up a little to the other mum's during a discussion about pregnancy.  That wasn't a great idea; I was met with blank stairs, the other mums didn't know what to say.  To me this emphasised the aloneness of being in mental illness and other's 'not quite sure what to say or do' reactions to it. Mental illness still evokes a certain almost fearful reaction; maybe because when we are faced with it it puts is in touch with our own fragility which can be quite a scary prospect.

My experience of depression in pregnancy is now playing its part in my decision whether to have another baby; could I go through that again?  I worry that it's likely to happen again, especially if it's caused by hormonal imbalance, and the impact this would have on my little daughter.  On the other hand pregnancy is also now a 'known quantity' and what went before will help prepare me in case the experience repeats itself again.
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