We need to talk about mental health and trying to conceive #takeoffthetape

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.

And then my periods stopped.

It could be the amount of exercise I was doing to manage the withdrawal and while I learned to function again. It wasn’t a healthy amount.

It could be the additional stress and anxiety caused by withdrawing from the medication and no longer having its support. A final goodbye kick in the teeth.

I went to my usual doctor. He strongly implied that he thought I shouldn’t have come off the medication – or should go back on. He said it often helps with conception as it makes you more relaxed. Which would have been some useful information to know at that first appointment.

Maybe if I’d known more about how trying to conceive can interact with anxiety I would have been more cautious – or at least more prepared. Either way that appointment pulled the only certainty of the last five months out from under me and added yet more questions to my attempts to find the right way to look after myself.

A truly difficult balance

I’ve been trying to balance a truly vicious cycle. I don’t want to go back on SSRIs just yet. It’s only been three months and I was on them for fifteen years. I want to give myself longer to settle and adjust. Coming off was so traumatic I would find it very hard to find a clear path to taking them again right now. But I do feel a regular low level of anxiety that surges up without provocation: spiky, sickening and refusing to be controlled. Except with exercise.

I need exercise to function. And I need to function. I need to be good at my work, to engage with friends and family, to be silly and loving with my husband and playful with my dog. That stuff is all vital to my mental health as well. Exercise has held it all together. With frequent long runs, cycles and regular challenging spin classes I can cope pretty well. Without them I become much less resilient and much more vulnerable to the automatic thoughts that kick off the spiral into anxiety and very low mood.

But something needs to change. My body is telling me that. In some ways (and on good days) I suppose that’s a cool thing. Nature is telling me I need to work things out, focus on recovery and find a better balance before it will think about letting me get pregnant.

I’ve been trying my best. I’m exercising less, eating better and doing more mindfulness practice. I’m wearing the world as softly as I can. I’m trying not to look directly at conception – and certainly not directly at everything Google has to offer on the subject.

Things are changing – and the signs suggest I might be ovulating again. Fingers crossed. And if not I’ll give things more time to settle. If it turns out that, at some point, that involves medication again, so be it.

And maybe, in a way, in the long run and whatever happens, trying to conceive will have also helped me find that balance and pushed me look after myself better than I was before. Let’s hope so.

 

P.S – I was quite anxious about sharing this. It’s not an easy thing to talk about. But when I posted it on Twitter yesterday I got responses like this. Which is why we should keep these kind of conversations going – and why I’m supporting #TakeOffTheTape.