Posted by My OB said WHAT?!?.
Jul
11
Posted by My OB said WHAT?!?.
“Do You Want Anti-Depressants?”
“Do you want anti-depressants?” -OB to mother who was emotional about wanting to VBAC after two cesareans, at her 25 week prenatal appointment.
There are 42 comments to this post.
Sarah Dorrance-Minch had this to say,
Jul 11, 2010 @ 4:10 pm (Quote)
No, I do NOT want antidepressants (which are all class C or D in pregnancy anyway, so unless I am depressed enough to be calling the local suicide hotline or otherwise proving myself to be dangerous to myself or other people, most physicians wouldn’t be offering me antidepressants anyway, because the risk would outweigh the benefit).
What I WANT is my VBAC.
Also a competent care provider. You do not qualify. Not only are you tactless, but you blythely offered my possible teratogens just because you don’t like seeing me display emotion. I’ll be going elsewhere, now, thanks.
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Brenda Reply:
July 11th, 2010 at 4:36 pm (Quote)
Prenatal and post partum depression are very serious and you don’t necessarily have to be suicidal for the risks to outweigh the benefits of medication. Prenatal depression has been linked to many problems, not only for mom, but baby as well, including low birth weight and prematurity. Moms don’t need anymore guilt than they already have for seeking treatment, even including medication. Its hard enough.
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Erin Reply:
July 11th, 2010 at 5:24 pm (Quote)
Agreed. I know a lot of moms who were greatly helped by meds during pregnancy, especially those who already had children.
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Cmat Reply:
July 11th, 2010 at 7:51 pm (Quote)
Agreed, but I think the point is that this woman is probably not depressed, just frantic that she wants to have a normal birth and avoid repeat surgery. Being frantic and being depressed are two very different things. If she was depressed though, I hope the doctor found a way to help her. To me it just sounds like he/she is trying to brush it off as something else.
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Brenda Reply:
July 11th, 2010 at 10:49 pm (Quote)
I was referring to Sarah’s comment which implied it would be irresponsible? to treat prenatal depression with a prescription unless the mother were suicidal/an immediate danger to self/others. I strongly disagree with that presumption.
I agree, the OP’s doctor was a dismissive a** and I hope she switched immediately and got her vba2c.
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Sarah Dorrance-Minch Reply:
July 12th, 2010 at 9:24 am (Quote)
It would be irresponsible to casually offer a person antidepressants just because s/he is emotional. Pregnancy only raises the stakes. SSRIs, tricyclics, MAOIs, etc are not vitamins. They shouldn’t be handed out casually. Period.
Besides, plenty of studies have shown that most forms of depression, even major depression, respond only about as well to a placebo as they do to antidepressants. Tincture of time and cognitive therapy seem to be more effective for most cases. Antidepressants are most effective when used for chronic dysthymia and for severe, major depression – the sort that comes with suicidal ideation, violent threats, and delusions. In the latter instance, they work best in combination with mood stabilizers or antipsychotics. And therapy is still best kept short term, and combined with talk therapy.
I am aware that this is one of the biggest controversies in psychiatry, but there’s enough evidence that it’s actually made mainstream news outlets including _Newsweek_.
Any doctor who is quick to write a scrip for psychiatric meds at the slightest provocation is either unaware of potential side effects, dismissive of the emotional needs of his/her patients, or getting some kind of kickback from a pharmaceutical rep. Or all three.
When it is obvious that a patient is presenting with a serious disorder – and often the patient will say, “I think I have depression, I need meds, what’s safe?” or something along those lines – not allowing access to meds (or at least to a psychiatrist who can screen the patient and see what therapy is most appropriate) is also extremely irresponsible. Depression can actually trigger premature labour if there are other factors involved; it can make labour more painful and difficult. This is because depression raises the levels of catecholamines and other stress hormones, and inhibits the brain’s ability to process serotonin, dopamine, and oxytocin.
Depression is not the same thing as breaking into tears over a couple of miserable birth experiences. I found the doctor’s comment above to be dismissive and belittling.
Oh, BTW, I had PPD so bad after the birth of my first child that the only reason I didn’t kill myself was that I was too exhausted to even try. My first few months were a living hell. I think I know what depression is.
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cheeks023 Reply:
July 11th, 2010 at 9:54 pm (Quote)
agreed, however if this woman actually was depressed the doctor just blew any chance of ever helping her with his thoughtless and throw away remarks. If he had truly meant it I hope to heavens there would have been more tact involved.
No, it seems to me this was just a passive aggressive way of telling the woman to grow up and get over herself.
I think Sarah was being flip…If the doctor could so callously speak about depression then this is kind of a “tit-for-tat” so to speak.
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Sarah Dorrance-Minch Reply:
July 12th, 2010 at 9:35 am (Quote)
I was being dead serious. (I’m apparently even sarcastic when I’m not trying to be funny. Or so I’ve been told.)
I have a couple of editions of the PDR (admittedly, out of date and in need of replacement), Hale’s _Medications and Mother’s Milk_, several editions of the less in-depth _Pill Book_, a _DSM-IV_ (also out of date), and I do a lot of reading on pharmaceuticals and drugs in general because I think they’re interesting. When I was very young I tried to grow ergot on Minute Rice; I didn’t know much about horticulture (or about how Minute Rice work) but it does illustrate my perseveration rather nicely. I think drugs are interesting, even though I don’t generally use them.
I also like to read up on issues in psychology, to make up for my lack of natural instinct when it comes to people and social interaction. I have been reading about antidepressants and about what is considered most effective in the treatment of depression, including pre and postpartum, and currently opinion is leaning toward only using medication as a first-line treatment in certain types of depression.
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Emotions scare doctors. The OB values his or her surgical skill as setting him or her above midwives or physicians who deliver babies, so women who very emotionally and emphatically do NOT want their services, or feel the should not have delivered via surgery in the first place, cause them cognitive dissonance.
We should be grateful. (And I’m grateful the option exists!) Any woman who is not entirely thankful for her cesarean, no matter what the circumstances, threatens their world-view and therefore is probably defective.
America is currently a shut-up culture. Give the grieving person a pill and the grieving person will go away and stop threatening the complacent world-view of the listener. :-b
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Sarah Dorrance-Minch Reply:
July 12th, 2010 at 9:48 am (Quote)
What REALLY scares me is that now that most of the first and second generation SSRIs and “atypicals” are going generic, and many of the antimanics and antiseizure meds are headed that way as well, the pharmaceutical companies are direct-marketing ANTIPSYCHOTICS to the general public.
“Studies show that many people do not find relief of their depression with just an SSRI. Abilify has been shown in clinical trials to be effective in treating depression when used in conjunction with an antidepressant…” The numbers are probably massaged the same way they were when SSRIs first came on the market.
Abilify, Zyprexa, etc are NOT just safe alternatives or conjunctives to antidepressant therapy. They are serious psychiatric meds that until recently were only used for treatment of schizophrenia and severe, delusional mania.
Then, after a few years, they started to be used off-label for the treatment of Alzheimer’s and dementia (no evidence that it worked; in fact, there is plenty of proof that antipsychotics are not effective or safe treatment for Alzheimer’s and senile dementia, and come with too many health risks, but doctors still continue to prescribe them off-label anyway, the same way they continue to use Cytotec to induce labour despite the manufacturer’s black box warning against that use).
The manufacturers smelled money, just in time for the the expiration of the patents on various antidepressant standbys.
So now antipsychotics are being peddled as antidepressant therapy.
Hello? These drugs have serious, permanent side effects. Tardive dyskinesia and diabetes are not rare misfortunes; they’re somewhat uncommon, but there is a world of difference between “uncommon” and “rare.” There are other side effects as well. You can read about them online, or in a book about medication and its side effects.
Sometimes Big Pharma really disgusts me.
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Heather P Reply:
July 13th, 2010 at 4:36 am (Quote)
I agree with you on a couple points but not all. Medicines going generic is a good thing. This means that people who can’t afford the $200 for a 30 day supply of Abilify can get it. (Abilify is not currently generic)
My husband is clinically depressed and the two medications that work for him are not generic. He’s already tried ALL the generic drugs and they don’t work. We have to rely on free manufacture samples from his doctor in order for him to obtain his medicine.
That said, they shouldn’t be handed out like candy to people just because they want to avoid major abdominal surgery. They have serious risks that need to be discussed whether the risks are outweighed by the benefits.
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He was probably trying to be helpful, but… EPIC FAIL.
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Jane Reply:
July 11th, 2010 at 4:48 pm (Quote)
I was 25 weeks pregnant when I told my PCP my unborn baby was going to die shortly after birth. I asked him if he could prescribe me antidepressants then if I needed them.
The man had always been cold to me, but in that moment when he said he’d do that if I needed it, and he would find something fast-acting, I saw this helplessness in his eyes. That he’d trained and studied and practiced for all these years, and in the end, the only thing he could do for me was prescribe a pill I didn’t really want that MIGHT blunt the pain.
He was trying to be helpful.
I remained his patient for eight more years and after that, he was always warm to me. I don’t know if he changed for everyone, but to me, he had changed.
Maybe this doctor changed too afterward. We hope.
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cheeks023 Reply:
July 11th, 2010 at 9:57 pm (Quote)
Jane, how did you know if I might be so bold as to ask? Was it a gut feeling or a medical condition?
Sorry to be so nosey.
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Jane Reply:
July 12th, 2010 at 3:59 am (Quote)
“Routine” ultrasound at 22 weeks showed the baby had anencephaly. Her whole story is here: http://tinyurl.com/24sk4dr
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THe Deranged Housewife had this to say,
Jul 11, 2010 @ 5:49 pm (Quote)
“If it means you will get off my a$$ about this VBAC, then yes, give me a prescription right now!” Geez.
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I agree with everyone here, including The Deranged Housewife. No, I don’t want pills, I want a VBAC but if it will make you feel better doc, sure, give me pills & I’ll go home & toss ‘em in the bin & we will both be happy. Excuse me while I give my forehead an unhealthy dose of keyboard !!!!
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MOMof4 Reply:
July 14th, 2010 at 8:55 am (Quote)
I like that Anne!! I refused the RX and that is when I decided to find a doc that would allow VBAC.
When I was pregnant with my 3rd baby, I had been bleeding for three weeks. This same doc “thought” I was having a miscarriage and gave me a prescription to “finish” the job. HE didn’t even take a pregnancy test to see what was going on. Dumbfounded and couldn’t speak, I took the prescription and went to have a lab test. My HCG went up and up. I gave the prescription back to the doc and said, “I don’t think I will be needing this”. After my last blood test that went up again, He ended up with Bells Palsy. I had always hoped it was from trying to kill my baby but I learned that it is thought to come from the herpes virus.
Had I taken this prescription, I would have ended a perfect pregnancy!!! She is now 4 years old!
Believe me, I DO NOT go to this doc any longer. People told me I was crazy to continue to see him. I think I was too but I thought the best thing was to stay and pray for him. However, I regret it because at that pregnancy, I was desiring a VBAC as well and the only doc at that time was out of state and my husband wouldn’t let me go there. I do PRAY that he doesn’t do this to anyone else. I hope other women have the same instinct as I did when he offered these pills.
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Sheva had this to say,
Jul 11, 2010 @ 7:31 pm (Quote)
Brenda, you’re 100% right. When the benefits outweigh the risks for taking mess during pregnancy and postpartum, mom could and should take them. And kudos to her for taking care of herself.
But I think the issue here is that the mother was expressing dissatisfaction with her care during previous pregnancy and birth, an instead of accepting the disappoinent (and possibly the blame) and focusing on her requests for her care in the future, the doc made mom look incompetent and overly emotional.
And having seen the pulp that is left of some women’s self worth after being hurt (physically or emotionally) by caregivers, I think doc here was being a tad defensive.
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Brenda Reply:
July 11th, 2010 at 10:50 pm (Quote)
See my above reply.
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Sarah Dorrance-Minch Reply:
July 12th, 2010 at 9:57 am (Quote)
And mine. Given that there is massive and somewhat acrimonious debate going on right now about whether antidepressants are as effective as a front-line therapy as they’ve been made out to be, it would make more sense to refer a mother who presents with depression to a psychiatric specialist who probably knows better what is safe in pregnancy than an obstetrician or a family doctor, and who would be able to assess better what form of therapy would be most effective for the mother’s specific symptoms (drugs might not even work all that well in the first place. And then again, they might).
And usually a mother who is in mourning is not presenting clinical depression. Neither is a mother who is crying angry and emotional tears of frustration. Not all extreme emotion is clinical depression. In fact, most probably isn’t.
I am aware that many people who are depressed will not report it, but will keep it to themselves. However, I think many more will reach out for help when they need it. This is a good argument for depression screening as part of prenatal and postnatal care. Diagnosing depression or other mental illness simply because a pregnant woman starts crying in the office about an emotionally charged issue is inappropriate and patronizing in the extreme.
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CCindy Reply:
July 12th, 2010 at 12:47 pm (Quote)
Hey, did you know that the only thing more effective than Zoloft is exercise. Yes, you read that right. Put down the pills and go for a walk. The fact that this doctor is passing out pills like candy to a person who really only wants to be listened to is the problem. The fact that he is treating outside of his specialty could also be viewed as a problem. If I had started sobbing about how I didn’t think I could go on after my first husband died and how I didn’t know how I was going to endure Labor and delivery without him by my side. Do you think that would have been the proper diagnosis? No, neither do I. Stop throwing pills at everything! You are as bad as the U/S and Fetal Monitor obsessed OB’s. Never medicate for depression without TALKING about the circumstances first! It is completely inappropriate.
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CCindy Reply:
July 12th, 2010 at 12:55 pm (Quote)
Sarah that wasn’t for you, but whoever is arguing with you.
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Sarah Dorrance-Minch Reply:
July 12th, 2010 at 4:48 pm (Quote)
Yeah – I got that from the context. 
BTW, while Zoloft is considered one of the safer antidepressants for nursing mothers, and for pregnant mothers depending on the gestational age of the fetus, it is one of the hardest SSRIs to quit. Going cold turkey is not recommended; tapering of can have unpleasant side effects if you are not carefully monitored.
Mind you, it’s a bad idea to take any kind of psychiatric med without being carefully monitored, anyway. It’s not like asking for a prescription for Claritin, excuse me, Clarinex (the non-generic version of Claritin that you can’t get over the counter).
This is especially true if you want to try taking a psychiatric medication off-label for other reasons (tricyclics are so-so for relief of most forms of depression, but they have been proven to raise the pain threshold, so are often used to help prevent or lessen the impact of migraine headaches and other forms of chronic pain).
Antidepressants are not the only psychiatric meds used off-label. Depakote and Topamax (used to control seizure disorders) and some of the stronger tranquilizers are being used as first-line treatments of chronic pain as well.
You definitely want to see a specialist if you want to try using them to treat nonpsychiatric conditions, and it’s really better if you want to use them to help treat depression or bipolar disorder to see a specialist, too. The primary care physician usually is not as well read up on the side effects, safety in different populations, etc. Usually a PCP’s primary source of information, thanks to time constraints involved in running a busy office, is… the pharmaceutical rep. Conflict of interest here. Big time.
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Kit Reply:
July 12th, 2010 at 7:16 pm (Quote)
I have tried “putting down the pills and walking” and it resulted in six days of forced hospitalization. I listened when my dad told me that it was all a matter of ‘getting over it” and not only nearly killed myself, but put my nephew in a lot of danger by passing out while he was alone in the house with me. (My mom stepped out and left the nine month old alone in the house with me, without informing me first.)
I have been in therapy and tried every pill there is… and then I found one. It, at a middling high dose, works beautifully. Its an unusual med for a female paitent, and I am blessed that a doctor thought to give it a try.
I’m not sure why, but your post about ‘walking it off” hit a nerve with me. But as i said, i have no clue why so its probably my crazy acting up again.
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CCindy Reply:
July 13th, 2010 at 6:21 am (Quote)
Kit, I’m glad you found soemthing that works for you, but even more glad that you are in therapy and working with a specealist. Without reviewing your previous posts, I’m sure that you are not in favor of the doc passing this stuff out like candy either.
I’m also wondering if you dad is the shut-up and get over it type or the let’s talk about it and work our way through it type. ( no answer necessary.) I’m not even going to ask about your mother. What responsible adult does that!
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Kit Reply:
July 14th, 2010 at 10:15 am (Quote)
My dad is a “shut up and get over it” type. And honestly, my mom probably assumed I knew she was leaving. Her leaving nephew with me wasn’t unusual, since she normally did to walk down the street and retrieve some of the family kiddos from school. But boy did she get a shock when she came back to me unconcious and bleeding out, nephew screaming from his playpen (since I had heard him AFTER cuting myself and went stumbling out to try and soothe him. NOT TO SELF: Collapsing in own blood =/= soothing to infants) and the dogs howling in rage really gave her a shock.
Strangely she still would Nephew alone with me after that, but she would bring him into my room and plop him into my arms so I would be sure to know that he needed me more than I needed to die. It sounds really bad written out, but I’m a weird Bipolar. In my mind I deserve to die and should die quickly, but if I’m useful (ex: taking care of nephew) then that means I don’t need to die until I’m not useful anymore.
And no. No passing out psychiatric drugs like candy. I was put on lots of drugs that were TERRIBLE choices by a phychaiatrist who I honestly assume got his licensing from a cracker jack box. One of my pills produced my ONLY psychotic episode, where I tried to stab my uncle. (That pill was for schitzophrenia, which i don;t have, and made me hear things… really bad things. I wasn’t shocked when it was taken off the market either.) FTR: Uncle was fine. He took the knife from me and sat on me until i came to my senses.
ahem.
I’m gonna shut up now. I really don’t want people tinking I’m nuts. I really am all better now.
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So it’s a sign of depression to not want to have major surgery? What a moron of a doctor, probably trying to pay for a new car or something.
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Sarah Dorrance-Minch Reply:
July 12th, 2010 at 10:00 am (Quote)
Oh, women have always been accused of insanity when they get emotional or inconvenient. It’s been going on for centuries.
Aren’t you glad it’s 2010 instead of 1910? A hundred years ago, we were subjected to hysterectomies and clitorectomies to cure our “hysteria.” Being prescribed drugs at the drop of a hatpin is comparatively tame.
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Sarah Dorrance-Minch Reply:
July 12th, 2010 at 10:03 am (Quote)
Oopsie. I forgot about the lobotomies. They were common, too.
The first treatment, however, in the late Victorian and Edwardian periods, was the “rest cure.” Charlotte Perkins Gilman wrote about it in her short story “The Yellow Wallpaper.” Forced isolation, darkness and other ways to attempt some semblance of sensory deprivation, and gradual introduction of limited contact in the form of talk sessions with the doctor combined with “therapeutic massage” – in short, stuff the United Nations would consider a form of torture commonly used in brainwashing. Fun, what?
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I was NOT depressed. I had 1 vaginal birth and then 1 c-section and was forced to have a 2nd repeat. I was told “it was a good thing I had the forced repeat because my baby was 10lbs, 13 ounces, there was NO way you could have birthed that big baby!!!”
Being pregnant with my 4th child, I was desperate to have my baby the way GOD intended. I went to this OB asking to please let me attempt VBAC. NO he said and then with me crying, he preceded to tell me I can have anti depressants if it would help!
My only depressant was that doctors have screwed up my body and I couldn’t find a doc that would allow me to VBAC. Eventually at 30 weeks, I did find one but still ended up with a nightmare of a birth. Placental Abruption. It was MY fault I was told by my new doc that I almost bled to death because I wouldn’t allow her to stop the hemorrahage after the birth! You wake up from anesthesia with someones arm up in you and see if you don’t scream and cry to stop!! You only hear whispering and no one tells you what they are doing down there, you are only blamed for it the next day. All my c-sections are my fault! NOT! Now I need the anti-depressants cause you have messed me up tremendously. It took me about 7 months to recover from this nightmare birth!
I was diagnosed with PTSD after this traumatic and disappointing birth! The abruption was not near previous scars so this was not due to previous forced c-sections. According to the doc. At least she was honest about something! This doc wrote LIES in my chart after the birth and for some of my appts. YES, please hand me the anti-depressants for your awesomeness in being a doctor!! HA!
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Sarah Dorrance-Minch Reply:
July 12th, 2010 at 4:52 pm (Quote)
How horrendous.
I’m not sure (law is not one of my areas of perseveration, although all things considered, it really ought to be) but I think you are allowed to comment on or correct your records. Maybe someone here knows more about how to go about it. “Lies.” Good grief! Although it’s a great way for the physician to cover her own sorry arse.
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MOMof4 Reply:
July 14th, 2010 at 9:01 am (Quote)
Sarah, I’m sure I could force her to correct the records but I don’t want to mess with this witch! What’s done is done. I am trying to get on with my life. I didn’t think I would ever recover from this fiasco birth. I was a freaking nut case for the first 7 months. When I talk about it, I get fuming mad. So I try my best to just let it go.
I am highly into politics and I am hoping that someday, I can get into that and make changes. even small ones will help. That is my goal. Besides hopefully becoming a Doula and hopefully a midwife in the future. I WILL make sure my two daughters have a better birth than I did. Hopefully I can help my two daughters-in-law if that ever happens!
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CCindy Reply:
July 13th, 2010 at 9:34 am (Quote)
What exactly makes you think the abruption wasn’t over the scar tissue? You said this doc wrote lies in your chart. What makes you think this isn’t another lie?
I wish I could give you a big hug. I tried to VBAC and it didn’t work out twice. But, I was treated with respect both times. Whereas the primary c-section not so much. It is amazing how their words can affect us.
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MOMof4 Reply:
July 14th, 2010 at 9:13 am (Quote)
CCindy, You are right. I dont’ know if she was telling the truth. It is not written in my medical records. I had called the nurse in the office and asked this question. I was told it was in the upper quadrant of my uterus.
Of course out of 5 docs in this new office, I ended up delivering with the only non VBAC doc. So I don’t think she would have lied about that part. She did try to get me to have a hysterectomy before they took me into the OR to have the emergency c-section. NO WAY, are you nuts!??? Well, yes she is!
Thanks for the “hugs”. I am doing very well at the one year mark. However, I didn’t think I was ever going to make it. I was a basket case my self. I never wanted to kill myself because I wouldn’t give that woman the satisfaction to think it was her fault. However, I cried day after day, night after night. I knew this was my last baby and she ruined it and my life. I knew it wasn’t my fault I abrupted. These things just happen. I was also OK with having the 3rd c-section. My only problem was her. How she treated me during my short labor before the abruption and how she treated me in the hospital and after.
I wrote a letter to her (thinking I wanted to mail it). I told her off and exactly what I thought of her. I realized that I couldn’t mail that to her cause I’d probably be arrested..lol.
So I took that letter and I placed it in my Bible. I said a prayer and told God that HE has to take this from me. I can’t go on living mad like I was. I needed to be there for my 4 children. I dont’ and won’t ever forgive this woman but I have put it all aside and LIVE for me, my husband and my children. They are more important than living mad like I was. This is where I want to get into politics. It is crazy that this woman is allowed to continue her job and just like the OB I fired. They get to continue wrecking peoples lives. I want to change that. I don’t know what or if I can but you can sure bet your money that I will do everthing I can. I will be getting into the faces of the goof butts in government and do whatever I can. One change would be better than none. We will see!!
At this point, I still refused anti-depressants. Not that there is anything wrong with them, I just don’t take prescription medication. I don’t trust them at all. Too many drugs come out and then the take them off the shelf because someone died or has life time troubles from them. I’m more of a “natural” chicky.
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I was offerend meds for depression and also sleep aids after I had a 16 week loss and then a 5 week loss just right after this. The OB just asked if I wanted the meds. Uhmmmm…isn’t it normal that I would be sad after two babies in a row have died inside my body? This was at an office visit right after the second loss. I really felt offended actually, that normal love and loss with emotion would be pilled away. I decided the best medicaine for me was to grieve fully.
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“Yes, doc; in fact, I think I’ll self-prescribe a providerectomy and the biggest available dose of evidence-based care.”
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Sara Reply:
July 12th, 2010 at 5:24 am Sara(Quote)
I *must* find a way to use “providerectomy” in a conversation. A+.
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