26 weeks, 3 days/24 weeks 1 day*

When the midwife said she’d like to refer me to the perinatal mental health service I just nodded and agreed.  Sure, there was a bit of a difference between my attitude now and that of five years ago, but the worst that could happen is I turn up for an appointment and never go back.

You see, me and psychiatrists have a bit of a love hate relationship.  Well ok, that might not be the entire truth; it’s all hate really. 

You see, I had my first encounter with a psychiatrist at 17.  The man uprooted me from my hospital bed where I was quite comfortable staring into space and generally trying to avoid my life and took me into a consulting room where he tried to get me to tell him whether I would seriously try to take my own life again.  I told him no, but I wasn’t too sure myself.  I couldn’t tell him why it had happened, just that it had. 

And so it began.

That meeting earned me a straight ticket to Parklands, our not so local mental health unit.  Now you see, I laughed at House last week (because it’s House, and that’s all you can do) but really it shouldn’t have been funny.  Because I’ve been there. 

They assigned me a psychiatrist, Dr R.  It was Monday.  I didn’t get to speak to her until Wednesday.  When I got back to the outside world I saw her once a week.  Her and her student, Dr F.  I couldn’t talk.  It wasn’t that I couldn’t find the words, it was that I didn’t have them yet.  When I did, I was so numb from the drugs that the words just wouldn’t come out.  There were other ways to talk, but they interpreted it as a need to increase the dosage and the gag was tied tighter.

Almost a year later I pulled myself off those meds through a combination of forgetting to take them, and really not wanting to take them.  The crash was horrific but I dragged myself back.  I didn’t want to go back to see Dr R again.  I didn’t trust her.

But sooner or later I was going to crash again.  And it happened whilst we were in Brasil.  A psychiatrist or even just someone who understood such things was a distant dream.  I’d got health insurance but the logistics of translation were a nightmare and in the end it was decided that the best way for me to get treatment would be to go back home.  I didn’t argue; there was nothing I wanted more than to return to the UK by that point.

Within days of our return I’d signed back up with my old family doctor.  We discussed my options: they were limited.  I begged her not to send me back to Dr R or Dr F.  She referred me to the same team with the stipulation that I not be seen by either of them.  There was one other doctor. 

I don’t even remember the name of the other doctor; I only saw her once.  She barely even gave me a chance to speak before she made it clear that her treatment method was to medicate and ignore everything else. 

I refused to go back.  I felt so bad coming out of that appointment that I couldn’t imagine it would be worth going through that on a regular basis.  I went back to my doctor, let her deal with the medication, and I cried on her shoulder and that of the health visitor.  We moved again and every month, when I went to collect the prescription for my meds, I sucked it up and talked to a different doctor, telling them that I was fine. 

In the times we’ve moved since, I’ve seen a couple more doctors, all of whom suggested a referral to the local psychiatry team.  Each time I refused and explained my reasons.  Each doctor agreed that they were happy to take charge of my care. 

And then the midwife looked at my history and she drew her own conclusions.  Fair enough, they were the same conclusions I’d drawn quite some time ago.  Bearing in mind my history, in getting pregnant and having another baby I was taking quote some risk of another crash.

And so the referral.

I didn’t really think about it.  I got the letter, made the appointment and stuck it in my diary for two months later.  By last week I’d completely forgotten about it.  It was only when the Wicked Witch reminded me that I wouldn’t be in till late on Tuesday morning that it dawned on me.  My appointment with the consultant perinatal psychiatrist, Dr K. 

He started asking me why I thought I’d been referred.  The don’t usually see women just because they have a history of depression, he said.  So I explained my history.  It was like a moment of understanding. 

We talked about the medication I’m on and how I feel it’s working.  If I’m honest, it is.  As long as I take it, I function just fine.  I will admit that I’ve not been as measured since I’ve been pregnant, but I’d put it down to pregnancy hormones playing their part and, once I realised I was pregnant and it all clicked in to place, I’ve been ok with that. 

But, in terms of Lumpy (I know, we still haven’t found a better name), the meds have been known to cause persistent pulmonary hypertension in newborns(PPHN).  The way it was described was that instead of there being a 1 in 1,000 chance of PPHN when not taking the meds, if I carried on much longer (it’s safe up until 20 weeks), that chance would go up to 6 in 1,000.  So Dr K asked me if I wanted to switch to something else.

I explained that my GP had thought I’d need to change  meds once Lumpy was born if I wanted to breastfeed.  Dr K disagreed and said the he felt that it would be fine to continue taking as long as it was done carefully.  My GP hadn’t mentioned PPHN, so I know who I’m inclined to believe: the man that does this for his daily living.

So he picked another drug and went off to get a prescription.  We talked about how to come off the first drug and how to start taking the second.  Man, I’m going to rattle when the two combine in the middle.  And then, once the rattling is due to subside, it won’t actually.  It’s been hard enough to get my head round taking one tablet a day but swapping to three seems unimaginable to me.  And that’s not just three in one go, but three over the course of the day, not to be taken after early evening either (because yeah, I really can do without the insomnia that would bring). 

It’s a lot to take in, especially as I’ve been on the old meds for three years this time round.  It’s left me feeling rather unsure of myself and what the next few weeks will bring.  But I’ve got to have a follow-up appointment with Dr K in a month’s time, so at least I’ve not been assessed and left to drift. 

But hey, I just don’t know how this is all gonna work out.