The Treatment Plan: Finally Approved By All

I got on a train before dawn this morning in order to make it to my appointment with Dr. P at 8:30 am. It was worth it. We had an awesome chat (we always do) and made each other laugh (we always do). We talked about why I am against the idea of tapering my Effexor dose or trying to switch to a better-researched, more-often-prescribed SSRI:

“I have accidentally lied to everyone every time we have made changes to my meds. I will say ‘I’m fine! I’m fine!’ And then ‘OOPS I lost my job because I was so anxious I couldn’t leave the house. Maybe I’m not fine.’ I am terrified that if we do it again, that will happen again. I don’t want to do it again. I can’t afford to lose this new job.”

She completely agreed with my reasoning. She told me that she had just finished a frustrating and unsuccessful attempt to switch another patient to Zoloft. This was a huge relief, because honestly, I would have doubted myself if she had questioned my decision. In fact, while I was talking, I was thinking “Maybe I’m just not being tough enough?” That’s not a thought I need. It’s also not an accurate thought. I am one tough lady.

At the end of our session, I heard the most wonderful words I have heard ever during this entire process:

“I wouldn’t change a thing.”

Phew!

I have officially done everything I could possibly do. Including all of this:

I hope not to add any prescriptions to my daily regimen of pills, but I have acquired quite a collection of vitamins and supplements. I’ve replaced prescriptions meant to help with migraines and insomnia. Recent blood work revealed that I have almost no Vitamin D in my body; without Vitamin D, I’m not going to even get pregnant, let alone give a fetus enough Vitamin D to grow bones and other important things. The weird thing is that I’ve been taking quite a bit of D since I first learned I was deficient last summer. And yet… nothing! So I added some more of that. There are other vitamins and supplements to prepare my body for pregnancy, too.

It’s starting to make me laugh, because there so many bottles. I had a drawer for them. They don’t fit anymore. I tried to take a picture for you, but they didn’t all fit in the frame. I have a very large pill organizer like the ones old people use. Seriously. I made these collages so you could see all the bottles, though:

 

Clockwise: Calcium, Prenatal, Fish Oil, Vitamin D
Clockwise: Effexor XR 150 mg, Effexor XR 37.5 mg, Klonopin, CoQ10, Vitamin B2, Passion Flower tincture, Magnesium Citrate

What are they all for? Well, here’s a list, excluding the prescriptions:

  • New Chapter Bone Strength Take Care Supplement (calcium) & New Chapter Organics Perfect Prenatal: These two are for the pregnancy. Most people take one prenatal vitamin per day after they find out about a pregnancy. The problem with this is that most prenatals have lots of iron and lots of calcium, but our bodies can’t absorb both at the same time. “Calcium inhibits iron absorption from non-meat sources. Wait at least 2 hours before taking an iron supplement following a calcium supplement or vice versa” (MIT). The coolest thing about the New Chapter prenatal is that it’s made from food and includes probiotics; you take three small pills a day instead of one huge pill, and it’s so easy on the stomach that you can take it on an empty stomach. [New Chapter has not asked me to praise their products, nor have they paid me. For the record.]
  • Nordic Naturals Arctic D: Cod Liver Oil (liquid): Fish oil contains Omega-3 fatty acids, including DHA, key elements for, well, life in general, but especially for pregnancy. “DHA is an essential fatty acid—we must get it from diet or supplements, because our bodies don’t make it—and consuming enough DHA is critical for normal and healthy development of infant brain, eyes, and nervous system.” And… “Omega-3 fatty acids are highly concentrated in the brain and appear to be important for cognitive (brain memory and performance) and behavioral function. In fact, infants who do not get enough omega-3 fatty acids from their mothers during pregnancy are at risk for developing vision and nerve problems.” My nutritionist recommends this brand for several reasons, but it comes down to this: “…fresh and pure raw material: fish low on the food chain, which naturally contain low levels of impurities (and are also ideal for long-term sustainability, given their short reproductive cycles). All of our products are made exclusively from four types of fish, none of which is endangered: wild-caught Arctic cod (Skrei)…” Do you know what’s in the fish oil pill in on the drug store shelf? Mean neither. Also, it really does taste like lemon, and there’s no burping. Watch the expiration date, if you use this: three months after you open it, it’s done. And I mean done. I learned this the hard way. (The Arctic D has extra Vitamin D in it–to help with my deficiency.)
  • Vitamin Code RAW D3 is made from food and other stuff found in nature, like the New Chapter products, but it’s got 5,000 mg of D3 in each pill. I’m hoping that between the sheer amount of D in the supplement and the “RAW” part, my body will start absorbing and retaining some of the stuff.
  • CoQ10 and B2 are supposed to help prevent migraines. My neurologist recommended this. The suggested dosage varies, but I take 400 mg. The migraine treatment with B2 is 400 mg as well. I’m not taking that much for now, at least until I can find out if it’s safe during pregnancy. Note: I took another brand of CoQ10 (I think it was NatureMade) and it had all sorts of artificial colors in it, so I threw it out. Read the labels! Why put artificial colors in a nutritional supplement? I don’t understand it at all. Apparently because it’s good for the heart and blood it should be colored bright red? So strange.
  • Passion Flower is the extract of said flower, and I put some of this tincture in a glass of water before bed. I’m really hoping that traditional medicine is right, and passion flower helps with sleep and anxiety.
  • Magnesium Citrate is helping my body handle all the iron in the prenatal, aid digestion in general and is also good for anxiety. Ever seen that Natural Calm powder stuff? It’s mostly magnesium oil in pill form. It’s just easier for me to remember pills than powders (because of the old lady pill organizer…)

Both the magnesium and the passion flower were given to me by the latest addition to my team, a naturopath, acupuncturist and Chinese medicine practitioner. We’re mostly going to use acupuncture to help with my sleep issues, since we don’t want to add a bunch of herbal stuff that might not be so safe for pregnancy (natural is not the same as safe!). The passion flower has been approved by an herbalist she trusts, and that’s good enough for me–the dose is tiny.

If you haven’t tried acupuncture, no matter who you are or whether you are perfectly healthy, DO IT. It feels so good. I rarely ever feel any of the needles themselves, if I do it’s like a tiny pinch, and after a session, I feel like five pounds have just evaporated out of my muscles.

So that makes nine kinds of pills and two liquids, but it’s actually a total of 15 pills I swallow every day. And two liquids. I guess that’s why I’m so careful about what’s in each one of them.

10 Comments

  1. Oh my gosh! When I was TTC I totally had an old lady pill organizer. Actually, I had three. Because I had supplements that needed to be taken morning, noon, and night, and I wanted to make sure that I was taking the right thing at the right time of day. I took a good 20 pills a day. People teased me, but I did finally get pregnant, so something about the cocktail WAS effective!

    January 29, 2012
    Reply
    • Anne-Marie said:

      Haha my regimen is too complicated for the morning, noon, night organizers, but I did look at one and just went “No. That’s too much.” I also need it to fit in my purse! And I’m glad you left this comment today, because I had brunch this morning with single friends from college and had to pull out the organizer to take some of the “must take with food” supplements. Um, I swear that this is rational behavior! No, really! This doesn’t happen to be one of my crazy behaviors…

      I feel like I want to take them to help counter-balance the risk posed by the anti-anxiety meds, too. Does someone, somewhere think that there might be a connection between, say, Vitamin D deficiency in pregnancy and some sort of physical malformation? Well, gee, let’s not add that to the risk of physical malformation increased by taking the Klonopin… I have no real idea if that’s going to help counter-balance the meds, but it can’t hurt to give the fetus every vitamin and mineral it could possibly need from day 1!

      January 29, 2012
      Reply
  2. Ruby Girl said:

    I suffer from anxiety as well and am now 7 weeks pregnant. I have battled with the klonopin thing and am doing the same as you; counteracting with every good thing I can get into my body, despite the morning sickness! :) I was ravaged with guilt the other day and my husband told me ‘you act like you are doing everything you can not to do something BAD. When I see it as you are doing everything in your power to do GOOD.’ It was so helpful. Good luck to you! I am glad I stumbled upon your blog, I look forward to checking in!

    March 16, 2012
    Reply
    • Anne-Marie said:

      Thanks, Ruby! Your husband is a smart man. Mine issues similar reminders, too. In fact, we seem to have lots in common–I am now 7 weeks pregnant, too! Have you had an ultrasound, yet? My OB is super awesome and did a transvaginal ultrasound to get as much detail as possible–seeing that little bean already looking baby-like and that heart beating so strong was a huge relief. She knows all about my anxiety and meds, of course, but she thinks that more frequent ultrasounds will help. Let’s hope the insurance company agrees with her, because so far, she’s right! What a relief.

      March 16, 2012
      Reply
      • RubyGirl said:

        How exciting! I didn’t realize you had conceived reading through your blogs. ‘Apparently’ pregnancy can ease anxiety symptoms for many women; not seeing anything here yet but I am hoping for some relief in the 2nd trimester. Are you enjoying your pregnancy so far? I have an appt. for my first ultrasound 4/2. I put it out a ways as we travel from the snowy mountains down to the big city and I want to make SURE we can hear a heartbeat. Was it exciting?! That is wonderful you have a supportive doctor. Has your OB been able to give you any concrete data about your meds, or offer some relief? I was referred to a great doctor whom delivered the healthy babies of two friends, but I was recently told he is au natural, strictly, and now I fear some judgment mixed with ignorance of anxiety. Hmmmph.

        March 16, 2012
        Reply
        • Anne-Marie said:

          I didn’t announce it publicly until about three minutes before I wrote my reply! I do have concrete data and will happily send it to you if you’re willing to share your email address. It comes from a database of potential teratogens that some doctors subscribe to; I got it not from my OB but from the psychiatrist I saw for about six months (in addition to my regular psychiatrist) who specializes in perinatal mental health. She’s quite a long drive away, so she’s not my primary psychiatrist, but she really helped both me and my partner understand the risks. My OB did tell me what she pulled up on her computer, but it was mostly about animal studies. She’s the calmest person; it’s hard to imagine her judging. She always says “Well, let’s look at what we know” and reads the science out loud before telling me what she thinks I should do.

          I would totally call ahead if you’re worried about judgment. Call and say look, we’re far away, I don’t want to come in if he’s going to fight me on this treatment plan I’ve worked so hard on without even listening to me, so have him call me to talk about it as soon as he can. My OB once called me back to read me data over the phone about my migraine meds and very early pregnancy (like, I wasn’t sure I was pregnant yet and I had a monster headache) to assure me that, before a missed period, I could take it. I’ll switch to midwives for the birth, but I am staying with her for the first trimester (she doesn’t deliver babies, so I guess she’s really a GYN) because she’ll do all the detailed ultrasounds when I need reassurance (1st tri is when the real risk occurs–“physical malformation” eek). If an OB isn’t willing to talk to you about concerns over the phone, he’s probably not the best for an anxious person! That said, he might we totally willing to be educated. He may have just not come across this before.

          March 17, 2012
          Reply
          • Anne-Marie said:

            PS Really do email me! amtonyan [at] gmail [dot] com 

            March 17, 2012
  3. Biokatie said:

    Congrats. I had a son 2 yrs ago and I was only able to taper to 37.5 Effexor. He was a champ….born early and small due to preeclampsia but very strong….no nicu time. I am currently 25 weeks and haven’t started my taper yet. I think I will try 1 month of 75… Currently on 150…but I have the severe side effects. With morning sickness just ending and having diabetes 2 not sure I have it in me…but will be trying. Good luck…great blog.

    March 28, 2012
    Reply
    • Anne-Marie said:

      Ugh, I *hate* tapering Effexor. Do you mean that you feel side effects from the drug or from tapering? Because I don’t think there is anyone who doesn’t feel strong side effects to tapering this drug. It’s such a crazy chemical. Going down even the smallest steps, I feel shaky. Do you get that electric shock feeling? Like someone is zapping you periodically from the inside? Eew. I’m seeing my psychiatrist in mid-April, and we’ll see when she wants to start trying to taper. I tend to to better with a really, really slow process, so maybe it would be better to start as soon as the 2nd tri starts. Especially because I want to taper the Klonopin, too, but closer to the birth. Gosh, I hope this baby is not early!

      Take care of yourself! I read that your chances of developing preeclampsia are a bit higher if you’ve had it before, so take good care of yourself! Lots of rest? Is that good for it? I try not to get ahead of myself, so my knowledge is mostly limited to 1st tri for now.

      March 29, 2012
      Reply
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    May 17, 2014
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