It’s been awhile since I got all up in the mental health side of things which is a good thing in many ways. Sure, you may miss my witty and sparkling prose detailing the in’s and out’s of my sometimes crazy ol’ mind but feeling on top of things mentally is something I’m very much enjoying. It never hurts though to be reminded of where you once were and this is especially true as I reach the last trimester of my pregnancy and hurtle with rapid speed towards ‘B’ day.

I was asked the other day if I ‘still’ suffer from OCD, a question that I initially didn’t think much about but upon further reflection, found slightly perplexing. I suppose because I haven’t spoken or written much about it lately that you could assume that I was ‘better’ and no longer ‘had it.’ But as anyone who has ever experienced anything on the mental health spectrum will tell you, this stuff doesn’t just ‘go away.’ When I’m filling in forms at a new doctor or health care provider and the ‘pre-existing medical conditions’ box appears beneath my pencil, I write ‘suffers from OCD and anxiety’ without even thinking about it. Because I do. It may not be something I’m actively in treatment for, but I’m constantly, acutely aware of its presence.

I guess you could say that I’m currently in the ‘management’ phase of things. Happily cruising along pretty smoothly, aware that there’s a passenger in the back seat but not overly bothered them. They’ve quit yelling out obscenities and requesting crap songs on the radio so I’m quite happy to just let them be. We’re cool and we co-exist as best as possible. But they’re still always there.

This phase is a good one to be in, especially at this point in my pregnancy as I wasn’t quite sure how things would unfold once I flew off the medicated radar. I’ve written before about my decision to wean off off anti-depressants while up the duff (you can find that scintillating copy HERE) and, as of this week, have been medication free for the past 33 weeks. It was a decision reached in consultation with my mental health posse (ok they aren’t really my mental health posse, nor are they really my mental health team, ‘they’ are my psychiatrist and psychologist but there’s something I quite like about referring to them as my ‘posse’) who both agreed that I had responded well to both therapy and my course of SSRI Lexapro and could most likely manage without supplementation. And I have managed and managed well. Apart from a slightly bumpy patch right after weaning, I’ve felt good.

For me personally however, pregnancy isn’t really the issue, mentally. The post-natal period is when things started to go pear shaped last time and hence has been ear-marked as the potential ‘danger zone’ this time around. I blame the potent combination of hormones and sleep deprivation, two things that can join forces to scramble even the most resilient of minds, so I’m not all that suprised that my sometimes dodgy brain has an increased chance to come a-cropper.

And so we have an action plan. While I would have liked to have written it on parchment scrolls and perhaps sealed it with wax, it is instead a kind of boring mish-mash of notes spread throughout my medical files at my hospital, psychologist and psychiatrist offices, detailing where I’ve been, where I am and what we have to come.

I’m a gal who likes a plan so having something in place to head off what I know to be a rather excruciating descent into hideous anxiety and a never ending spiral or horribly intrusive thoughts is appealing.

Simply being so much more aware of my mental state and being able to tune in and evaluate my thinking patterns, already puts me a step ahead of last time. These days, I can recognise when things are starting to slide, and generally act accordingly. The rest of the action plan is all about strategies to maximise my chances of remaining in the cruisy management phase and ultimately, stay well.

Here’s how it’s shaping up:

 – On call therapy – I will be booking an appointment with my psychologist in the next fortnight for the fortnight after birth. I may not have anything at all to discuss at the appointment, except for the requisite commentary about sleep deprivation and aching boobs BUT having an appointment in place means that I’ll be both aware of how I’m feeling (so that I can report back) and have an avenue should things be a struggle. I know there’s a strong possibility that I’ll be dwelling deep in the world of overwhelm at that point and being able to verbally spew it all out to a caring but objective professional is key to remaining on top of things.

 – Medication – The plan has always been to re-introduce a low dose SSRI basically the moment I give birth. I have visions of my midwife delivering the placenta then handing it over to a colleague who will replace it with a little white pill with ‘Lexapro’ written on it. The general thinking is that introducing an SSRI will help negate the extreme swings my brain might otherwise try and undertake when tired and hormonal. By keeping things level from the start, its thought that there won’t be the opportunity to swing too far into crazy town. At this stage however, I’m still on the fence as to what I want to do. On the one hand, it makes sense. On the other, I wonder if I can manage without. When you’re feeling good and stable and well, it’s realllllly hard to remember just how awful you once felt. It’s like those memories fade away or are tinted to appear less intense than they might have actually been. I’m a little suprised my reticence in returning to medication. I have never had any qualms about being on, and sharing the fact that I take, SSRI’s. I’ve always believed being medication free is good but it doesn’t make me feel like I’m a better person than when I was medicated. I guess I’m afraid to tip the balance and re-introduce something new when the current formula is working. I’m going to have to see how things play out in the coming weeks and speak with my ‘posse’ again to determine the best course of action.

– Diet – Not going on one but ensuring that I stick to eating actual food as opposed to existing on coffee, sugar and Up N Go like last time (shudder). When I think back the the weeks after my son was born, I struggle to fathom how I managed to slip so far down the basic nutritional path. A combination of everything going on internally made my food choices poor to non-existent. I literally don’t remember anything I ate and went large periods of time without eating anything of any substance at all. Thank GOD my mum prepared dinner for us a few nights a week as that seemed to keep me going. It’s bizarre to look back on, as someone who’s so passionate about food and wellness and eating in general, but in a way, I was a different person then to who i am now and I think it all just seemed too hard. This time around, i know that what I put in my mouth not only impacts my milk supply (and bebe) but also my mental state. When I eat poorly (and sporadically) I feel like crap. Plain and simple. I’m working on batch cooking a bunch of stuff to freeze as well as ensuring I’ve got plenty of healthy breakfast recipes and smoothies on file for when things get hazy and I’m most likely to slip into bad habits.

Preparation– Be ready, make sure you have an amazing bapram and the best bacarrier available. Speak to experts and do it right.