Do you know what a psychologist does? Do you know the difference between a psychiatrist and a psychologist?
In this article, we answer these questions. We discuss the types of professionals that will treat your mental health illness and the most common medications for depression and anxiety.
This part 2 of a 3 part series on mental health during infertility or after baby loss.
In part 1, we talked about recognising the symptoms of common mental health conditions and taking the first steps to get medical help.
In part 3, we cover tips to reduce short term overwhelm and stress, plus groups and forums to gain support.
As always, you can click on the links in the blogs to be directed to trusted information sources. A list of resources is also found at the end of each blog.
If you are worried about your mental health, book an appointment with your GP or a psychologist for assessment and appropriate treatment.
See or Speak To Your GP
If you have persistent symptoms that affect your daily life, speak to your GP, make an appointment to see your GP or call NHS 111 in confidence. Your GP will ask you questions as part of their assessment. They will make a diagnosis and discuss the next steps with you.
Depending on where you live, your GP may make a referral to the local improving access to talking therapies service (IAPT) or refer you to a mental health team to decide the types of therapy that can help you.
Your GP may also recommend and prescribe medication such as antidepressant drugs.
Contact The NHS Improving Access to Psychological Therapies (IAPT) Service
In England, you can contact your local NHS talking therapies service, also known as 'Improving Access to Psychological Therapies (IAPT) '. IAPT offers evidence-based psychological therapies to people with anxiety disorders and depression.
You’ll be asked to complete a questionnaire on the website then an initial assessment is arranged by phone. Afterwards, depending on the outcome of your assessment, treatment options will be presented to you. Therapy such as cognitive behavioural therapy (CBT) or counselling may be offered, in person, by phone or online.
Click on this link and enter your postcode to find the website for your local IAPT service. Once you are on the local website, look for the referral or self-referral page.
How to Find a Private psychologist
Psychologists, also known as counsellors, are trained to assess mental health conditions and provide psychotherapy. These services are available in person, by phone or video.
Psychologists are available on a self-pay basis or by payment from a health insurance provider.
If you are using health insurance your provider will want a referral letter from your GP. Your GP may also be able to recommend a practitioner.
You can search the British Infertility Counselling Association (BICA) register, British Association for Counselling and Psychotherapy (BACP) register or UK Council for Psychotherapists (UKCP) register or individual practitioners.
Therapists consult in person, by video, by phone or text.
What is the difference between a Psychologist and a Psychiatrist?
Psychiatrists are medical doctors who specialise in the assessment and treatment of mental health conditions. They prescribe drugs, psychotherapy and other treatment procedures.
Psychologists are not medical doctors. They are trained in the assessment of mental health conditions and providing psychotherapy. Therefore you can be assessed by a psychologist first and they can advise on whether you should see a psychiatrist. As mentioned earlier, you can also see your GP for assessment.
Psychologists do not prescribe drugs or administer physical treatments for mental health.
In the UK, GPs treat mild to moderate mental health conditions and psychiatrists treat more complex or severe mental health conditions some of which may be related to physical medical conditions.
Psychiatrists work closely with other mental health team members (in the hospital or community), such as mental health specialist nurses, mental health social workers, and psychologists.
Do antidepressants affect fertility or IVF Treatment?
The most common treatments for depression and anxiety are the selective serotonin reuptake inhibitor antidepressant drugs (SSRIs) such as Citalopram (Cipramil), Sertraline (Lustral), fluoxetine (Prozac) or paroxetine (Seroxat).
The doctor prescribing the medication will tell you whether the drugs could impact your ability to conceive or affect your baby's development in pregnancy.
In some patients with moderate or severe depression, it will be safer to continue the drugs as the risk of harm from the mental health condition may be greater than the risk of not conceiving or risk of harm to a foetus.
Each individual’s circumstances will differ. Therefore get advice from your doctor to make an informed decision. It’s also essential to be monitored by your doctor whilst you are on medication or for a period of time if you have stopped taking medication.
Never stop antidepressants suddenly and do not change the dose of your antidepressants without speaking to your doctor first as it can be very dangerous.
A study published in 2017 in the American Society of Reproductive Medicine at an IVF clinic looked back over the outcomes of patients that had IVF and preimplantation genetic screening and patients who had a single-embryo transfer between 2012-2017. They reviewed 19,464 embryos, of which 743 embryos had been exposed to an SSRI and 18,721 had not.
They looked to see if there were chromosomal abnormalities between the patients exposed and those who hadn’t and reviewed outcomes of IVF treatment including clinical pregnancy, multiple pregnancy and loss. They didn’t identify any differences between the two groups and concluded that SSRIs do not affect IVF outcomes or increase chromosomal anomalies in embryos.
Another study published in 2016 analysed 3,355 menstrual cycles in 957 women; during the study, 92 took an antidepressant, the most commonly an SSRI. The study results suggested that antidepressant use decreases the ability to become pregnant naturally.
Reduced libido and erectile dysfunction are common side effects of SSRIs, and these symptoms may persist after treatment has stopped.
Some case studies and animal studies (Low-quality evidence) show that SSRIs can negatively impact semen quality and DNA fragmentation, but insufficient research in humans has been performed in this area, and therefore high-quality evidence isn’t available.
Overall medication is only given when it’s absolutely necessary. If you have any concerns or questions, speak with your doctor.
Next time….
In our next blog, we cover tips to manage stress and overwhelm.
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Information resources
References
Embryo aneuploidy is not impacted by selective serotonin reuptake inhibitor exposure Carlos Hernandez-Nieto etc al, ASRM Volume 108, Issue 6, Page 973-979
The Effect of Antidepressants on Fertility
Marianne M. Cailla- Lennon et al, Am J Obstet Gynecol, 2016 Sep:215(3):314e1-314.e5.
Effect of antidepressant medications on semen parameters and male fertility
Beeder and Samplaski, International Journal of Urology (2020) 27, 39-46
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