I had three miscarriages last year. My most recent loss has left me experiencing night terrors. I feel exhausted and broken, but I remain hopeful.
My GP prescribed me mirtazapine, but will antidepressants help me process my pain or mask the feelings I need to work through? Cognitive behavioral therapy (CBT) had limited success.
Carly Morgan, Bristol.
I am sorry to hear about your repeated losses and it is essential that you receive appropriate support while the cause of these miscarriages is investigated.
Many doctors overlook the mental health toll and often focus on the complex search for the physical causes of miscarriage.
But fortunately, his GP has taken care of this and prescribed him an effective antidepressant.
A stock photo of a grieving woman standing with it in her hands by a window.
This would be based on your symptoms, including night terrors and the feelings you describe, and the medication should help.
Mirtazapine is an older type of antidepressant, known as a tetracyclic, and is often used to treat depression with anxiety or insomnia, so it should help you sleep better, address how tired you feel and improve your mood.
Antidepressants take time to work: it may take four to six weeks of taking this medication before you begin to notice improvement.
I’m also wondering if, instead of CBT, you could ask your GP if they would refer you for counselling.
As there may be a waiting list, you can decide to go privately. (Check that the counselor is professionally accredited: both the UK Psychotherapy Council and the British Association for Counseling and Psychotherapy have lists of qualified counsellors; or you can contact pregnancy and baby loss counseling charity, Petals.)
Mirtazapine can be taken during pregnancy; There’s no convincing evidence that it affects a baby’s development in early pregnancy, according to the NHS, but your health professionals will tell you all about this: Treating depression is important.
My thoughts are with you.
Five years ago, I was diagnosed with phrenic nerve palsy in my left lung after an x-ray. Over the years, my breathing has gotten worse: I can only walk a few steps before running out of breath; Even laughing can make me short of breath.
I need to sleep supported by pillows that help me breathe. I asked for a consultant recommendation a year ago but haven’t heard anything. I’m 69.
Shirley Robinson, Burnley.
DR MARTIN SCURR: There are many ways in which the phrenic nerve can be damaged, even inadvertently during cardiac surgery; as a result of viral infections such as shingles (which causes shingles) entering the neck; or a chest disease such as tuberculosis or lung cancer
This slow deterioration in his ability to breathe must have been alarming.
His condition occurred when one of the two phrenic nerves, which supply both sides of the diaphragm (the domed muscle under the lungs that helps breathing), was damaged.
There are many ways the phrenic nerve can be damaged, even inadvertently during cardiac surgery; as a result of viral infections such as shingles (which causes shingles) entering the neck; or a chest disease such as tuberculosis or lung cancer.
But in about 20 percent of patients, there is no known cause for phrenic nerve palsy, which appears to be the case for you.
You may have only had minimal symptoms of shortness of breath when you were first diagnosed, but this has gradually gotten worse. It is now important that you are seen immediately by a consulting doctor who can thoroughly evaluate you to determine what treatment would benefit you.
One possible option is an operation to tighten the diaphragm on the affected side, a procedure known as plication.
You may also benefit from continuous positive airway pressure (or CPAP) while you sleep: here you use a mask connected to a machine that gently forces air into your airways.
CPAP is an effective treatment, usually offered to patients with obstructive sleep apnea (where breathing stops intermittently during sleep).
I suggest you go back to your GP and ask about seeing a specialist as soon as possible for evaluation and treatment.
- Write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email drmartin@dailymail.co.uk. Dr. Scurr cannot correspond personally. Answers should be taken in a general context. Consult your own GP if you have any health problems.
