Grief has left me feeling broken and drained: Ask the GP DR MARTIN SCURR

Health
By Liam

By Martin Scurr for the Daily Mail

Published: | Updated:

I had three miscarriages last year. My recent loss gave me night terrors. I feel drained and broken – but I remain hopeful.

My GP has prescribed mirtazapine – but will antidepressants help me deal with my grief or will they mask feelings I need to deal with? Cognitive behavioral therapy (CBT) has had limited success.

Carly Morgan, Bristol.

I’m sorry to hear about your repeated losses and it’s important that you receive the right support while the cause of these miscarriages is investigated.

Many doctors overlook the mental health implications and often focus on the complex search for the physical causes of miscarriage.

But fortunately, your family doctor solved this problem and prescribed you an effective antidepressant.

A file photo of a grieving woman standing with her hands at the window

A file photo of a grieving woman standing with her hands at the window

This would be based on your symptoms – including night terrors and feelings you describe – and the medication should help.

Mirtazapine is an older antidepressant known as a tetracyclic antidepressant, often used to treat depression with anxiety or insomnia. So it’s designed to help you sleep better, relieve your feelings of fatigue and lift your mood.

Antidepressants take time to work: it may take four to six weeks before you notice improvement.

I’m also wondering if you could ask your GP for a referral for counseling instead of cognitive behavioral therapy.

Since there may be a waiting list, you may choose to schedule a private appointment. (Check whether the counselor is professionally accredited: both the UK Council for Psychotherapy and the British Association for Counseling and Psychotherapy have lists of qualified counselors – or you can contact the pregnancy and baby loss counseling charity, Petals.)

Mirtazapine can be taken during pregnancy – according to the NHS there is no clear evidence that it affects the baby’s development in early pregnancy, but your doctor would discuss all of 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 worsened: I can only walk a few steps before becoming breathless – even laughing can cause shortness of breath.

I have to sleep with a pillow propped up so I can breathe. I asked to be referred to a counselor a year ago but haven’t heard anything. I’m 69.

Shirley Robinson, Burnley.

DR. MARTIN SCURR: There are many ways the phrenic nerve can be damaged, including unintentionally during heart surgery; as a result of viral infections such as herpes zoster (which causes shingles) entering the throat; or a breast disease such as tuberculosis or lung cancer

DR. MARTIN SCURR: There are many ways the phrenic nerve can be damaged, including unintentionally during heart surgery; as a result of viral infections such as herpes zoster (which causes shingles) entering the throat; or a breast disease such as tuberculosis or lung cancer

This slow deterioration in your ability to breathe must have been alarming.

In my opinion…be wary of “natural product” claims

Manufacturers often go to great lengths to assure us that their products contain “natural” ingredients.

However, this does not necessarily make them safe or healthy. This was confirmed by a recent study in the Journal of the American Medical Association, which examined the ingredients of so-called natural or herbal sports supplements taken by fitness enthusiasts in the hopes of building muscle or improving performance. The researchers found that 12 percent of the supplements they analyzed contained at least one banned chemical – and of 57 products tested, 40 percent contained none of the ingredients listed on the label.

While athletes should take note of these findings, there is a lesson here for all of us: stick to a balanced diet of fresh, healthy, nutrient-dense foods rather than being seduced by supplements.

Her condition was caused by damage to one of the two phrenic nerves that supply both sides of the diaphragm (the dome-shaped muscle beneath the lungs that helps with breathing).

There are many ways the phrenic nerve can be damaged, including unintentionally during heart surgery; as a result of viral infections such as herpes zoster (which causes shingles) entering the throat; or a breast disease such as tuberculosis or lung cancer.

But in about 20 percent of patients, there is no known cause of diaphragm palsy – which seems to be the case in your case.

It is likely that you had minimal symptoms of shortness of breath when you were initially diagnosed, but these have gradually worsened. Now it is important that you are seen promptly by a specialist who can evaluate you thoroughly to determine what treatment would be beneficial for you.

One option is an operation to tighten the diaphragm on the affected side, a so-called plication.

You can also benefit from continuous positive airway pressure (CPAP) while you sleep: This involves wearing a mask attached to a machine that gently pushes air into your airways.

CPAP is an effective treatment usually offered to patients with obstructive sleep apnea (in which breathing stops intermittently during sleep).

I suggest you go back to your GP and ask to see a specialist for assessment and treatment as soon as possible.

  • Write to Dr. Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email drmartin@dailymail.co.uk. Dr. Scurr cannot enter into personal correspondence. Answers should be considered in a general context. If you have any health concerns, contact your primary care physician

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