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Cymbalta and Pregnancy

post #1 of 64
Thread Starter 
Hello, I am so frustrated, I just don't know who to turn to. I thought maybe someone on this forum might have had a similar situation to mine. I have been researching and asking my doctors and no one can give me a straight answer.

I am 41 and had a positive home pregnancy test. If I am pregnant I would be 3 weeks along. For the past three years I have been on Cymbalta for treatment of depression. I just don't know if it is safe for me to take the Cymbalta while I am pregnant and I also know that stopping Cymbalta is a difficult and painful experience with lots of strong side effects.

First I looked on the Cymbalta literature, it says contact your doctor if you become pregnant... Cymbalta is not recommended during the last three months of pregnancy or breastfeeding. Then I called my pharmacist to ask what to do, he told me it is not recommended during pregnancy but I should call my doctor. I called my doctor and he actually told me he didn't know and I should call my ob/gyn. This makes me so angry to hear from a doctor, if you don't know something, find out! I am relying on you for good advice. That is why we pay you!

Anyway, my ob/gyn said they won't see me til the 6-8 week point. So I am so confused as to what to do. I have continued to take this cymbalta because if I don't I feel nauseous and strong headaches. I told my "doctor" that I want to come off of this drug but I know that means he will just decrease the dosage over time. I am so worried that everytime I take it now, I am hurting the baby or doing harm to its development.

Does anyone have personal experience with depression and cymbalta during pregnancy? I would appreciate any information as I am feeling very confused and scared. Thank you!
post #2 of 64
Cymbalta is a category C drug... it has been shown to cause problems in rabbits, but there has been no definite link to humans (if there was an undoubted connection, it would be category D or X)

Most doctors are okay with women still using category C drugs IF the benefits outweigh the risks.

In your case, with depression, that very much could be so.

If your OB will not see you until 6-8 weeks and did not outright tell you to stop taking it (which of course would be bad to do!) then what I would do myself is continue to take it until I talk to my OB.
post #3 of 64
I don't have any first-hand experience, but noticed a thread in the May ddc that was discussing use of antidepressants during pregnancy and thought perhaps the info there would be useful to you: link

Congratulations on your pregnancy, and I hope you are able to find the answers you are looking for.
post #4 of 64
I have no personal experience with Cymbalta or other SNRIs, but I have both taken and quit an SSRI while pregnant. The issue with SSRIs (and I'm assuming SNRIs) is that they can cause respiratory problems in the newborn if taken during the third trimester, so you definitely have time to sort this out and odds are that everything will be perfectly FINE if you wait until after your 6-8 week OBGYN appointment to make a decision.

Depending on the specific issues associated with Cymbalta you may want to wean off of it either completely or while transitioning onto another antidepressant that it safer to use in the third trimester and/or more breastfeeding friendly. Most of the issues with (most) antidepressant use during the third trimester are that they cause non-permanent, non-fatal problems in some babies... so depending on your psychiatric history and other maternal risk factors the benefits may outweigh the risks to continue on some form of psychiatric medication while pregnant.

The issue which would be huge for me, personally, is finding a medication (or alternative to medication) which you can tolerate and that is safe for breastfeeding; not being able to breastfeed on a medication would be a total deal breaker. The good news is that there are many SSRIs that are safe to use while breastfeeding. I would cross-post over on the breastfeeding forum and/or check out a copy of Medications and Mother's Milk by Thomas Hale.

Only you and your doctor can decide if going medication-free is a viable option for you. I have a diagnosis of bipolar 2 and theoretically shouldn't be able to maintain a high level of functionality without psychiatric medication(s), but I have now for over 3 years. Two things that have really helped me are investing in a good "blue light" box and practicing relatively strict social rhythm therapy when things get tough. Ellen Frank has written a fairly helpful book on the subject which my former psychologist recommended to me; it's worth checking out even if you plan on remaining on an antidepressant. (FYI: The book is written in reference to bipolar disorder, but the theory was developed to treat unipolar depression.)
post #5 of 64
FYI..

According to Hale's 2008 Medications and Mother's Milk, Cymbalta is rated as an L3 (moderately safe), which is what the rating typically is when there haven't been many studies in nursing moms. He mentions some caution is recommended, as there was one study done in which moms experienced a lowered milk supply.
post #6 of 64
Thread Starter 
Thank you all for your advice and information. I really appreciate hearing from you all. This forum is a wonderful thing and it is helpful to hear advice from other women! Already something free has helped me more than anything my "doctor" has told me for a large fee.

I have decided to go off the cymbalta slowly... 30 mg per day for 10 days then stop. I am also now looking for a new doctor one who is familiar with natural ways of dealing with depression... therapy and maybe some sort of exercise and meditation.... acupuncture?

I don't want to be on the cymbalta during the last three months or breastfeeding. It may get tough but I am committed to it and will seek the help I need to get through it naturally. Having my first baby five years ago really made me aware of how strong and powerful our bodies are if we let them do their thing naturally.

Thank you all for your advice and I wish you happy pregnancies and healthy babies.
post #7 of 64
Hi Sunny,

We're absolutely in the same boat. I was on 60 mg of Cymbalta and when I discovered I was pregnant, I decided to begin tapering off.

My doctor told me that I could stay on the drug because there was really no research one way or the other to prove it was unsafe. I decided to go ahead and go off, even though I know other moms have taken it through their pregnancies and been just fine. It's a personal choice for sure.

I'm down to 40 mg a day right now. I do have headaches, there was some dizziness. Though honestly, who the heck knows if those were from Cymbalta or from just being in my first trimester. I do have to say, that once my doc put me on those mega horse-pill sized prenatal vitamins, the dizziness disappeared.

I think that really good nutrition, a light lamp (like someone else mentioned), and solid exercise (not too crazy, but just walking a little each day) is a big help in tapering off.

It might sound odd, but in some weird ways, I feel like this was a good time to go off Cymbalta. Whenever I feel sick I never worry, "oh is this my brain going nuts because I'm weaning off Cymbalta? Did I make the wrong choice?" Instead I just think, oh god, here comes the pregnancy headaches, headrushes, and pukey feeling. I feel like it's reduced my self-generated anxiety about going off the drug, if that makes sense.

Sometimes when I was on 60 mg, I would miss a dose here and there (forgetfulness). But I would always remember to take it again when I got brain zaps. You might've had those. It's that feeling when your brain feels like it just got a weird electroshock. Not really dizziness, just time slowing for a few seconds then lurching back into rhythm. I have definitely not gotten those at all during the weaning off, so at least that's good.

Hope you are feeling well. Are you on 30 now? Let us know how this progresses. We can compare notes as we go through it.
post #8 of 64
I was curious to see if anything had changed between the 2008 and 2010 Hale's Medications and Mothers' Milk, so I checked my book that was sitting on the counter after a helping call. FWIW, it is still categorized as C class for pregnancy and L3 for nursing.

Good luck and I hope you find some peace of mind soon!
post #9 of 64
Thread Starter 
Partaria,
I just picked up my prescription for 10 30 mg pills. So today is my first day with the reduced dosage. I completely understand what you wrote about it actually being a good time to come off the drug. If I was alone and pregnant it wouldn't be such an easy decision for me to come off this cymbalta. I know that my depression has been bad in the past and really affected me and therefore those around me. This time I feel lucky to have lots of family support and people nearby to help keep an eye on me.

I am expecting this weaning off of cymbalta to be difficult but I am determined to cope with it through deep breathing and exercise. I also am looking into a light lamp as you and another had mentioned.

I would like to keep in contact while weaning off together. I think it could be helpful to us both.

Today I am hopeful and excited. How are you?

Take Care
post #10 of 64
Hi Sunny,

Yes, let's definitely stay in touch! It's good to have a buddy when you're going through this.

Yesterday I was feeling so down. I was crying a lot, just feeling so sick and so yucky. It's difficult because as much as we (DH and I) want this baby, I just didn't know I was going to feel so freakin' awful for the first trimester. Sometimes I find myself wishing I wasn't having a baby, then I feel this awful guilt for having that thought. All of that can of course, trigger some pretty deep depression plunges. It's hard. I feel sometimes like I'm walking the edge of a cliff.

But the good news is that DH dressed me in a jacket, helped me put on shoes, and hauled me outside for a quick walk with our dog. That turned into a 30 walk around the neighborhood, and as we walked I felt better and better.

The physical symptoms of withdrawal w/Cymbalta seem to be ok. No brain zaps. A little dizziness, but it's not so bad. I'm just so watchful of myself for any kind of emotional plunge. But I'm trying hard not to focus on my fear of that so much that I sort of make a self-fulfilling prophecy. If I find myself falling into a spiral, I will deal with that when and if it happens. But if it's not happening right this moment, I try to push it out of my mind.

How are you feeling, sunny? Deep breathing is a great idea. Are there any yoga or meditation classes near you that you might join?
post #11 of 64
rparker can I ask what lamp you use/recommend?

I am looking into this as a an option for ongoing, as yet undiagnosed fatigue.

Thanks!
post #12 of 64
I was advised that the benefits outweighed the risks and took it all through my pregnancy and nursing. My baby had no withdrawal effects and now a perfectly little happy guy at 9 months.

The best thing is I avoided PPD this time around. I made the mistake of stopping my anti-d first time around and suffered terribly through my pregnancy and had terrible PPD. That certainly wasn't good for my little one.

Anyway, I was advised by two high risk OBs to stay on it and I am glad I did.

Good luck!
post #13 of 64
I also took cymbalta during pregnancy and breastfeeding. There were no problems. It was definately better for me to have depression treated than not treated. I had severed PPD after my first and second. I stoped effexor while pregnant with my first, and took nothing with my second. If you are on it, please do not stop! Most of the info we have on cymbalta during pregnancy is based on its sister drug effexor, which showed a slightly lower birthweight (mine weighed in at almost 10lbs and was the largest of my three) and withdrawl. Withdrawl is even less likely if you are bf. Also, cymbalta is a rather large molecule and may not pass well through the placenta to the baby.
post #14 of 64
This could be purely coincidental, but my first when I wasn't on meds was born almost a month early, had reflux, and is now a very sensitive, often stressed child. My second was born full term, has no reflux, and is the most laid back happy baby you'll ever meet. I have to wonder if the stress I went through with my first pregnancy might have caused me to have my first early and lead to the other problems.

Probably coincidence, but perhaps not.
post #15 of 64
Quote:
Originally Posted by EnchantedMamma View Post
rparker can I ask what lamp you use/recommend?

I am looking into this as a an option for ongoing, as yet undiagnosed fatigue.

Thanks!
I have the goLite P1 by Apollo Health which I bought at least five years ago. It looks like the company has been bought by Phillips. I think this is the closest thing on the market to the product I own (and probably a lot nicer):

http://www.usa.philips.com/c/light-t...hf3332_60/prd/
post #16 of 64
Thread Starter 
Hello Partaria,
How's it going? I am happy to hear that you have some good support, that is so important. If it helps any, when I was pregnant with my daughter, I was so sick the first trimester. Nausea and hunger at the same time. I lost a lot of weight and could barely eat anything. And this was without going off of any prescriptions.

Then one day after the first three months... bam! I felt great. No more sickness the rest of the pregnancy. So hang in there, you will get better and more than likely will not feel so bad for the whole pregnancy.

I am doing pretty good with coming off Cymbalta. I am on day 7 of the reduced dosage, then in 3 days go off it completely. I have had headaches, strange dreams, flashes of light in my head, extreme tiredness and a bit of nausea. But really I have tried to keep busy and also got enough sleep with an occasional afternoon lie down... if possible.

Hope you are doing well.
post #17 of 64

smile.gif hello yes i want to know the same thing as iv just been put on Cymbalta after being depressed for years and trying others and want to know if its safe aqs im not on the pill atm (i will asap) and pregnancy could happen,i adore babies always have and cant wait to have another but im not ready yet and wouldnt want to harm my baby.

post #18 of 64
I was on meds last time for fibromyalgia. Can't remember what type, but I did have to switch before the third trimester. Some antidepressants can theoretically cause high blood pressure in the last trimester, so they prefer to switch if meds are needed. I have found that cod liver oil is more effective for me, but of course the efficacy would vary depending on your body chemistry.
post #19 of 64

SWITCH to Prozac!!! Prozac is the only drug they have done intense studies on without harmful side effects to the baby! That is the easiest way to ease off of Cymbalta as well. It may not be AS effective but it is MUCH safer for your baby and it also allows treatment and relief for you. I have been in your shoes and done much research. Please call your doctor immediately to switch to Prozac.

Hope this helps.

 

post #20 of 64
haven't read all the responses.

my friend, who is an OB/GYN nurse, has been taking cymbalta for years. she recently decided to TTC so she has weaned herself off of it. from her knowledge and experience, she is not convinced it's safe.

i had taken zoloft off and on for years for depression but weaned myself off after I got pregnant. I miscarried that pg the exact same week that I had myself full weaned off the zoloft. I did not go back on it because I wanted to get pg again. I did and now have a 2 month old baby. I will not consider going back on any antidepressants until after my baby has stopped breastfeeding, which means most likely 2-3 years.

the fact is that no matter how much a doctor may say something is safe, there really is no way they can know for sure because they don't do scientific trials or studies of pharmaceuticals on pregnant women. they can only use data after the fact to see if any problems show up. I don't want to take that risk so I don't take any meds during pg unless absolutely necessary.
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