Anti-depressants in Pregnancy?

[loudmama]

Hey all,

I'm about 4 weeks along with baby number 3, & I'm trying to get some more info on anti-depressants in pregnancy. I was diagnosed with PPD when my 10 y/o was about 6 months old. Manifested itself mostly as anxiety. Realized through all of this that I have had lifelong history of anxiety & depression & that pregnancy & parenthood just brought it to a head. I've been on meds for it since then.

I stayed on meds through pregnancy #2, switching to Prozac while pregnant & Zoloft while nursing. I figured I would have to switch from my current meds (Zoloft & Wellbutrin) to something else during this pregnancy. When I called the psychiatrist who prescribes my meds on what to do, he told me wean off them entirely. And I have to admit I'm a bit worried about this. I'm in a good place right now with my anxiety & depression & have it mostly managed with the meds, vitamin D, & a good workout program.

I obviously want to do what is good for the baby. However, while my depression has never made me suicidal, it is not pretty. I function, but not well. And after the baby, even with meds it's not pretty. My DH is still scarred from my PPD. I will be meeting with someone In my potential care providers office on Wednesday to talk about it. (The Family Practice Dr I will work with if I can't have a home birth is on vacation.).

Has anyone taken meds during the last couple of years while pregnant? My youngest is over 5 years old, & I know there have been more concerns in recent years. I might be ok without meds right now, but as fall comes around, I'm a bit more worried. Working out, Vitamin D, & my full spectrum light might help, but I'm still concerned. My awareness helps as well, & I have resources & people who can help, but still...

I know there are many around here who do not think these meds are ok in pregnancy or anytime. I respect that. But please respect that for someone who has been in that spiraling vortex of anxiety & depression, this is a valid concern.

I know where to look to find out the class of meds. But what is a good place to get balanced info? Anyone been where I'm at, or close?

Thanks for your help.

L

[always hope]

I just saw my psychiatrist because I am planning my second pregnancy. I am on paroxitine 60mg. She said that you should reduce your dose to as low as possible but still be well. It is much better for your baby for you to be well. Not sure about your meds though. Sounds like you need a second opinion.

[Imakcerka]

Wellbutrin is not a good thing to be on while pregnant.  Actually they're finding more and more that a lot of those kind of medications are causing lots of problems.  My DH was on Paxil and wellbutrin for over 4 yrs.  In that time frame he was unable to produce viable sperm.  Neither of us used protection and were unable to get pregnant.  Took 6 months after he got off of paxil and wellbutrin for me to get pregnant.  Two miscarriages and finally this one seems to be going well. 

I have heard of other instances where babies have some medical issues that are linked to Wellbutrin.  I would try CBT.  That could help.  I would also question any doctor who inlight of the new discoveries disregards them and tells you to stay on them.

[LalaithYamainu]

I'm on Zoloft right now, 8 weeks into my first pregnancy, and both my Family Doc, my OB, and my doctor father strongly recommend that I stay on it.  It's the safest pregnancy one, right now.  The risks are there, but the risks of trying to go through a pregnancy without it... well, for me, at least, are much more dangerous.

Though all the commercials on right now about "was your baby born with a defect?  were you on zoloft when you were pregnant?  we can help!!!"  is not pleasant.

[loudmama]

I'll see how it goes. Today was my last day of weaning off of Zoloft. My anxiety has it's moments, but it's doable for now. I'm more irritable, but that could just be hormone related.

I get it, many meds are unknown in pregnancy & it does seem seem we are doing large experiments on this stuff in people. But it really is a hard balance.

L

[Imakcerka]

Good luck to all you mamas out there.  I understand how difficult it is by watching the pain my DH goes through.  Mentally, emotionally and physically... I do what I can to keep the stress low on DH, and help him through his hard moments.  He's sick of being dependent on the meds.  And though I know he functions better on them.  I can't force him.  Love to you all.

[MsFortune]

I would see another psychiatrist, if possible.  I'm irritated that her/his first response was to say to wean, rather than to have you come in and talk about options.  Discuss how you planned to manage issues without meds, at the very least, or discuss medication options.  Telling you just to wean and sending you out without a safety net is irresponsible and dickish.

There are many medications options, and all have different levels of risks.  The problem, as you know, is that it is hard to get data on pregnant women and drugs.  You can't do a randomized clinical study and put 1/2 on meds and 1/2 not.  It's not ethical.  So the data is pretty limited.  They have to look at animal study data, which is not an exact science since people are different, and post market pregnancy studies.  

The big risk with SSRIs is a very small - but real - risk of cardiac birth defects.  I can't find the paper with the details (stupid internet) but I found one that summarized the known risks of each med.  In general, SSRIs are the best and most well studied.

From what I remember, Paxil is the worst of the SSRIs.  Prozac scored well, but probably because it has been around the longest and so its effects are the most studied.  Celexa looked OK as did Lexapro.  I took Lexapro during both my pregnancies, and for what this anecdote is worth, both my kids are healthy and awesome.  I have regular depression, not PPD, so I chose to stay on meds throughout both pregnancies.  

Wellburtin is not an SSRI and I recall it was not good.  I don't remember how Zoloft scored.   

In general, the decision to use a drug during pregnancy should be a weighing of the known risks to the baby against the medical needs of the mother.  Only you can make that decision, but you need real facts, and a psychiatrist who is willing to have the discussion.  

I don't think you should take advice from random people off the internet, but here is mine.  Get a new psychatrist, or request an in person meeting with this one to discuss medication options.  I'd stop taking the Wellbutrin (I don't think you need to wean from it like other drugs) and stay on the Zoloft until you get a psychiatrist who can give you better advice.  

Good luck.  Depression sucks, and you deserve help.

[always hope]

Most SSRIs are pretty well studied. Try infantrisk.com for more info. They have a really good summary of the latest research. I would say that if you are already finding yourself anxious and irritable that you should keep a close eye on your symptoms as they may get worse. Sorry to be a downer but that has been my experience. I am cutting back on my meds now and even dropping 5mg every 2 weeks I have noticed a change.

Best wishes. Such hard choices to make.

[friendly fire]

i'm about to be done with my third pregnancy and have taken Prozac during all three.  i had just started the meds before getting pregnant with my first son who just turned six.  my dosage was pretty heavy with my second son who will turn four next week.  my dosage during this pregnancy is the lowest possible at 10 mg.  my boys are both diagnosed with autism and were 6 and 3 weeks early.  i am happy to say i am 39 weeks with this pregnancy and anticipate going to 40.  there has been a recent (very small and somewhat unsubstantiated in my opinion) study linking prozac use especially in the first trimester to autism in children.  i can safely say my second child is more severe.....and it is true i had been on the drug for two years when he was conceived and as i stated before, took a heavy dosage throughout the pregnancy.

these are just the facts in my case!

[kdaisy]

I have been on Zoloft since my first was 8 months old.  I took it all through pregnancy number 2.  Like a pp said, my midwife and doctors all recommended I stay on it.  No ppd the second time around was awesome!

[LynnS6]

Coming late to the party here -- I was on Paxil (Paroxetine) all during my pregnancy with dd. She was a little 'jittery' her first day or two, but she's now 7, healthy, happy and very bright.

I would recommend a second opinion. There are risks to being on SSRIs, but there are also risks to not being on them. (It can affect fetal brain development, for example.) It's not an easy choice either way.

Please make a plan with your doctor NOW about follow up, whether you stay on meds or not, since you know the hormone fluctuations will put you in a very fragile spot postpartum. I had to increase my Paxil dose after birth.