Which SSRI safest during pregnancy?

[EllasMama]

I'm getting the itch to have another baby, but didn't have much success with limiting my meds in my recent attempt. I take Lexapro 10 mg (it's the new generation of Celexa) for depression and mild anxiety.

I've been trying to locate some info online about what is SAFEST during pregnancy. I find a lot of articles that reference a ~1998 study that showed Zoloft, Paxil, and Prozac were considered safe (there might have been one other one). And generally I seem to read that all SSRIs are considered okay if the risk from taking them is lower than the risk of NOT taking them. But I can't find anything newer or anything that offers an opinion on what is considered the safest.

I keep reading that Zoloft is considered safe overall, is safe for breastfeeding, and it has an anti-anxiety effect like Lexapro, so I wonder if I should switch to Zoloft. I hate to switch unnecessarily, though, b/c Lexapro works well and I haven't tried Zoloft before. Does anyone know of any info about Lexapro or Celexa, or comparisons of what doctors think are the very safest depression meds?

Thanks!
Carol

[MilkOnDemand]

I've been on Zoloft for some time now, and my OB & my sister (a physician's assistant specialized in obstetrics) both agree that Zoloft is one of the safest SSRI's available during pregnancy and breastfeeding. I'm taking 50mg/day, and feel very comfortable with my decision to continue it. In your situation, I'd probably try switching, under the physcian's watch, prior to becoming pregnant. Pregnancy is not a good time to mess with medication for depression.

[jmreinke]

I have no idea what is safest, but I went on Zoloft at 30 weeks and took it until dd was about 9 months old. I had no problems with the pregnancy or with breastfeeding. I am very glad I was on the Zoloft. But, like I said, I have no experience with any other SSRI's so I can't really give you any comparisons for you.

I have a friend locally who is taking Prozac for PPD instead of Zoloft, mainly because her insurance will pay better for the Prozac over the Zoloft.

[EllasMama]

Did either of you cut down or wean off Zoloft in your last trimester? I keep reading that doctors recommend that to help the baby not have withdrawals, but having tried unsuccessfully to get off my meds recently, while in good health and spirits, that seems like a recipe for APD &/or PPD. I just didn't sleep much when I was hugely pregnant, and lack of sleep makes my depression much worse. I can't imagine stopping my meds at that time, but I would of course consider trying it if it were necessary.

Thx!
Carol

[AllyRae]

I wonder if breastfeeding itself would help the baby not go through withdrawal symptoms? They baby is still getting a low dose and would probably receive lower doses as the baby gets bigger? I would imagine that would help curb the w/d symptoms if you don't wean off the meds during the 3rd tri?

[MilkOnDemand]

I'm actually just getting ready to enter the 3rd trimester and there has been zero discussion of changing my dosing in either direction. Because I plan to breastfeed for a couple years, I imagine that when/if I wean off of the Zoloft it will be gradual, so the baby will be gradually weaned as well. And, if he weans on his own, that too is gradual - so in effect, the withdrawl would be minimized.

I did try a switch to Wellbutirin early in the 1st trimester, but for whatever reason my body did not accept the switch well, so only 2 weeks of it and I went back to the Zoloft.

[jmreinke]

I just started the zoloft at 30 weeks, so no, I didn't wean down, I went up. When I quit when dd was about 9 months old, I just weaned off of it over a two weeks time period. I didn't notice anything with dd after birth, or when I quit the Zoloft.

[EllasMama]

That makes total sense that breastfeeding would mean the baby wouldn't experience abrupt withdrawal! Duh, I just hadn't clued in that everyone doesn't breastfeed and so some babies would abruptly stop getting any of the med. Glad to hear that your doctors aren't recommending that. I just can't imagine feeling like I absolutely had to stop taking it in late pregnancy. This will probably be my last pregnancy, so I want to enjoy it as much as I can!

I think I'll talk to my healthcare provider about switching and see what she says. I decided to put off trying to conceive for a little longer so I have time to try to wean off altogether or switch to Zoloft or whatever works.

Thanks so much!

Carol

[Softmama]

I went to see a psychiatrist who specializes in PPD before conceiving this baby (I had severe PPD after the birth of my lst one). Her first choice med is Zoloft. My regular family practice doctor agrees. I just had to start it at 22 weeks and will not be decreasing my dose for the last trimester. Although I will try and maintain the lowest dose I can while pg (50 mg seems to be working), I will definitely increase if I need to.
Last time I started Zoloft when ds was 2 months and came off of it when he was 9 months. He nursed the whole time and didn't seem to experience any withdrawal. So I am hping hte nursing will work for that again this time around.

[stayathomecristi]

hi mama,

The consensus seems to be that Zoloft is the safest ssri during pregnancy and breastfeeding. I got my information from my counselor who called MASS General Hospital in Boston to confirm what she thought. They told her that Zoloft is the best choice as well. She also had read some studies which showed that out of all the meds out there, this was the best choice.

So....if you gotta be on an anti-depressant it looks like you're on the right one.

Best wishes

[stayathomecristi]

ADDENDUM: a little off-topic, but I would stay away from Paxil despite what any studies say.

My friend who is not preg. has been trying to get off it for some time and is having a very difficult time doing so. If you do an internet search, you will probably find a forum or two and some info about withdrawal from Paxil.

JMHO--stay away from it!

Cristi

[EllasMama]

Yeah, it sounds like Paxil is tough to wean off of. In the end I think I've decided to stick with Lexapro. Unfortunately I'm not aware of any studies done on Lexapro, but it's essentially the same as Celexa and that was deemed okay at the time Prozac and Zoloft were. I didn't like the thought of switching to Zoloft without knowing whether it would even work for me. I may try to get off St. John's Wort, though, which I also take.

Thanks for the info!

Carol

[Jish]

Lexapro has only been on the market for about 2 1/2 years. Thus, it isn't as studied as the rest of the meds. The best med for you to be on whether you are pregnant, nursing or not is one that works the best for you.

I got pregnant with my third knowing full well that I might have to stay on my meds. I went off to get pregnant not knowing that I was already a week pregnant. I had a great pregnancy and had no depression or anxiety whatsoever. Pregnancy can be very protective for some women and they will feel great. Hopefully, you will be one of those women.

[polka123]

Zoloft is the drug of choice for PG & BF.
it has a very little shelf life in the body so less is transferred to fetus or b/f'ing baby. Prozac can stay in the body a week so that's not good

Every Dr & Nurse & every piece of research I did comes back to Zoloft