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| *Women health>>>Pregnancy |
Any OBGYNs out there? Is there an antidepressant that's safe to take during pregnancy? |
I'm currently on Effexor XR 37.5mg. I've tried to come off of it. When I'm not taking something, I have terrible panic attacks and cannot function. I cry all the time. I want to have a baby. I have moved and have never seen the same gyno more than once. I need to find a permanent one I trust. I've read some things online where some people say it's ok to take it while pregnant, but other doctors say "no way." There is a lot of emotion and mixed information on this complicated issue. Unfortunately there is no 100% concensus on exactly what to do. There is a general thread of recommendation. SSRI's are first line recommendations in patients who suffer from moderate to severe psychiatric illness, depression and anxiety due to the adverse consequences of untreated illness. There do appear to be some minor complications in a few children who have been exposed to SSRI's at the third trimester. (see below) Further there is the concern of passing the medication through breast milk once the child is born. Some medications are better than others and some simply have not been studied as hard. (like Effexor). I think if you can tolerate Luvox (and it works for you) then that would be one you could take with relative safety and continue to take it through breast feeding. Cohen LS, et al published in JAMA that pregnancy is not "protective" with respect to risk of relapse of major depression. Women with histories of depression who are euthymic (normal thyroid) in the context of ongoing antidepressant therapy should be aware of the association of depressive relapse during pregnancy with antidepressant discontinuation. Suppaseemanont asserted that current appropriate treatment for pregnant women with moderate and severe depression is antidepressant medication, although there is no consensus on the best antidepressants for use in pregnancy. Thus, the psychotropic drug must be chosen carefully to minimize negative effects on infants and mothers, for some studies have demonstrated deleterious effects on infants. Sivojelezova A, et. al. studied Celexa. They concluded that Citalopram (Celexa) use during the period of embryogenesis in pregnancy (early term) is not associated with an apparent major teratogenic risk (birth defect and lost of the baby). Late pregnancy use of citalopram is associated with increased risk of poor neonatal adaptation syndrome, recently described with other selective serotonin reuptake inhibitors. These thoughts are echoed with Kalra S in a article trying to arrive at reasonable advice on the subject. Antidepressant use during the third trimester has been associated occasionally with a transient neonatal withdrawal-like syndrome characterized by jitteriness, self-limiting respiratory difficulties, and problems with feeding. When counseling patients, the risk of these adverse effects must be weighed against the risks associated with untreated depression during late pregnancy. Abrupt discontinuation of psychotropic medications has been associated with both physical (eg, withdrawal) and psychological (eg, suicidal thoughts) symptoms. Bellantuono C, et al published an article recently. The pregnancy is considered to be relatively high risk period for depressive episodes in women, particularly for those with pre-existing affective disorders. Epidemiological studies indicate that between 10% to 16% of pregnant women fulfil the diagnostic criteria for major depression and on average 20% is affected by an anxiety disorder. Pharmacological treatment of depression during pregnancy, however, brings with it certainties and dilemmas. It has been reported that untreated depression is associated with impaired feto-placental function, premature delivery, miscarriage, low fetal growth and perinatal unwanted effects. On the other hand, the use of antidepressant drugs in pregnancy might be at risk of major malformations (teratogenesis), neonatal toxicity, especially withdrawal symptoms and neuropsychological-behavioural impairment. In addition, the abrupt discontinuation of antidepressants, because of fear for adverse fetal effects, exposes women to serious clinical problems, in particular the disease relapse. A number of reviews indicates that among antidepressant drugs, the older SSRIs (in particular fluoxetine, sertraline, citalopram) seem to be avoided of teratogenic risks; for these reasons such drugs are nowadays considered of choice for the treatment of depression during pregnancy. Less information is available for other drugs, including triciclycs, venlafaxine, mirtazapine, bupropion, escitalopram and duloxetine. Withdrawal symptoms have been reported for all antidepressants; these symptoms, however, were self-limiting in majority of cases and had a favourable outcome. Inconclusive findings emerge, so far, from the few longitudinal studies focusing on the long-term neurodevelopment outcome in children. Nordeng H, et al from Norway wanted to explore the passing of medication through breast milk. Data from the literature indicate that the relative dose to the infant is lowest for fluvoxamine and sertraline, somewhat higher for paroxetine and highest for citalopram and fluoxetine. Adverse effects were reported in three of the 119 breastfed infants. Our own results show minimal excretion of fluvoxamine (Luvox), small excretion of paroxetine (Paxil) and higher excretion of citalopram into breast milk. If treatment with a selective serotonin reuptake inhibitor is started during the postpartum period, fluoxetine (Prozac) should not be the first alternative. High doses of citalopram should also be used with caution. However, when the use of an SSRI is clearly indicated in a breastfeeding woman, available data generally indicate that the positive effects of breast-feeding outweigh the risks for pharmacological effects in the infant. In a somewhat older article (2001), Altshuler LL, et al. concluded that among antidepressants, selective serotonin reuptake inhibitors (SSRIs) were recommended as first-line treatment in all situations. The specific SSRIs that were preferred depended on the particular clinical situation. Tricyclic antidepressants were highly rated alternatives to SSRIs in pregnancy and lactation.In evaluating many of the treatment options, the experts had to extrapolate beyond controlled data in comparing treatment options with each other or in combination. Within the limits of expert opinion and with the expectation that future research data will take precedence, these guidelines provide some direction for addressing common clinical dilemmas in women, and can be used to inform clinicians and educate patients regarding the relative merits of a variety of interventions. I hope all of this did not overwhelm you too much. I wanted you to see that there are solid studies on this subject that can help guide the decision process. You might want to print all of this out and bring it to your physician for his/her input. Good Luck!! Source(s): JAMA. 2006 Feb 1;295(5):499-507 MCN Am J Matern Child Nurs. 2006 Jan-Feb;31(1):10-5 Am J Obstet Gynecol. 2005 Dec;193(6):2004-9. Can Fam Physician. 2005 Aug;51:1077-8 Recenti Prog Med. 2006 Feb;97(2):94-107 Tidsskr Nor Laegeforen. 2001 Mar 30;121(9):1156-7. J Psychiatr Pract. 2001 May;7(3):185-208 there is no such safe anti depressant thats safe when your pregnant. Avoid drugs as far as possible , especially antidepressant drugs. |
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