Could use some advice re: anti-anxiety meds and pregnancy

[hudsonam]

I posted something along these lines and then removed it, fearing someone might get offended, but I did a search and found some similar posts, so I think it'll be Ok. I have a beautiful, healthy child, who I thought would be my only child for the first year of his life, when I was suffering from anxiety. I started taking Lexapro, and the urge for another baby returned. Or should I say started. I'm now on Zoloft and I don't know if and when I'll ever be able to go off. It runs in my family, although the people in my family who take these meds haven't had to take them their whole lives. It's been more off and on.

I really want to have a second, as you might have seen from my post about baby #2 and moving, but I really wonder if it's worth the risk of taking anxiety meds when there isn't 100% proof that it's entirely without risk. Would I be a horrible mother to put my baby at risk to satisfy my own desires? Should I stick to one child?

DH is not a fan of me being on the meds while pg. We talked about maybe moving first in about a year, and then getting pg (rather then getting pg possibly this coming summer), so I can see if I'll be able to go off the meds (among other reasons). I'm so torn because I want another child very much, but I am concerned about the potential risks associated with taking the meds. It's one thing if you have to start taking them while you're pg, because you didn't necessarily plan for that, and your mental health is as important as your physical health while you are pg, and one affects the other, and I don't even have an issue with someone who knows that they will be on the meds their entire lives, and they have no children and really want a family. Maybe that's hypocritical, I don't know. I am just having a moral dilemma about my current situation. I don't know what I'm looking for here. Maybe some BTDT advice, or words of widsom. TIA!

[megs4413]

not the same situation so take it for what it's worth:

i had a very difficult and complicated pregnancy with DD and had to take lots and lots of meds just to get through it with my life (and hers). i knew full well that another pregancy was risky and woudl require meds again. meds that have not been adequately tested in pregnancy. i went ahead and did it. do i have guilt about that? absolutely....but that's mostly from other people. i know that giving my child a sibling, and giving my husband a son was a selfless thing to do. i know that one day i will see how silly it was to ever think that DS didn't belong with us, or was a "mistake" to risk pregnancy for.

having said that, DS has a cleft issue. the docs say it's unrelated to the meds and is partly a genetic thing. but, i wonder if the meds are responsible for it sometimes. of course, in the grand scheme of things, i think i'd still prefer to have my son with a cleft...than to have only one child cause i didn't want to 'risk' it.

i know several women who needed to take anxiety meds during their pregnancies. perhaps there are drug options out there that you don't know of yet? have you spoken with your doc about it? are you just concerned with taking any meds at all?

i hope no matter what you decide, you have peace with that decision.

[youngmommy]

I went through a huge meds/pregnancy issue. After about 3 years of searching I found a doc who could really help me (through Harvard's breastmilk research program.) She and I continue to weigh the cost/benefits of the meds, but she's at least willing to talk to me about the subject. Before her, I couldn't even find a doc who would consider allowing me to take my necessary meds during pregnancy. It was either suffer through pregnancy or not have a baby.

ETA: Wow! I jumped strait from pregnancy to breastfeeding! I'm going to add here that the doc I was reffered to through Mass General's Breastfeeding Pharmacology site also has helped me deal with the issues of using these meds in pregnancy.

Here's the Mass. General Site on Breastfeeding Pharmacology:

http://www.womensmentalhealth.org/topics/breastfeeding.html


I think I remember finding my doc by poking around the site to find a phone number. Then I called and asked to find a helpful doc in my area, and they gave me a name. HTH!!


One more edit to say: if anyone is dealing with any sort of psychiatric medecine issues in pregnancy/breastfeeding and lives in the twin cities area, I found a doc who can help. Feel free to pm me and I will give you the name and phone number. I searched for 3 years to find her, and I've already helped one friend connect with her. I'm happy to share my findings with you as well.

While we're editing, I'll add another great resource for breastfeeding and medication info:
http://neonatal.ttuhsc.edu/lact/
It's a forum for health professionals only, but you could send your doc to the site for some of the latest info on the topic.

[hardysmom]

First, I really wouldn't feel so guilty. It is a very reasonable issue. I HAVE been there personally.

Talk to your OB. Most anxiety/depression meds have been around long enough at this point that there is A LOT of experience and research on their use. Physicians are very clear on which ones could be harmful and which ones are fine. If your doctor says they are OK, I really wouldn't be too concerned. I have several friends who have been on different SRI anti-depressants both during preganacy and breastfeeding.

Prozac is commonly given during pregnancy. I know that Zoloft is supposed to be the safest during breastfeeding, so it may also be an option during pregnancy.

Let your DH speak to the doctor if it a concern. I know a lot of spouses have trouble with idea of long-term anti-depressant use, even when a pregnancy isn't involved. It is the old trap that since you now seem OK, maybe you should take a break from the meds EVEN THOUGH you know intellectually that it is a bad ides.

Point is, depression can be managed during pregnancy. Worst case is that you go off the meds and end up with a serious bout of post partum, kwim?

Stephanie

[emily_gracesmama]

I went off my very long time use of prozac with my daughter's pregnancy, intending to stay off the whole time, well by 20 weeks I was such an emotional mess, the docs said they'd rather see me on meds than putting the baby through the stress I was with my current mental state. I went back on prozac, switched to zoloft around wk 36 and breastfed her. Now I am pregnant again and stopped my zoloft when I supected I was pregnant. I intend to stay off as long as I can but as soon as I see myself or the others around me see me needing it, they are under strict orders to SPEAK UP. I feel ok now and no one has said anything but I do think I will probably go back on at some point, just knowing my history. I wanted to be off the first trimester since that is when the baby develops their organs. But it is much better for the baby for you to be a mentally healthy momma so do what you need to do. The only drug my docs are strictly against is paxil, which has been in the press for problems, they were fine with prozac or zoloft for me.

[StantonHyde]

I have been on Zoloft for over 10 years--family history of chemical depression/anxiety. My issue is that it gives me insomnia and I was taking Ambien--which you can't do when you are pg. So my internal med doc had me go down to 50 mg of Zoloft (from 100) and quit taking Ambien. I found out I could take the old Unisom--which they prescribe for morning sickness--and it helped me sleep. 6 weeks after having DS under very stressful circumstances I realized I was a wreck and called the peds office and asked if I could take 100 mg and breastfeed. Yep. Plus then the article came out about Zoloft being one of the safest to take during bfing.

With DD, I never tapered down. Stayed on 100mg while pg and bfing. No postpartum whackiness this time. Easier circumstances, too. Both of my kids are just fine--physically, developmentally, etc.

I increased my dose another 50 mg after my mom died this year and it has helped a lot.

Repeat again and again--if I were a diabetic, I would take my insulin forever. Same thing with "head meds". Having a stressed out/anxious mommy is very bad for kids. Which is why I will not have three children :-) You do have to ask yourself--can you handle 2 kids if you are on meds? If the answer is yes, then have #2. If not--go for one. I know plenty of people who have done that and their family unit is much better off because they knew their limits.

[Tondi G]

I know of several moms who took Zoloft throughout their pregnancies and while breastfeeding and have beautiful, healthy babies/children! If you need to take the meds then you need to take the meds. If you think you can wean from them and attempt to stay off of them as long as possible during your pregnancy then great! Form what I understand if you are going to take any antidepressants while preggo or breastfeeding Zoloft is the way to go!!! If you want another child then go for it.... as the saying goes you will never regret the child you have but you may regret the one you don't!

for what it's worth I ended up on Lexapro after my 2nd son was born due to anxiety and panic attacks... just weaned from the meds (yesterday was my last day). I wouldn't hesitate to take the meds again if I needed them pregnant or not! My SIL took Celexa during her last month of pregnancy and while nursing her 2nd child. She had bad PPD after her 1st and just didn't want to go down that road again! Her daughters are both healthy and bright!

HUGS and Good Luck

~Tondi
Mommy to Mason 7/8/01 and Aidan 5/4/05

[DrSally]

I think in talking to your doc, you should weigh the risks/benefits. A lot of studies haven't been done on meds during pregnancy b/c you can't ethically do a controlled study on pregnant women. So, just b/c there isn't research, doesn't mean it is not safe, it's unknown. But, there is a registry where people who have taken meds during preg/bfing report any side effects, so there is some info from there. Also, depression/anxiety during pregnancy can have a lot of effects on the fetus as well (stress hormones, postpartum bonding, etc), so it definitely is a risk/benefit issue. Have you tried psychotherapy? There are very effective therapies out there. If therapy works for a person, there less chance of relapse, as opposed to just meds, where stopping creates a greater chance of relapse. But, that's my bias as a therapist.

[barbarhow]

I am sorry to give you conflicting information-but there are several good research studies out there on the use of antidepressants in pregnancy. Most OBs prescribe Zoloft quite frequently for depression and anxiety. A year or so ago some data emerged that Paxil should not be used in pregnancy. The results have not yet been confirmed and many experts in the field question the validity of that study. However, since there are many other SSRIs that effectively treat depression women should be switched from Paxil to another SSRI, ideally, prior to pregnancy and certainly at first indication they are pregnant.
The current research on the rest of the SSRIs which include Zoloft, Prozac, Celexa, Lexapro show no increased risk to the fetus than placebo.
This decision is one to be made by a woman in conjunction with her healthcare provider (psychiatric and OB) and her partner.
If you google pubmed and then do a search on depression and pregnancy-there are several great articles from peer reviewed sources. HTH
Barbara-mom to Jack 3/27/03, a Red Sox fan
and Anna 5/12/05, my little Yankee fan!

[pittsburghgirl]

I can't add much except that I take Lexapro, and my OB was very firm that I should continue on it should I become pregnant. (We have infertility issues so it's not likely to happen before we close the door on it, but I did discuss it with her last year). My DH is VERY opposed to it, in fact regularly asked me when I'll be going off the meds, but I am in no hurry. I had anxiety during my pg (from IVF - the reason for much of the anxiety) and then when DS was about 13 months, depression (which is when I went on the Lexapro), and the meds have helped me enormously.

Marilee
mommy to James
http://b3.lilypie.com/CSwdm4.png

[Scsigrl]

I can understand your though process. I did not find out I was PG for the first 3 months with my DS. I had been on Zoloft for 7 years or so. OB said it was fine to take till the last 2 months and that we would taper it out then. Well, I tapered it off sooner... and my DH can tell you 3 days after I stop taking my meds. This time NOTHING! You may be surprised that you do not need it while PG. I went through the rest of my pregnancy without needing it. I think the natural hormonal shift has something to do with it. That said, if you do need to stay on it, it is OK! I can understand it not being your ideal pregnancy... but like I heard a Dr on TV say once;) "If Mama ain't happy, ain't NO ONE happy!"

I understand it is a tough choice to make... Follow your heart and you will not be disipointed!

[DrSally]

Barbara is right, there are good research studies out there. I guess I was (unclearly) referring to medications in general and trying to say that it isn't known "for sure", but then almost nothing is during pregnancy. I, too, wouldn't go with Paxil, but there are many other SSRIs with better track records. I hope you can have a good discussion with your ob about this.

ETA: Sorry if I seemed like I was in the "no camp", Given the avail info, I would urge you to talk to your ob about continuing on meds at least for the first 2 trimesters, and see what he/she thinks.

[hudsonam]

Before I can make any decision, my husband has to be on the same page as me. He's on the fence right now too. He first said 'No way' to being on the meds while pg. After I told him that my OB/GYN said I could stay on them, and that he recommends I do stay on them, he's slightly wavering, but I know he will worry the whole time and if God forbid anything goes wrong, he'll blame it on the meds.

I hear conflicting stories about being on it at the end. First I'd heard that if you have a history of any anxiety, depression or PPD, that you should go on it at the end of your pregnancy so that it's in your system when the baby is born. Now I'm also hearing that you should wean off of it at the end. Which is it?

I guess that's the type of thing that concerns me. You hear conflicting things, and until recently, Paxil was considered safe, wasn't it?

Well, thank you for all the advice and kind words. It's going to be a very big decision for us. I would love it if I can manage off of the meds. Maybe I will look into psychotherapy. It can't hurt. Thanks again!

[DrSally]

I think if you stay on it or not until the end of your preg depends on the severity of your previous symptoms and the cost/benefit of being on it when your hormones drop when/after the baby is born. So it really isn't either or, it's a "it depends".

[gina]

I have btdt. I took Zoloft through most of my pregnancy. I was very nervous about it but based on what my doctor was telling me, the effects of stress is proven, the effects of the medicine is not. I guess it depends on whether you think you can live without the medicine. My dose was very low (like 25 mg). I decided to quit taking it mid to end pregnancy. I did not want to continue taking it especially since I was going to be breastfeeding. I was going to be quitting my job after maternity leave so one major stressor was leaving my life anyway (my job), so I figured I could handle it. I had a very uncomplicated pregnancy and birth and now have a healthy
11 month old girl.

I saw an article in Parents Magazine May 2006 that said Babies whose mothers take an SSRI in the second half of pregnancy have a one percent chance of developing persistent pulmonary hypertension, a potentially fatal lung disorder. (according to a study in the New England Journal of Medicine). It also said that another study in the Journal of the american Medical association said that women with a history of depression who stop taking their antidepressant during pregnancy are likely to have a relapse which can increase the risk of preterm delivery.

I took other medications during my pregnancy also. With each one I just tried to weigh the risks and decide if the risk was greater than the need for the medicine.

I would definitely try going off the meds before you try to get pregnant to see if you can go without. If you can't go without then it doesn't mean you can't get pregnant. Maybe you could at least lower the dose some. I am not a doctor, so this is just my opinion but some ideas to consider since I went through this too.

The advice I kept getting from all my doctors was that stress has a proven effect on the baby, the medicines do not have a proven effect. Just weigh your risks and make the best decision and pray for the right answer. Hope this helps.

Gina E
DD 15 yr
DD 11 mo

[StantonHyde]

I am a big believer in therapy. I have used therapists off and on for years--they really help me cope and teach me skills to get through rough spots. You just have to find a good one. Although one of the best ones I went to was just somebody on my insurance plan who was available.