antidepressants during pregnancy

Emma - posted on 07/08/2009 ( 14 moms have responded )

5

73

0

im neally 24 weeks pregnant... and coz i had PND really bad with my last child they want me to start taking prozac now... i dont want to do anything thats going to harm my baby but i dont want to end up the way i was after my last child.. im going crazy not knowing what to do plz help..

MOST HELPFUL POSTS

Coral - posted on 07/12/2009

13

13

0

Everything I have read says certain medications are fine to take for depression during pregnancy Prozac being one of them. I personally will not take them during pregnancy, I was advised to but am very paranoid because I had a miscarriage a year before this pregnancy. You can also talk to pharmacist or other doctors or nurses to get another opinion. It is safe technically but it is ultimately your choice do what your body feels is right and if u need help with the depression there are many natural alternatives to drugs.

Christina - posted on 07/10/2009

6

4

0

I have a 2 yr old daughter, and during my pregnancy, my OB wanted me to take an antidepressant, as I have struggled with depression for many years. However, my psychiatrist advised against it due to the potential risks. I am a psychology major and wrote a short paper on Antidepresaants during pregnancy. It really depends on the severity of your depressive symptoms. If it suits your situation, you could wait until after birth to start the medication, since exposure is MUCH smaller during breastfeeding than during pregnancy. Prozac is the most studied during pregnancy, and seems to be the safest, though there will always be a chance of fetal malformations. My personal issue with taking any brain-chemical-altering substance is that I was forming/growing a little brain in my body and it didn't seem right. So, I researched and here is my paper below: I hope you find it helpful



"Untreated Depression Risks

Women who become pregnant while taking an antidepressant are faced with a difficult choice. The historically safe route with medications during pregnancy is avoidance. However, during the past decade, studies have suggested that untreated maternal depression “may actually have more adverse effect[s] on fetal well-being than antidepressants do (Stowe 2001).” At the annual American Psychiatric Association (APA), Wisner, MD, MS announced that, “Depression is not a benign state. I think of depression itself as a kind of toxic exposure.” Stowe, MD, director of the Pregnancy and Postpartum Mood Disorders Program says, “I have spent the last 10 years of my career worrying about the impact of medications. I’ve been wrong. I should have been worrying more about the impact of illness (2001).”



Numerous studies have revealed adverse effects on fetal and infant health. Untreated depression during pregnancy is associated with low birth weight and premature labor. Alcohol, nicotine, and illegal drug use are potential adverse effects of a depressed mother-to-be (Stowe 2001). Depressed women have higher levels of stress hormones as well. According to Stowe’s animal studies, “the offspring of mothers subjected to high levels of stress during pregnancy show abnormal growth and impaired learning as adults.” Dr. Stowe’s group revealed that 6-month old infants whose mothers had been depressed during gestation “show a higher than normal cortisol response when subjected to stress (e.g., loud noises).” Potential negative parenting behaviors during the postpartum period are more prevalent amongst depressed mothers (e.g., neglect, abuse). Depressed mothers also exhibit low levels of positive parenting, such as reading, interacting, ensuring safety.



A 2007 study in An International Journal of Obstetrics and Gynecology examined the use of antidepressants before, during and after pregnancy. 97,680 Canadian women between the ages of 15 and 45 were studied between 1998 and 2002. Only 3.7% of women used antidepressants in the first trimester. This statistic increased to 7% of women after childbirth (Ramos et al 2007). Selective Serotonin Reuptake Inhibitors (SSRIs) were the most common form of antidepressants used. O’Keane and Marsh’s commentary piece notes that the rates of depression tend to be higher in women during the childbearing years, “with as many as 25% of women in some countries being diagnosed during pregnancy, with a 13-15% rate of postnatal depression.” O’Keane and Marsh note that maternal depression during pregnancy is being under-treated and that “severe depression is associated with poor long-term developmental outcomes in babies (2007).”



Antidepressant Risks

On the other hand, pregnant women using antidepressants are also exposing their infants to this medication. According to Dr. Stowe, “not only do antidepressants pass through the umbilical cord, but the medication that the fetus excretes into the amniotic fluid is reabsorbed by the respiratory and gastrointestinal tracts. In the case of fluoxetine, the latter routes of exposure alone can add up to a dosage of 3 mg/d (2001).” How does this exposure affect the unborn child? Dr. Stowe and his colleagues used a rat model to investigate this issue; his group’s findings revealed that “the concentration of fluoxetine in the fetal brain is roughly three quarters of that in the mother’s brain.” The implications are clear to Dr. Stowe, who states, “If you give a woman an antidepressant during pregnancy, you’re probably giving the child a therapeutic dose of that medicine (2001).”



In more than 3,000 exposures to fluoxetine, “there has been no evidence that these medications increase the risk of miscarriages, premature birth, or major birth malformations (Wisner 2001).” However, the 1996 New England Journal of Medicine article is a major exception. This study compared 228 pregnant women who took the drug with 258 controls who did not. Chambers, MD and colleagues reported that “infants whose mothers used fluoxetine while pregnant were more than twice as likely as control infants to have three or more “minor anomalies” and perinatal complications (Chambers 1996).” Chambers’ team also found that these exposed infants had an “8.7 relative risk of poor neonatal adaptation (e.g., respiratory difficulty, jitteriness) and a 2.6 relative risk of being admitted to a special care nursery.”



Since Chambers’ findings were not consistent with Dr. Cohen’s studies, he performed a study using the same design as Chambers et al. To Dr. Cohen’s surprise, the findings were “very consistent” with those of Chambers’ group, “showing an increased rate of special care admissions with prenatal fluoxetine exposure—anomalies such as left facial droop or a skin lesion on the arm—were not problems one would typically attribute to fluoxetine exposure (Cohen 2000).” Cohen believes that many doctors would consider a short special care nursery stay to be a “reasonable precaution for an infant exposed to antidepressants.” In prenatally exposed infants, “there have been several reports of possible withdrawal effects, such as tremor, sedation, and decreased muscle tone (Cohen 2000).” He adds that these problems resolve within 72 hours of birth.



Dr. Wisner pointed out, that “the minor malformations observed in these studies are a marker for some subtle central nervous system anomaly that might not become apparent until later in development (2001).” Another study followed 135 children who had been exposed to either fluoxetine or tricyclic antidepressants during pregnancy through 7 years of age and compared them to non-exposed controls. The results indicated “no significant differences in IQ, temperament, behavior, reactivity, mood, distractibility, or activity level (Levinson-Castiel et al 2006).” Yet another research team’s data can argue that early exposure to SSRI’s can disrupt “the normal maturation of the serotonin system and alter serotonin-dependant neuronal processes (Simpson et al, 2006).” Simpson et al note that exposure to SSRI’s in utero may have “long-term neurobehavioral consequences (2006).” Unfortunately, despite accumulating research, it still remains unclear as to whether or not untreated maternal depression or antidepressant use during pregnancy has long-term effects on human child development and behavior.



The pharmacological treatment of choice for depression, anxiety, and obsessive–compulsive disorder are SSRI’s. These drugs are specifically recommended for treatment of these disorders during pregnancy and lactation (Wisner et al, 2000; Cohen et al, 2004). Consequently, there is a significant likelihood that infants will be exposed to SSRIs either in utero or via breast milk. ‘Neonatal antidepressant exposure syndrome (NADES)' in rats include such behavioral changes as “locomotor activity, reduced male sexual activity and competence, increased ethanol consumption, dysregulation of the hypothalamic–pituitary–adrenal axis, increased rapid eye movement (REM) sleep time and reduced latency to enter the REM sleep phase, and increased immobility in the forced swim test Maciag, 2006).” Adults exposed to similar doses of antidepressants do not exhibit behavioral effects after discontinuing the drug. According to Maciag (2006), this indicates that the neurobiological response to long-term antidepressant exposure differs between early life and adulthood.



Weighing the Risks and Benefits

The degree or severity of the mother’s depression plays a significant role in determining her individual risk-benefit scale. Dr. Cohen states, “If we can avoid medicines and use psychotherapy, that would be wonderful, but in patients who are severely and recurrently ill, I don’t think we have that luxury.” The use of non-toxic options, such as improved diet, exercise, and regular talk-therapy sessions may be favorable in patients with milder depression. One thing the experts agree on is a woman’s decision to use antidepressants during pregnancy is an extremely personal one. Even after extensive counseling, some of Dr. Wisner’s patients will say, “I don’t care how much you tell me about what is known about these drugs, I just cannot put a drug in my mouth during pregnancy. I’d rather take the risk of depression.” Dr. Cohen states, “What we tell patients is that there is no perfect decision, and no decision is risk-free. Patients need to know about the risk of exposure, and they need to know about the risk of untreated disease.” "

Written by Christins Fenwick, MU, please e-mail me if you would like to view my resources.

Christie - posted on 07/13/2009

30

24

8

I was 3 months pregnant when I went on Zoloft for PPD. My first baby was only 3 months old when I found out I was prego again. I took the Zoloft for the duration of my pregancy. My daughter is now 18 months old and there have been no issues with her. She is fine, and hitting all of her milestones. It is always hard to consider things like this while pregnant because it is not just you that you have to worry about. In my situation the medication helped me out of a hole that I would not have been able to pull myself out of alone. I hope this helps put your mind at ease. Good luck to you!

Raichel - posted on 07/11/2009

1

9

0

Quoting Emma:

antidepressants during pregnancy

im neally 24 weeks pregnant... and coz i had PND really bad with my last child they want me to start taking prozac now... i dont want to do anything thats going to harm my baby but i dont want to end up the way i was after my last child.. im going crazy not knowing what to do plz help..



I am now 36 weeks pregnant. I have been on Cymbalta for several years before I became pregnant and I've had no problems whatsoever during my pregnancy. What it really comes down to is will the good of the medication out way the potential bad. That's how it is with all medications. If your doctor thinks that the benefits outway the risks, then it's obviously a better choice to listen to your doctor. From the things I have read, Prozac is one of the safest and most studied anti-depressant during pregnancy. I definitely had concerns about what I am taking, as there has not been a lot of studies done, but for me being off the medicine would have had a much worse effect on my baby then the medication itself. You just have to trust you doctor, especially since they were the ones that went to medical school and have the degree. They generally know what's best. Also, remember that being informed is great, but there really is such a thing of being "too informed" so to speak. Doing research is one thing to be aware of potential risks and what not, but reading and re-reading and over analyzing can really just upset you more when there might not even be a reason to be upset in the first place.

Ez - posted on 07/11/2009

6,569

25

237

I have bad panic attacks (where I actually pass out) and have been on Lexapro for the last 4 years. It's an SSRI (also used to treat depression and OCD) and it was safe for me to take during my pregnancy and while breastfeeding.
PND is a very serious matter and I urge you to consider your doctor's requests to start medication now. If you're uncomfortable with Prozac look into some other alternatives. Talk to your doctor until you come to a solution you're both happy with :)

14 Comments

View replies by

Christine - posted on 07/17/2009

19

6

3

I'm sorry I don't know where you are from but I am in Canada and there is a Mother Risk line you can call here to ask about any medication. I was also in that position and called to ask about several different kinds and the risks. There are some that get passed on more than others and there are some that are better during pregnancy and not the best for breast feeding and vise versa. I know that I picked what was best for my situation for both pregnancy and breastfeeding.

Amber - posted on 07/10/2009

72

25

9

I had severe postpartum depression after my son was born and did not get treated for three months, that was the absolute worst time of my life and when I became pregnant with my daughter I switched to Zoloft. My daughter was born absolutly healthy and she is a very smart bright child. I think for the sake of having the best experience after your child is born you would be wise to take something before he is born. I don't think I took anything for the last month, but went right back on the day she was born. It is a very personal decision, but I wouldn't take any chances on waiting until it is to late, it is very hard to recover at that point.

Jocelyn - posted on 07/10/2009

5,165

42

275

you can take st johns wort thru your pregnancy, it works as a low-dose anti depressant. it'll also help you sleep better. i was on cilexa for ppd and switched to st johns wort after about a year and a half, and the results from both were the same. good luck :)

Kate CP - posted on 07/10/2009

8,942

36

758

I'm bi-polar and I've been on Zoloft (the sister drug to Prozac) for years. I took it all throughout my pregnancy with my daughter. Prozac is listed as a level C drug on the FDA website. You can look there for more information or this is a great site and easy to navigate:
http://www.safefetus.com

Abby - posted on 07/10/2009

28

11

1

I would NEVER have ECT unless you absolutely NEED it, because the two people I know who have had it done have regressed mentally (from in their early or mid 40s back to a ten year old) and from what I understand this is common among patients of this type of therapy- so unless you want your significant other to be taking care of your baby and you as you slowly approach your child's age mentally, I would avoid this at any and all possible costs. I would, however, talk to your doctor about Zoloft because that's the 'safest' drug for pregnant women, or so I have been told by every doctor at my OB practice. I wish you the best of luck!!!

Crystal - posted on 07/08/2009

3

119

0

I was taking Efixor during my pregnancy, but in the last trimester my doctor switched me to Zolfot and everything was fine. Maybe you could try something like that, that is known to be safe until it is okay to take prozac. I

LaCi - posted on 07/08/2009

3,361

3

171

Personal opinion, I wouldnt take it during pregnancy. It permanently affects childrens brains, who knows how it would affect a fetus. theres a great documentary called GenerationRX, shows specific details on damage to childrens brains from commonly prescribed meds. Prozac and ritalin were the big two.

I am totally for antidepressants, had very bad ppd and waited too long to get medicated with my son. But no way would I take that during pregnancy. Its a tough situation.

Jessica - posted on 07/08/2009

47

22

6

Google the medication that they want you to take. That may have some good information on the MIMS website. I had PND with my second thankfully not to the medication like you, but i felt that it was a real battle within me between the emotional side of me and the logical side. Some times the emotional side of me was so strong that, thats all i could think about. My baby was not settling well so the emotional side of me was telling me that i wasn't doing a good job. The logical side of me was telling me that he has reflux and not liking the formula and that was why he wasn't settling. All it took was for me to discuss at the time what i was feeling and reassure my self that the logical side was right. I believe that ECT (Electro Convulsive Therapy) is a treatment given to pregnant women who suffer depression with great affects for the mum and no ill effects on the baby at all. I know that sounds a little barbaric but its done in hospitals under doctors and anaesthetists in a day procedure. I do hope this can help.

Join Circle of Moms

Sign up for Circle of Moms and be a part of this community! Membership is just one click away.

Join Circle of Moms