Pregnancy and Antidepressants: Deciding What You Should Do

[omcv]

http://blogs.health.yahoo.com/expert...OXrmoxvK4c08gF


A new study of antidepressant use during pregnancy has reawakened the discussion of whether pregnant women should take these medications. Published in the Journal of the American Medical Association, the study followed more than 200 pregnant women who previously had been treated for major depression. The women were not depressed at the beginning of their pregnancy but were still taking antidepressant medications or had only recently discontinued them.

During pregnancy, 43 percent of the women experienced a relapse of major depression. Twenty-six percent of the women who remained on their antidepressants had a relapse, compared to a 68 percent relapse rate for those not taking an antidepressant. That's an impressive difference and clearly demonstrates the benefits of antidepressants. Interestingly, it also refutes the popular notion that pregnancy somehow protects against depression.

Deciding whether to use any kind of medication during pregnancy is often challenging for both patients and their doctors. (Prenatal vitamins are one of the few exceptions without any controversy.) Protecting the fetus at all costs is a very appealing goal. On the other hand, the new baby's health will depend a great deal on the health of the mother. Therefore, some compromise may be appropriate.

I'm currently treating a 21-year-old woman who is 8 months pregnant. She has been admitted to psychiatric units many times after overdosing on medications or cutting herself. Now she's doing very well on an SSRI antidepressant. She's been taking child care classes and is looking forward to having her first baby.

How harmful to a fetus are psychiatric medications? Fortunately, the FDA has developed a rating system to measure the risks of prescription medications. Under the system, a rating of A, B, C, D, or X is assigned to a medication based on available information about its potential benefit to a patient and potential risk to a fetus. Here's a summary of the rating system:

Category A: Controlled studies of the medication show no risk. Adequate, well-controlled studies in pregnant women have failed to demonstrate risk to the fetus. Very few medications, none of which treat psychiatric symptoms, are included in this category.

Category B: No evidence of human risk. This means that there are risks to animals but not to humans or, if no adequate human studies have been done, that the animal findings are negative. Psychiatric medications in this category include bupropion, buspirone, clozapine, and doxepin.

Category C: Risk cannot be ruled out. Human studies are lacking and animal studies are either lacking or indicate some potential for risk. However, potential benefits may outweigh the potential risk. This category includes most antidepressants and antipsychotics.

Category D: Positive evidence of risk. Investigational or post-marketing data (evidence gathered from reports of the medication in use) show risk to the fetus. Nevertheless, potential benefits may outweigh the potential risk. Psychiatric medications in this category include alprazolam, carbamazepine, clonazepam, diazepam, lithium, and valproate sodium.

Category X: Contraindicated in pregnancy. Studies in animals or humans, or investigational or post-marketing reports have demonstrated fetal risk that clearly outweighs any possible benefit to the patient. No psychiatric mediations are in Category X.

Any woman being treated for a psychiatric disorder who has become pregnant or is attempting to become pregnant should consult with her health care provider to discuss the risks and benefits of all her medications. She also should discuss and become informed about the risks of taking no medications. Untreated severe depression can have devastating consequences.

[Dark_Moons]

I believe from a males point of view that women who are on antidepressents and if drug poses no threat to fetus, after consulting with dr, should stay on the medication for as long as she needs to be on them.

[omcv]

I was on Paxil for my entire pregnancy, of which is now considered a Category D drug by the FDA. My DD is fine but it gave me a bit of a startle when I found out the new research. Of course my dr/midwife advised the same, weighing the risks for myself and the unborn baby. I have since switch to Prozac because of other reasons, but feel a bit safer on it, I mean if I was to get pregnant again. As it is still classifed as a Category C drug. Of course it has been on the market for a longer period of time too (1988).

[Dark_Moons]

Being on both Paxil and Zoloft, Paxil is a very bad drug that most drs perscribe. It had a lot of side effects that happened. When I was switched to Zoloft if was easier on me and now I am not taking anything. Of course this is my opinion and I am not a pregnant woman so it will affect you gals diff then us guys.

[omcv]

When I first got pregnant I stopped taking my Paxil out of fear. I was living in England at the time and no immediate access to a dr. Once I was able to get in i was a mess. The withdrawals from Paxil were horrible! I went back on and was afraid to come off. It was only when I gained 40 pounds, depression worsen, my dr suggested that I try Porzac. I was afraid of the withdrawals again, but dr assured me that they were made of similiar chemical makeup and I should have no problem with the transition. He was right, I love the prozac!!! I have even lost weight while being on it. I feel more motivate and loving life more. After three years of anti-depressants it is nice to find one that works. Maybe in the future I will not have to take them, but if I do, it is better then having the depression, panic attacks, pocd, etc.

[Jane8660]

I was on lexapro (which i think is cat c) for the first 6 weeks of my pregnancy, went off them once I knew i was pg, had a missed abortion 9 and half weeks. had a dc around 2 and half weeks ago.
My GP insists it doesn't affect pg but I'm too nervous to go back on them, I"m just doing therapy.
although at the moment im finding it a bit difficult. sometimes i have good days but im noticing the bad days more & more.

[ABumpyGal]

Many, many (((hugs))) for you Jane

I'm glad they are finally putting some more effort into finding out just what drugs are safe, which are not, which ones cause what defects, etc. I understand they can't exactly do human trials on such things, but with so many women using these medications you'd think they'd be able to piece things together a bit better.

At least half of my medication is emblazened with stickers that announce "DO NOT get pregnant while on this medication!". I have been told that if I did become pregnant, I'd have to have an abortion. That scares me so badly that my partner is getting a vasectomy (his choice, he does not want children) and I will probably also get my tubes tied for good measure! BCP are not an effective form of contraception for me. In fact, they seem to act as a "fertility treatment" for me, if anything.

I know so many women who take psychiatric medicines who either make great mothers, or who probably would. It's a shame that this issue isn't more nailed down to make things a bit easier.
Dana