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Antidepressants in pregnancy (question)


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#1 hearts_in_asia

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Posted 05 January 2010 - 04:04 PM

Some of you may know my history because I've always been very open about it, but to summerize for others: A bit over 5 years ago I started taking ADs for anxiety (the garden-variety kind tongue.gif) and depression. I've been on a couple of different ones and eventually found that Efexor was the one that suited me and there I've stayed ever since.

With advice and monitoring from my doctor, I went from 150mg down to 75mg at the beginning of my pregnancy and I've been doing really well. Now I have a script for the lowest dose (37.5mg) and I'll start those this week. The idea is to get down to nothing before the birth so that our baby doesn't have withdrawals from my medication before they are born.

What I would like to know is did anyone here do something similar? And if you did, what did you do after your baby was born? Did you go straight back on medication? What influenced your decision, whatever it was?

The problem is that I feel really well at the moment, but what with hormones and the upheaval of a new baby who knows what my head will do afterwards! I won't be doing it on my own in any case, I have my gorgeous husband and our families and friends as backup, I'm very lucky smile.gif

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#2 atua

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Posted 05 January 2010 - 05:00 PM

hun i'm on 100mg a day of zoloft atm with a view if required (esp around 30w) of inc as high as 300-400mg per day.

i didn't start taking them til i was pg - zoloft apparently have the 'goldstar' of AD's in pregnancy and have one of the lowest transfer rates into BM and across the placenta - which is important as i'll be on them for another good 9-10mths yet.

i discussed with my psych all the pros/cons of being medicated in pg - basically i was informed of ALL potential side effects (ie lower resp rate at birth and some unsettledness for a few days as they withdraw - though previous experience has taught me most babies aren't overly 'settled' for at least the first 6w post birth) - i will be (in theory) monitored in hospital for 48hrs post birth (i say in theory as they never bothered with my strep b status so i have even less faith this time round - esp since i will be in a single room to boot) so i have made sure *I* know what to look for in terms of withdrawl in bubs.

i think you're already on the right track - you already can forsee what might (doesn't mean it will) happen post birth and have put support measures in place for your safety and for ikky's safety as well - big kudos for you hun for doing that smile.gif
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#3 Kir23

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Posted 08 January 2010 - 07:01 AM

I've spoken to several doctors about this.

I am pregnant and on anti-depressants. I have been told that yes, they probably will go thru to the baby, however they will also be getting the medication in my breast milk so it won't be a sudden break for them.

Most anti-depressants are Class B drugs, as tests with anti depressants can not be done on Pregnant women this is the highest classification that you can have.

I know that in the US (where i am currently) there is a warning on pretty much all anti-depressants during pregnancy, however, as they can not complete offical testing programs most of these warnings are based on individuals or a specific doctors experiences.

My doctor and i spoke about the options, especially since i was also put on an anti-depressant for morning sickness (strange, but it worked when nothing else did).

Basically he said to me that, yes it is possible that my baby might be a little grumpy, it is much better for the baby to have a healthy mummy who can cope with life.

Another interesting fact, there was a paper written about the intake of fish which shows that the higher your intake of fish the less likely you are to be diagnosed with post natal depression. As some fish is unsuitable during pregnancy my doctor recommends taking fish oil.

hope this helps and if you have ANY questions please feel free to PM me

#4 Bec75

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Posted 08 January 2010 - 12:16 PM

I was on efexor throughout my second pregnancy at a dose of 150. It was safer for me to stay on it than come off it. It was such a stressful situation because of the effects it would have on Emma. The good news is that there were none. Emma did not receive any withdrawals considering the amount I was on. When Emma was born they had to up it too 300 because of the risk I posed on Emma.

I was sent to a mother/baby unit after a week in hospital and I had to go cold turkey from the efexor. If I was you after speaking to professionals after it all I would consider going back even on a small dose but maybe try something else other than efexor as it is one of the hardest drugs to come off.

Emma was not grumpy what so ever and believe it I was shocked at how happy she is.

I am not sure if this is your first or second pregnancy but dont listen to the comments that you might not suffer depression with the second baby because that is a load of crap. You actually suffer worse with the second than with the first.

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#5 Tigridia

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Posted 08 January 2010 - 12:29 PM

I am not currently pregnant but am hoping to be in the not too distant future. I have a neurological condition that has meant that I've been on over 30 different medications in the last few years. A lot of these are anti-seizure meds, neuropathic pain meds and ADs. I'm finally on a combo that is actually helping my pain level somewhat and my condition has stabilised so I can kind of function most days. My neurologist and GP want us to consider having a baby while I'm stable and are keen on my staying on my meds while pregnant.

All my current meds are Class B3. One of them is an AD, Cymbalta. Most people seem to have a negative reaction to being on meds during pregnancy but most doctors seem happy for people to be on meds that will help them be a better mother and function day-to-day. We haven't specifically discussed dose reductions or anything yet but I think the doses I'm on I will stay on.

I was on Effexor at one point (2 different times). The first time I was tapered off and did ok. The second time I came off the 75mg/day dose cold turkey (due to a silly neurologist who wanted a fast medication transition) and it was awful. I know a lot of people have trouble even on the 37.5mg dose of Effexor, so be careful as it's a notriously hard med to come off.

I don't have a lot of useful advice to add, but I'm pleased that there are others here who will understand what it's like to be on meds during pregnancy.
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#6 atua

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Posted 09 January 2010 - 09:50 PM

i agree completely with the girls - if it is safer for you ON the meds than off, stay on them - it's all risk v risk - and cortisol will transfer to bubs through the placenta - a friend was in an extremely stressful (DV) situation when pg - it flowed through to her child and the effects are still lasting years later sad.gif

for me that's what made the decision easier - i can function better, i am a better parent to my existing children, i am a better wife, i am a better friend, i am a better human being and this all in turn means i am better at nuturing the life inside of me.
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#7 hearts_in_asia

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Posted 09 January 2010 - 11:00 PM

QUOTE(atua @ Jan 9 2010, 10:50 PM) View Post

i agree completely with the girls - if it is safer for you ON the meds than off, stay on them - it's all risk v risk - and cortisol will transfer to bubs through the placenta - a friend was in an extremely stressful (DV) situation when pg - it flowed through to her child and the effects are still lasting years later sad.gif

for me that's what made the decision easier - i can function better, i am a better parent to my existing children, i am a better wife, i am a better friend, i am a better human being and this all in turn means i am better at nuturing the life inside of me.


Yes, exactly, couldn't agree more smile.gif Risk of problems due to meds was pretty minimal, but the risk of me going into a total meltdown back at the beginning was pretty high.

Thank you for the replies everyone. Just thought I'd update, I am 3 days in and so far so good! Not even a headache which was always a big clue that I'd forgotten to take it!

I'll stick with the Efexor (afterwards) though, people react differently to different medications and it has been much kinder to me than Zoloft (side-effect city!) and Celapram (zombie-ville).

I'm not sure yet if I'll go down to nothing before the birth, but we (ie me, husband, gp) will review that in a few weeks smile.gif Three days is a little too short to make any judgement on that.
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#8 Tigridia

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Posted 10 January 2010 - 01:40 PM

Hi Katie, I'm glad you are going well with dose drop. I think you are being very sensible about the whole thing and I'm sure you'll do the right thing for yourself and thus the baby.

A question for those of you who have already been through this: were you fine to still take you ADs while breastfeeding? I know most meds say not to use during pregnancy or breastfeeding, but if I'm going to be on them while pregnant I would prefer to stay on them while BF. I also really want to be able to BF so don't want to have to go straight to formula because of my medication. I will obviously discuss this with my doctors but was wondering what experience the rest of you had?


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#9 atua

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Posted 11 January 2010 - 12:09 PM

yup it's fine- if you're taking them in pg it's transferring through the placenta to baby anyway - i was on them whilst bfing molly (started at 3mths) and no effect on her - they do however warn you of potentially slower weight gains so just have that in the back of your mind if you have that issue you have a better idea of why that might be occuring (low weight gains can happen in untreated depressed bfing mothers as well).

great to hear the drop isn't effecting you hun smile.gif and it's odd isn't how different meds effect everyone differently? i can't take efexor - leaves me a right royal wreck -
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#10 Tigridia

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Posted 11 January 2010 - 01:34 PM

QUOTE(atua @ Jan 11 2010, 01:09 PM) View Post

yup it's fine- if you're taking them in pg it's transferring through the placenta to baby anyway - i was on them whilst bfing molly (started at 3mths) and no effect on her - they do however warn you of potentially slower weight gains so just have that in the back of your mind if you have that issue you have a better idea of why that might be occuring (low weight gains can happen in untreated depressed bfing mothers as well).

great to hear the drop isn't effecting you hun smile.gif and it's odd isn't how different meds effect everyone differently? i can't take efexor - leaves me a right royal wreck -



Thanks for that, glad to know it is actually possible. I will still check out my circumstances with the doctors (I'm on other meds too) but I don't want to give up on the hope of BF just because I have a medical condition that requires medication.
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#11 samante

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Posted 11 January 2010 - 02:42 PM

I was on AD's for years before becoming pregnant, plus about 2 years of fairly strong panic medication. When I became pregnant, I weaned myself off the panic medication and the AD's as quickly as I could. However, antenatal dep hit hard, I went back on a lower dose of AD - 100mg fluvoxamine (Luvox) at around 5 months and have stayed on it ever since.

The only thing the psych could say was that my bubs may be a bit harder to settle, much like what advice atua was given. I am still breastfeeding now (only on one feed a day) at 20 months and it's all a-okay. Lucy's developing really well, no problems there. Though I must admit, in my dark moments I wonder if taking the medication has had any detrimental effects. I guess I won't know for a while sad.gif

Thing is though, I look at it this way - happy mum = happy baby. If I couldn't take the medication, then I might not be here right now or coherant. It's a chemical imbalance with me that gets exacerbated by feelings of helplessness...much like new mothers feel.

One of the things I was proactive with was getting my GP to write a letter to the mother/child clinic people at the hospital, giving them my history before I went in to have Lucy. They actually came and visited me in the hospital the day after she was born to introduce themselves, and let me know what I could access if I needed to. Thankfully I haven't had to, but it made me feel a lot more secure and pro-active.

Goodluck! Effexor did not work for me either, it sent me into mania which was...not fun. Whatever works for you and your family. Take care.

#12 SEA

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Posted 11 January 2010 - 07:12 PM

QUOTE(Tigridia @ Jan 8 2010, 01:29 PM) View Post

All my current meds are Class B3. One of them is an AD, Cymbalta. Most people seem to have a negative reaction to being on meds during pregnancy but most doctors seem happy for people to be on meds that will help them be a better mother and function day-to-day. We haven't specifically discussed dose reductions or anything yet but I think the doses I'm on I will stay on.


Katie I'm sorry to hear you're still on tablets, but it's good that you're being sensible about your treatment.

Tigridia - I saw your post and the subsequent one about breastfeeding and wanted to reply. I wasn't on AD's while pregnant, but I have been since August last year when my little one was 11 months old. He was still having between four and five feeds a day at this time, but has now dropped to between three and four. I'm on a 30mg dosage, and according to my GP and the Mothersafe line they're safe to be taking. They probably have a bit of an effect on him, but whether that is me feeling calmer, or some of the medication passing through to him I'm not sure... I did a lot of research before I started taking them and felt comfortable when I did so. Have a good chat with your caregivers and like the others have said - it's safer you being on them, than off them if it's going to make you feel better.


#13 Tigridia

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Posted 12 January 2010 - 09:40 AM

Thanks SEA, it's good to know there is at least someone else here on Cymbalta and breastfeeding. I'm on 60mg/day at the moment but my neurologist is probably going to increase my dose soon. I do get a reasonable effect from 30mg/day so I might be able to drop it again when pregnant. I will see what my doctors want to do. While I am not on the drugs I'm on specifically for mental health issues (I have a chronic pain condition which Cymbalta and another drug called Seroquel are effective against) I do suffer from some depression linked to the chronic pain and seem to be better mentally when taking certain ADs. I have also looked at the studies for all the drugs I"m on and am fairly across all the risks. I also worry about any effect on a baby but I don't think I would do very well off them. I am considered quite high risk for PND due to my other health issues so am very pro staying on the drugs.

Thanks for all the comments. It makes me feel reassured. Sorry about hijacking the thread though!

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#14 samante

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Posted 12 January 2010 - 04:34 PM

QUOTE(Tigridia @ Jan 12 2010, 09:40 AM) View Post

(I have a chronic pain condition which Cymbalta and another drug called Seroquel are effective against)


Hi Tigridia,

I was on Seroquel and it was recommended to come off straight away due to the lack of information on it in pregnancy. Luckily I had come down to a fairly small dose at the time (25mg I think?) just to help me sleep. It's one of the newer drugs they don't have a lot of info on.



#15 Tigridia

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Posted 14 January 2010 - 12:30 PM

Samante, that is interesting about Seroquel! My neuro and GP think it's probably ok for me (it's still B3) but they may change their minds still. I'm also on a pretty low dose and could come off pretty easily if I had to. It is a bit frustrating that everyone has different opinions on the drugs in pregnancy debate. I am a moderator on another forum (medical forum) and I know most of the people on there (mostly based in the US) have been told absolutely not to take the same drugs I'm on, and similar ones, in pregnancy.


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