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AD's in pregnancy


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#1 Em-Jay

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Posted 21 May 2010 - 02:21 PM

Hey guys,

As some of you know I had quite severe undiagnosed ante & post natal depression with my first pregnancy and child. I have a super strong family history of depression and anxiety (both parents and 3 out of 4 grandparents) all of which mean that chances are I will develop the condition again with this baby.

I have been taking a proactive approach, and have been seeing a psychiatrist that specialises in PND (he is the director of Brisbane's post natal disorder clinic). I am going to be going back to a CBT courst (which I did when Em was young), and I also have 24 hour access to the mother and baby clinic.

At my appointment today my psych recommended that I go on AD's (cipramil 20mg a day). I have never been medicated for my issues before so this is a first for me - and I am also finding it extremely hard to digest as I am feel much better and much more in control throughout this pregnancy (I am coping well, if you will smile.gif ) so I am finding it hard to believe that the benefits of using meds will outweigh the negatives.

I went an filled my script at the chemist and the pharmacist was mortified. Printed out a big page saying that Cipramil is a class C medication and highlighted every problem it could cause in a baby and advised me that it wasn't great to use blink.gif Now obviously my specialist is a leader in his field and wouldn't prescribe me something for the sake of it, or something that would harm bub but this has thrown me for six! My anxiety has come back threefold just trying to decide whether to take the freaking meds or not sad.gif

It's so hard, I never want to be back where I was and due to my chances of going back there my specialist feels it best to start medicating now rather than wait until bubs is here and I hit rock bottom.... But I don't want to do something that will harm my baby either, especially considering that i feel 'well' at the moment.........

I know that I can't get medical advice here, but anything would be preferable to what I am feeling now!
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#2 ♥ Emsie ♥

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Posted 21 May 2010 - 02:28 PM

You mentioned that your psych is a
specialist innPOST natal depression, maybe he is
so used to prescribing that med for new mums, not pregnant mums?

I'd be seeking a second opinion Hun, especially if you feel on top of things.

Definitely don't take the meds until you find out for sure, but I'd be leaning towards the pharmacist being correct on the class c.

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#3 SmittenKitten

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Posted 21 May 2010 - 02:33 PM

Oh hun (BIG HUGS) first of all!

Did he ask why he wanted you to start on the meds now?? And not once the baby is born?

If you are feeling really strongly about taking the medication, I would definatly be giving him a call and just having a chat to him that you are not comfortable taking the medication. really be an advocate for your own mental health. Iam curious to know why he wanted you on cipaimil rather then Zoloft???? Then again ia m not a professional!

Don't concern yourself with what the chemist did/said or anything. They are not your concern. Yes class C is not "the best" but it was prescribed to you by a professional who know's what they are doing. Hun, I walk into a chemist and get a Class D drug. Yet, to this day no one has judged me or anything, its me with the guilt and feeling awful for getting the script filled out.

There is a great medication info line in Melbourne, I am happy to give you the number and you can give them a call and have a chat. But Personally if it was me and I was not comfortable I would, call the DR explain you are not comfortable and see what he say/suggests. I have made it VERY clearn to my PSYCH, and OBS that I do NOT want to be on any medication until after the baby is born (other then what I am cutting down on) and that I will not be on an medication that is Sedative.
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#4 mango

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Posted 21 May 2010 - 02:38 PM

As xxEmxx said, I would be getting a 2nd opinion, and holding out on taking them.

Pharmacists tend to be more up to date with medicines. And as Em said he might of perscribed it not thinking because he is use to post birth mothers.

Can you give him a call?

ETA: I also agree with smitten. If you aren't comfortable taking them now you need to discuss it with your doc and have your feelings about it understood. Also by the sounds of it a clearer reason for why he wants you on them now.

#5 Em-Jay

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Posted 21 May 2010 - 03:06 PM

THanks guys smile.gif

My psych already told me it was a class C medication and he knew alot about it so no surprises there. He told me that there might me risks, but that it has been around since the early 90's and there is no research that shows that it has a negative effect on the fetus (apart from 'withdrawal' after birth). I guess the A4 printout that the chemist gave me went into alot more detail.....

I have spoken to the PND unit that he works out of and they said exactly the same as he did - it is completely up to me whether I commence this process or not, and that I won't be judged either way.

I am torn I guess, because coming from where i have been....... I can't do it again...... I literally can not do it again. And if I am even starting to slide back towards that behaviour I want to address it with as much force as I can possibley muster.... It has affected me to the point where I don't think I will ever fully recover. Yeah I am doing well, and I feel positive and I don't have overwhelming anxiety anymore......... but 3 years on it is still a struggle to socialise and get out of the house and I don't think that will ever change.

So knowing this, my psych made the decision that meds would have more benefit than risk - particularly now that I am in the 2nd trimester.... I can see his point too - particularly as I am not 100% recovered, but it's a huge step to take at the same time....
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#6 mango

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Posted 21 May 2010 - 04:49 PM

In that case Em-Jay your dr is aware of the risks and your situation and is trying to help you the best he can. Hes very forth coming in the help (with the clinic as well) and I think you are in good hands. I think because you have such a fear of relapse, and not 100% recovered that that is why he has gone down the path he is suggesting.
The choice is yours now. Talk to hubby and anyone else with good information and whos opinions who matter and make the decision you are most comfortable with for your family.

I would be inclined to trust this dr because it seems you have a very open line of communication with him. Keep him up to date and you will do just fine smile.gif

#7 Tigridia

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Posted 21 May 2010 - 05:23 PM

I just want to let you know that I am on 5 different medications during pregnancy. One of them is an antidepressant and one is an anti-psychotic. My issue isn't straight depression it's actually a chronic pain disorder that these medications happen to help with. Most of the meds I'm on are class B and class C drugs. Now my meds were discussed with my GP and my neurologist extensively before I started TTC. Once I got my BFP I again double checked with my GP and the conclusion was still to stay on the meds. My neuro said he may adjust the dose in the third trimester to prevent withdrawal for the baby but we will see how we go.

I talked about the medication issue with my doctors and my husband before I got pregnant and we all concluded that it was best for me to be on the meds. There are risks but I weighed them up and went with meds. You need to be confident in your decision, so if that means asking more questions, doing more research or taking a little time to think about it then do that. There is no right and wrong just what is best for you and your family.

I totally expect to be judged by others for me decision. Luckily the only people who know I"m pregnant (so far) have been supportive smile.gif I don't look pregnant yet so no judgement from the pharmacist on my weekly trips in to fill scripts. But I do expect that down the track.

I know there are lots of lovely ladies on here who are on medication while pregnant, including ADs, so you won't be alone if you decide to go down that road.
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#8 Em-Jay

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Posted 21 May 2010 - 09:11 PM

Thanks for the help and advice ladies.

As much as I think about it, I still can't get my head around it so my decision is no for the moment. I will take some time to think about it and reassess if things get worse smile.gif
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#9 atua

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Posted 22 May 2010 - 08:46 PM

the reason they receive the class they do is because they cannot do conclusive testing on pregnant women.

hun- you know (as everyone else here does) that i was on meds with james - and the benefits for me did far outweigh the risks (which are minimal - you do have to be aware but worst case they can be more unsettled post birth and minor respiratory issues) but it lowers their cortisol levels which can have a massive impact later in life.

cipramil is safe when bfing- basically my psych (who deals only with AND and PND) takes the view that you are given what you could take if you were bfing as a small (read barely detectable) amt is transferred to bm.

i tend to go with your psych on this one - being proactive (through counselling, diet, CBT and meds) should stop (or at least lessen) any risk of PND developing.

i had PND with the girls and i never recovered - outwardly i did, but i'm pretty good at putting on a show - when my psych found out the short length of time i was on AD's she wasn't happy and i'm looking at a potential of lifelong on meds (adding to the mix i have been diagnosed with bipolar so i know the treatment for that is AD's and counselling for life) which doesn't worry me as i can honestly say, hand on my heart, that this the BEST that i have EVER felt as a mother - i feel bonded to ALL of my children, i have more patience, more tolerance and i am honestly so glad i started meds before he came - when you factor in it can take 4-6 weeks for meds to take full effect that's a long time when you are already looking down the barrel - and like you, i could NEVER go back to that dark place.

it is ultimately your decision and your decision alone - for me though meds have their place in conjunction with other treatments - we don't deny ourselves medication when we have other diseases and this is all depression/anxiety is - an illness that we have no control over when it strikes and how hard.

eta...no withdrawl effects in James - and TBH he is the cruisiest out of the lot - from birth he has been laid back and relaxed - now whether that is just his nature or the meds i will never know - but i like to think the fact that i am relaxed has had a flow on effect as he's come into a home environment where there isn't the tension there was before iykwim.
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#10 Lizzzard

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Posted 22 May 2010 - 09:27 PM

I thought I would just come in and share my experience, but obviously you have to do what you are comfortable with smile.gif I was on exactly the same dosage your doc is suggesting - 20mg of Cipramil- before, during and after both my pregnancies, and throughout breastfeeding. It was also a very considered decision that I discussed with at least 6 doctors during the course of both pregnancies and there was never one that questioned the decision. I'd suffered relatively mild depression in the past, but due to a family history and a few other factors, I was particularly concerned about PND as well, and this was one of the reasons I stayed on it. I briefly thought about coming off them and then going back on if I felt I needed it after the baby was born, but they can take a couple of weeks to take effect, and I didn't really want to risk sinking into a low during the first two weeks of my babies life, which I was more sure would happen than otherwise...so I decided just to stay on them. I know there is supposed to be some 'withdrawal' effects, but FWIW, I didn't notice any significant symptoms in either of my babies. What sealed it for me though, was how relaxed and confident I felt post-birth - I felt the regular amount of 'new mum' stress, but I didn't feel depressed or anxious at all, which I was incredibly relieved about, and I'm almost certain was due to the ADs.

Good luck with your decision - it's a tough one smile.gif
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#11 Kir23

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Posted 23 May 2010 - 01:10 AM

Hi,

Not sure if this is going to help but i will share my experience with you.

I was on cipramil 20mg per day for over 18 months prior to becoming pregnant.

I was initially still on this dose for the first few weeks of my pregnancy, i then had severe morning sickness, (which is not uncommon with women who are on antidepressants, as most anti depressants have nausea as a side effect, which can greatly be increased as your hormones increase).

My OB took me off of cipramil and changed it to Avanza (which is an anti depressant as well, but has shown in studies to help with morning sickness).

I was on Avanza throughout the rest of the pregnancy and at around 18 weeks i started taking an additional anti-depressant as i was still depressed.

at 32-34 weeks i stopped taking the second anti-depressant (i was feeling a lot better).

I am still on the Avanza, and gave birth on Thursday. The plan is to stay on the avanza for the next 12 months (i saw a psych who specialises in andi and post natal depression who recommended this). We are hoping that sticking with this course prevents PND.

I was advised to stay on this med and not go back to cipriamil during breastfeeding as there have been studies that show that the amount of cipramil in breastmilk is higher then using other anti-depressants (however it is still quite a low dose).

However if cipramil was my only option then i would have def taken it as opposed to trying to cope without meds.

As Sam stated above the reason these drugs are in these categories, is because they cannot do significant testing on pregnant women.

For me it came down to the fact that i needed to be on this medication to make sure i was in a good place mentally, and that a happy less anxious mummy = happy much less anxious baby.

hope this might have helped, and please feel free to PM me if you want to talk about it more.

#12 Em-Jay

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Posted 23 May 2010 - 08:59 PM

Thanks so much Sam, Lizzard and Kir for sharing your experiences smile.gif

I am still in two minds about taking the Cipramil - I mean at first the effects on the baby were worrying me, but now I am actually worried about the side effects if I were to start taking them (sounds silly I know - but i have a massive vomit phobia/sickness phobia and the thought of being sick as a dog is scaring the shit out of me!)

I want to, but I don't........ I know I should, but I still feel like I shouldn't..... I feel good, so the thought of going on them 'just in case' is worrying - but I know that my Dr is a specialist in his field so I should trust him too.... I just don't know.......
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#13 SmittenKitten

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Posted 24 May 2010 - 05:42 PM

Hi hun,

Cant seem to catch you on FB! Dad said he hated the ciprimil cos it made him nauseated. But don't forget it is different for every person,

What I was recommended Zoloft, knowing one of the side effect was nausea, I was like HELL NO! My only anxiety symptom is Nausea and my phobia is he same as yours. Slightly better now I have had HG during the pregnancy!.

Defiantly speak to the DR about your side effect concerns. See if there is any other medication that wont have the same effects.

Kir23. Would love some advice. I will PM you.
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#14 lil chicken

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Posted 26 May 2010 - 12:04 PM

QUOTE(SmittenKitten @ May 24 2010, 05:42 PM) View Post


What I was recommended Zoloft, knowing one of the side effect was nausea, I was like HELL NO! My only anxiety symptom is Nausea and my phobia is he same as yours.


Beth I'm on Zoloft and don't suffer any Nausea at all on it. For the first 3-4 weeks I was taking it I had every symptom on the packet but after it kicked in properly (which they say takes 4 weeks anyway) I didn't have nausea at all.
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#15 Woodland

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Posted 26 May 2010 - 01:27 PM

Really difficult choice, i'm sorry you're so stressed & anxious.

I used to be on Ciprimil about 15 years ago for about a year & when I ran out one time I suffered severe withdrawl effects. All the Doctors I saw swore that there were no withdrawl effects from Ciprimil but I was adamant & now it's widely known that it does have withdrawl.

Just be careful as if your baby suffers post birth withdrawl even half of what I did then that's awful.

Also they swear there is no negative effects on the foetus but they may have more info in 10 yrs & change their mind & then it's too late for you.

If it was me I would be tempted to try & wait into my baby was born & then bottlefeed it & start my meds then.

Good luck with your decision & well done on taking such an active approach this time.
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