Treating Depression in Pregnant Women
US Food and Drug Administration (FDA) published a Public Health Advisory on treating depression in pregnant women, because doctors and moms-to-be have to weigh the risks and benefits of antidepressants during pregnancy.
A risk of stopping antidepressants for a patient suffering from depression and taking depression medication is that the patient may experience a relapse. Earlier this year, researchers studied pregnant women who stopped taking their antidepressant medication during pregnancy and pregnant women who continued taking their antidepressant medication during pregnancy. Women who stopped their meds were 5 times more likely to suffer from depression relapse than women who continued antidepressants during pregnancy.
Another study suggested potential risks from SSRI class of antidepressants taken during pregnancy. Pregnant women who took antidepressants during pregnancy gave birth to babies that were 6 times more likely to suffer from a condition called persistent pulmonary hypertension (PPHN). This is a serious and life-threatening lung condition where the blood pressure of the babies’ lungs are very high and cannot get enough oxygen into their blood. The caveat is that this is a small study and additional studies have not yet been conducted to confirm the findings of this study. Late last year, the labeling for paroxetine (Paxil or Seroxat) was changed to reflect findings that use of this drug during the first trimester may be linked to increased risk of heart birth defects.
The FDA is advising that pregnant women on antidepressants should not stop taking their medication without first seeing their doctor, and weighing carefully the risks and benefits of continuing medication treatment during pregnancy.
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I was diagnosed as Bipolar Type I with rapid cycling mixed episodes in 2005 after an inattentive doctor placed me on Welbutrin for anxiety, and thus spurred my entire LIFE out of control with only 5 days of the medication. It has taken almost 2 years for my neurologist, primary care physician and psychiatrist to find medications that do not cause extreme adverse reactions in me.
Finally, on 400mg Lamictal + 20mg Lexapro , I leveled out. Two months later? PREGNANT.
Against all previously mentioned doctors and OB’s advice, I have sucessfully cut down to 150mg lamictal + 10mg Lexapro per day…but am now experiencing deep, dark depression that has left me feeling no desire to continue breathing.
I know what you are going to say. “Resume your medications. In YOUR case, the benefits certainly outweigh the risks.”
But…you are wrong.
I MAY survive this pregnancy without attempting suicide. However, if I took the meds to avoid becoming suicidal during pregnancy…and my baby had irreversible defects with which he/she would have to struggle for life…I would NOT be able to forgive myself, and would then be MUCH more unstable.
Yes, even if I took the medications, the baby COULD be perfectly fine. But if not, I would forever struggle with suicidal desires.
So, my question is not, “What should I do?”
I am just wondering…what would YOU do?
Um…how do I receive notification if my post gets a reply?
Ryanne -
Sorry there isn’t a “notify” function on comments. One way would be to email me directly at mhsourcepage@gmail.com and let me know that you’ve left a comment and I’ll be sure to check into the site.
jane
(will answer your other comment separately)
Ryanne,
You have asked a really tough question re: your pregnancy and suicidal ideation.
Since you asked, “what would YOU do?” I’ll dispense with the necessary disclaimers of me not being a licensed mental health professional and stuff I say is not meant to replace medical or legal advice and that this is for your info purposes only etc. etc. etc.
I understand your rationale completely. If you take meds and your baby ends up suffering for it, then you said you would find it difficult to live with yourself. Sure, there’s a chance that the baby may turn out perfectly normal, but like you said, it’s a “chance” and not a guarantee.
What would I PERSONALLY do? I’d do what you do. Were I pregnant and cut down my meds to control for a level of risk of mania, but find out that my depression has become dark and deep, I’d personally not resume my meds if I make a personal judgment call (and not a medical or clinical or statistical one) that I’d be putting my unborn baby at risk.
I too, would be struggling with the dilemma of putting my own life at risk v. putting my baby’s life at risk. I’d personally risk my own life because I know that there are non-medical things I can do to at least minimize danger to myself. This means letting my husband know about my choice and asking him to watch out for warning signs, finding myself additional support like therapy or support groups (online and offline), and whatever other resources I can find for myself. After all, I need to stay alive and well to keep my baby alive and well.
Given my history of depression, I know that I may be at risk for a relapse given enough stress or stimulus, so I have thought of questions like this. Of course your dealing with bipolar disorder is a trickier matter, because you are also dealing with the highs - not just the lows - of an illness.
Jane’s Addendum (June 15, 2007) -
According to the product insert, Lexapro is pregnancy category “C”, which means “it is not known whether LEXAPRO will be harmful to an unborn baby.” Furthermore, “LEXAPRO is excreted into breast milk and may affect a nursing infant. If you are breastfeeding a baby, do not take LEXAPRO without first talking to your doctor.” Source.
For Lamictal: “LAMICTAL has an FDA Pregnancy Category C designation. There are no adequate, well-controlled studies of pregnant women receiving LAMICTAL. LAMICTAL should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. For more information on the use of LAMICTAL during pregnancy, please see the Pregnancy section of the complete Prescribing Information for LAMICTAL.” Source. (Please note that this page on the website is meant for licensed healthcare practitioners)
Jane
(I’ll email you my response too)
Here’s one more question for you. No one will give me an answer for fear of the law…and I’ve surfed all I can stand to. But I NEED this info!
If a manic episode finds a pregnant woman wanting to “flee” and therefore a certain danger to herself, which sedative type medication could she take to enable sleep that would have the LEAST harmful effects on the unborn baby…if used only once in the 8th week?
With my disorder, there can come a point where a one time use of a category c medication is CERTAINLY less harmful than the impending alternative. I just need to know which category c sedating medication has the least devastating potential…a half a mg of alprazolam OR 25 mg seroquel?
(For example, medications are placed in this category for potential of causing heart defects…and others for the potential of causing cleft palate. Obviously a cleft palate would be less detrimental.)
I’m not sure what you mean by wanting to “flee”.
Unfortunately I won’t be helpful in your comparative question re: alprazolam v. seroquel as I’m not familiar with studies that may have been done on pregnancy effects of either drugs. Also, these drugs are of different classes of chemicals, and one cannot make a scientific or ethical comparison.
I should also note that these drugs are not approved for “sleep” although one of the side effects may be sleepiness in some people. Therefore, taking either of these drugs for the purpose of inducing sleepiness would be an off-label (and unapproved) use of either drugs.
Jane
I was pregnant and I was under severe depression, almost suicidal. But my gync told me to refrain from antidepressants. I am worried about what physical or psyhocological harms it may render on my baby. please respond.
Anjali,
I’d encourage you to seek the advice of a psychiatrist who specializes in depression in pregnancy. Since I don’t know the circumstances of how your gynecologist draws his/her clinical conclusion, I can’t comment. However, given the severity of your depression, please get a second opinion from a professional whose specialty IS depression.
There are many pregnant women who continue to take antidepressants due to medical need. While there are always risks with all medication (there’s a risk with everything - including being pregnant!), specialists who work with pregnant women do consider all the risks and benefits to both the mother and the child when dealing with severe depression and other mental/physical conditions.
best wishes,
Jane
thanx. I guess thats wat i need to do. I am just so worried about my baby. He has completed 1 year now, but I am still worried about the effects of my depression on his life.
Anjali,
I can speak from the position of a child whose mother suffered from untreated depression.
The greatest gift you can give your child is to be as mentally and physically healthy as possible, because this allows you to have a healthy, loving relationship with your baby.
Jane
I certainly will try to do that. but does it necessarily places my baby at higher risk of suffering from mental illnesses?
This would be a genetics-related issue, and you may want to ask your psychiatrist this question or for more information.
I’m 26 weeks pregnant with my third child and have just been diagnosed with anxiety disorder. I was beginning to have more and more episodes of inconsolable crying. Eventually, last week the episodes worked themselves up to thoughts of harming myself. My OB suggested going to the local hospital for further evaluation. The hospital suggested a voluntary stay in their psychiatric ward. The Dr. started me on Seroquel. After 5 days in the hospital, I have left on 25 mg of Seroquel 3 times a day with 150 mg at night. I have extreme guilt and fear about taking this medication during pregnancy but I know it is better then the absolute despair and thoughts of suicide. The really strange part of all of this was the onset has begun during pregnancy; I do not have a history of this type of disorder. It’s been almost a week on the medication and I’m slowly starting to feel myself again, but there is still the fear of all the unknowns (i.e. getting through the rest of the pregnancy, postpartum, and how the baby will fair). Any thoughts or advice would be greatly appreciated.
I had physical relation from last 5-6years, even i had taken pills72 so many tuimes,, and some times my period dates had also fluctuate.,,,,are they giving any troble at the time of pregnancy??????
hi im 29 yrs old,27weeks pregnant with my third child,i need help. it all started when i got pregnant with my first child,i started 2 feel really low and thinking stupid thoughts.i was crying alot,feeling like i wanted it all to end,everything seemed 2 get on top of me i couldnt cope with anything. anyway i didnt do anything about it,my daughter was born she was gorgeous,such a good baby. but then i got pregnant with my second child and things didnt improve 4 me i was just getting worse but still didnt do anything bout it cause i felt i couldnt i was feeling really bad. anyway my second daughter was born,she 2 was the same as her sister they r the best. well my partner couldnt cope with me so he decided we needed help so he rang our local gp and made appointment,i was refered to the hospital 2 see a pyscollogist,they put me on antidepresence and i was on them 4 about 3 years. well i have recently been taken off them and im getting worse again,i getting really hard 2 live with,my children must hate me cause all i do is have a go at them,i cant cope again i hate my life,i wish things was better.if it wasnt 4 my children i feel i would of ended it a long time ago pls help me
Sarah:
I’d see your doctor ASAP!!!!
There is a possibility that you may need to resume taking antidepressants, and that you may also be experiencing withdrawal symptoms from stopping your antidepressant.