To consider TTC whilst on ADs for PND..?

[Odaat]

I realise the title sounds pretty grim... But what do you all reckon? It's not something i would feel comfortable asking many people in RL as not many know I am on them for various reasons.
I desperately want another dc soon as dd is 1 and would like a close age gap (so I can resume studying and get a career after I have stayed at home say 4 years or so with my two kids) also I am just really broody and my dh would like a similar age gap.
I feel infinitely better since the ads (been on them since dec) and tbh the pnd wasnt that bad in that i bonded fine with dd- it was more just hormonal/ exhaustion/ circumstantial (family issues)
I could wait until I have finished counselling (which I am due to start soon) and I am off the ads - but that wont be until end of year i imagine. I appreciate it isnt that long. I just feel if ads are relatively safe to take whilst pregnant (as some are) why not go for it!?
However, i worry it is being reckless/ selfish and I should wait regardless. Very confused! Please help! All advice / opinions appreciated. I am curious what the general consensus will be on this ...

[billyokey]

I don't know much about AD's and whether they're safe during pregnancy, but assuming they are (maybe ask your doctor?) then I would say go for it! if its what you want why let the fact that you've suffered PND stand in your way, as long as you're happy that you feel well enough and can cope

[UnicornCrisps]

I would wait, I have been on ADs for PND for a similar amount of time (sertraline, which ADs are you taking?). I think it would be more sensible to stay level for a good while before puttibg yourself through the hormonal rollercoaster again. Maybe chat with your GP and see what they think?

[scarffiend]

I've been on ADs for a few years and didn't come off them when TTC - I saw a psych when pregnant as I was worried about the effect on the baby, but was told the negative effects on me would be greater than the potential negative impact on the baby. I say go for it x

[apermanentheadache]

I think I would ask doc what s/he thinks as only they know your particular circumstances. They may advise you stay on them if/when pregnant in order to avoid a second bout after a second child. I can completely see why you are keen to have two close together; the last thing you want, however, is 2 little kids + PND. Hard to balance up pros and cons as there are so many unknowns....

Do you have any othrr history of depression or was the PND out of the blue completely?

[Odaat]

You guys are right - a doc appointment is needed to clarify things really.
Funnily enough I did have depression prior to gettig pregnan. I came off ads very suddenly (told not to) as I felt fine. That is the ony time i have been on ads before. Now I am questioning i stopping the course of ads too early the last time caused a subsequent relapse of depresSion ? As I am told this can occur. Maybe my pnd was partly caused by not treating my prior bout of depression properly. In fairness i was only mildly depressed when I went on tem the first time and I came off them quickly as I thought I had just over reacted .

[DitsyDonkey]

I was on ad and went to my doctor when I wanted to start ttc, he told me that they could cause birth defects and that there was only one type if ad that could be used safely during pregnancy! I was on setraline.

My doctor is overly cautious.....I'm starting to wonder was he even telling me the truth, going on some if the responses here

[HellomynameisIcklePickle]

Please wait. It is tempting when you are depressed to think a pregnancy will help you turn your life around, but the big life change and all the messy hormones might just drag you in deep.

You owe it to your DC to be in perfect mental health, let yourself work through it first.

[Driveway]

Wait. It's the best way to look after your mental health.

[Odaat]

I worry if i wait and come off them ill be to weak to cope with another pregnancy in my natural state ( no ads) i know this sounds terribly defeatist, but it is true! So in a mad way i think I may aswell ttc whilst on ads - that way i can ensure i already have their help prior to next baby. But then i realise this way of thinking is rather warped and I need I have more faith that I will be ok without ads ...

[Odaat]

I just want to be the best mother i can to my dd and any other other dc I may have... Its sad i feel I need the back up of ads to ensure I'll be ok :/ deep down i know tht is not the case - it's just a comforting thought.

[iamsoannoyed]

I'm a doctor- my advice would be to make an appointment to see your GP. They will know your medical history and can advise you best.

You can take some antidepressants during pregnancy if the benefits of taking them outweigh the risks (we usually recommend SSRIs during pregnancy). The risks to the pregnancy have to be weighed up against the risks of suddenly stopping antidepressant medication and the risks of not treating your depression.

We don't have a clear understanding of the teratogenic effects of psychotropic drugs, nor their effects on neurodevelopment. It is thought there is a small increased risk of spontaneous miscarriage and congenital malformation, particularly cardiovascular ones. Much of the evidence is conflicting, although the newer and larger studies are giving a more clear risk profile.

Other side-effects of the use of antidepressants (especially SSRIs) in late pregnancy is the risk of a mild transient neonatal withdrawal syndrome of the central nervous system, motor, respiratory, and gastrointestinal signs. Usually very short-lasting and benign, but babies may be more closely monitored for "jitteriness". A more serious, but rarer, potential complication is persistent pulmonary hypertension (PPHN) of the newborn, which has been associated with exposure to SSRIs beyond 20 weeks of gestation.

That said, we don't have concrete evidence that would allow us to quantify the increased risks to the foetus as a result of using pyschotropic drugs.Therefore, whether the doctor would recommend continuing your medication or not depends on the risk/benefit balance for you with regard to your health.

I don't know what medication you are on, but it may be worth thinking about whether you plan to breastfeed, as some are not recommended in breastfeeding but can be taken (with caveats mentioned above) during pregnancy. So if you do plan to breastfeed and are taking these drugs, best to switch now than post-partum/during pregnancy. It also gives you time to see if they work for you.

Bottom line is speak to your GP- or psychiatrist if you have one. Alternatively, you could ask for a pre-conception counselling appointment with an obstetrician.

[bobot]

Completely contradicting what has been said above - my understanding is that the tricyclics are actually considered less risky during pregnancy than SSRI's. That comes from my own research and the opinion of 2 Consultant Psychiatrists. I personally switched from an SSRI to a tricyclic in order to conceive.

Usually imipramine (tricyclic) and sertraline (SSRI) are considered least risky in terms of breastfeeding. If you want to breastfeed then it might be worth thinking about in advance. But it is definitely a matter of weighing up the risks/benefits to you - and I'd advise you to do your own research, because it's likely that different GP's will give you different opinions, and they are not experts.

I disagree with anyone who says that being stable on medication is less stable than being stable without. Some people will need longer term treatment. It's really a matter of weighing up the risk of coming off them vs the risk of taking them during pregnancy - which isn't well known. Anecdotally, I have three children, all conceived, carried and breastfed whilst I have been taking an antidepressant - all fine and dandy. the only pregnancy that didn't end well for me was ironically the one in which I wasn't taking medication, just bad luck.

[bobot]

PS. In order to avoid the issues mentioned above with withdrawal in the newborn, it's possible to bring the dose right down in the third trimester, then increase it after birth. That's something you could discuss with your GP, or a specialist if you can be referred to one. Some areas will have a nurse in the community mental health team who deals specifically with perinatal mental health.

[wouldbemedic]

I wouldn't have terribly high expectations about seeing the doctor in connection with these issues. In my experience of this, doctors simply reach for that little fat Bible of drugs and look it up. (They then know about a quarter of what I'd known from Google before leaving for my appointment!) Most GPs and even psychiatrists very little personal clinical experience of prescribing medications for use during pregnancy. If they do have experience, there tends to be 'one 'safe medication' in each genre of illnesses, with not enough known about other medications to hazard an opinion. (That is, if the medication you're currently taking is not the 'known drug' for depression in pregnancy, be prepared for a possible battle to fight there). With an illness such as depression, many GPs are scared to prescribe anything due a lack of clinical confidence, so they will advise that it's safer to wait. Which it may be in some ways. However, given that you are going into another pregnancy and it's in your family interests for you to remain stable, (not to mention safer for your unborn baby's development,), I feel this might be a very good time to go ahead, when you're feeling fit and have a treatment regime that works (that said, do check the AD is not an out and out toxic one!) I take it that you don't need any posters on here to remind you that two babies are more work for one etc!!]

[Fruli]

I'm on ADs for PND and will continue to be on them for the foreseeable future. I expect I'll conceive any future child whilst still on them. I'm also medical and I know the risks with my druhg both for pregnancy and for BFing. The risks are generally small (depending on the drug) but you need to go into it with your eyes open - see your GP or psychiatrist if you have one and ask them.

[cupcake78]

I conceived on ADs knowingly with the support of my GP.

Changed my ADs to low dose of Sertraline before trying. Came off them happily at 6-7 months pregnant.

My dc is fine, happy, functioning and very normal.

I got PND and was put on citalopram within 10 days of giving birth. 8 months on and I'm off drugs, managing and everything is fine.

[Odaat]

Wow thankyou so much everyone who has commented. It means a lot !
I agree that often GPs contradict eachother on this matter, as they don't specialise in this area. I dont hve. Psychiatrist though so who do i consult? Can ask to be referred to an obstretician for this matter?
I am in 20mg of Fluoxetine. I am not looking to get pregnant tomorrow but possibly a month or two. I not I will wait until end of year... But at end of year I may still need the ads - hence my dillema!

[Odaat]

If not I may wait * sorry for spelling / grammar - i am typing off my silly, tiny phone!
Ps i have heard SSRIs are the safest. Worrying to hear they are not considered that by all? I imagine I would switch to setratitine (dunno how you spell that!) as I have heard often this is safest to breastfeed and be preggo with. I do wish to breastfeed as I couldn't with my dd due to traumatic labour, haemorraging and thyroid issues. All of which left me with no milk. This really contributed to my pnd i think.

[wouldbemedic]

You would need to see a psychiatrist who specialises in neonatal development. In my experience, there was one psychiatrist who did this in a hundred mile area, and every other psychiatrist tried to call her when they had a query. Drugs are very rarely tested for safety during pregnancy for obvious ethical reasons, so often all that can be done is to say, 'well, a lot of people seem to have ended up taking this during pregnancy and it seems to have worked out ok,' or 'definitely don't take this one as it was tetra-something or other on the rats'. The neonatal specialist I referred to was very, very busy with proper problems - women who were on a truckload of heavy duty psychiatric drugs and who needed to remain on them in order to stay sane/safe. She didn't have time to attend to my one or two medications and didn't tend to return any phone calls. By the time we got near her I was in the second trimester and those crucial first 12 weeks had passed. I saw her underling first who said, 'You know, babies bounce,' when I expressed my concerns.

My hunch would be that you will have to listen to the 'this one doesn't seem to be harmful but that one harmed the rats' speech and do your own risk evaluation.

[Odaat]

Woulbemedic - thanks, sorry to hear about your difficulties in getting help! I shall def do some more research then...
Sillylass79- thankyou. I have to agree that pnd is very much an individual illness and what may help one woman wouldn't help another etc. for me it was very much massive hormonal change and getting the coil, contestant bleeding, subsequent anemia , bad birth, not been able to bf. So much went on that I was totally not prepared for (who is!?)

[Odaat]

I think hormones play a massive part- but for me a lot of it was circumstantial I believe...