To consider staying on meds during pregnancy?

[citalofan]

Namechanged.

I have depression, anxiety disorder and agoraphobia with pretty severe panic attacks. Currently getting ready to TTC, and on the advice of one doctor I thought I'd at least try to taper off my antidepressants. I'm on 20mg citalopram, which has never been amazing for the panic attacks but keeps me on an even keel. I'm in week two of a slow taper and feel like I'm in hell - the physical withdrawal symptoms are not a huge issue but it's the resurgence of serious panic attacks. I was previously getting them maybe once a month and not as severe. I've had four this week and last night's was enough to make me wonder why I'm doing this.

I have a telephone appointment with the GP on Monday to discuss. I may just go back to my regular dose, but I am also considering switching meds as citalopram is still not very effective for the panic. I feel weak for this, I am aware of potential risks to any baby that may be conceived but I'm starting to think it's worse for my mental health to be unmanaged. I am also concerned about worsening mental health during pregnancy which obviously wouldn't be great for the baby either.

I have been on fluoxetine in the past for a short time so considering that, or whatever the doctor might suggest. I feel a bit of a failure, but the idea of dealing with pregnancy stresses while unmedicated is frightening ME. I have a history of suicidal ideation and health anxiety which is greatly helped by taking meds.

I would appreciate positive stories about taking antidepressants during pregnancy (and during breastfeeding if possible) if you have any. I will be trying to stabilise on whichever med I take before TTC. Everything else I am preparing as best I can, I am a healthy weight, I have a chronic illness but it is managed, I have a supply of folic acid ready.

Thanks in advance for any advice.

[citalofan]

Hopeful bump!

[citalofan]

And again :(

[muddledmidget]

Sertraline is a good option for during pregnancy, I'm not sure if you've already tried it. Have a chat with your GP and see what they think but if any changes are going to be made to your meds I think I'd do that before TTC just in case the side effects coincide with you feeling exhausted and sick from early pregnancy

[citalofan]

Hi, no I haven't tried sertraline before, have read mixed things about it but willing to try if it can help with the panic attacks. Hopefully the GP will listen to my concerns about being unmedicated, the previous one was quite sure I should come off the meds and didn't want to talk about alternatives. Absolutely I'll try and stabilise on any new meds for a month or so before TTC.

[ChocoholicMama]

I’m on Sertraline. Came off to TTC, after five months the anxiety attacks were getting too bad so I started back up again on the half low dose (25mg), intending to go up to the low dose (50mg) as normal after two weeks. Six days later I got the positive test and I’ve stayed on 25mg since then, with doc approval. Told my midwife and she said oh Sertraline, that’s fine. And that was that I’ll be moving to low dose after baby arrives. Ultimately my advice is go on meds if you’re having panic attacks. But check if your current med is safe enough for pregnancy or if you’re best moving to something like Sertraline. Be prepared that you’ll probably have to come off your current one fully before you can start a new one. But definitely take it if you need it... uncontrolled anxiety and panic is, IMO, far worse for pregnancy than low dose meds that are considered fairly safe. Xxx

[coffeeandpyjamas]

I took citalopram (think it was 30mg) throughout my whole pregnancy and everything was fine. From experience (I have depression and generalized anxiety) the prospect of not taking meds was not even worth considering. Advocate for yourself and if you don’t feel right coming off the meds, don’t be forced to by a GP. You know your body and mind best.

As a side note, I’m now on sertraline and it’s amazing. The first few weeks were pretty bad with nausea as I got used to it but now I have no side effects on it. Plus it has stabilized my mood better than citalopram ever did!

Good luck with TTC!

[dontdressme]

Place marking to remind me to come back and tell you about my experience. I have two happy healthy school-age children, I took Sertraline throughout both pregnancies.

[JustOneMoreStep]

My understanding is that for the vast amount of AD the general consensus is that it is better to stay on them rather than come off them during pregnancy. I was above recommended dose for venlafaxine under MH team. When I approached my GP about TTC he was adamant i should stay on them and i actually came off them against his advice. I should say that i had fantastic support from my family and an amazing counsellor who I trust so wasn't completely unsupported and coming off them has been the right choice for me. I'd say if you feel you need the meds to get through pregnancy then stick with them.

[bogoblin]

I'm currently pregnant and as citalopram works for me, I have stayed on it. I decided it was better to manage my mental health than to risk coming off it, and the GP I saw about it explained that while they can never say for certain a medication is safe for pregnancy, e.g. for labelling purposes or something like that, they have a very good idea what is and isn't safe. There are SSRIs like citalopram that are considered low risk.

But if citalopram isn't working for you, definitely work with your doctor to find one that does. It doesn't make you weak at all - managing your mental health is extremely important, and even an easy pregnancy can be hard work at times. Chuck in a load of extra hormones and well! Please don't immediately hear "risks to baby" and think you have to come off your meds - from what you write here I would personally make the decision to stay on meds and keep my mental health on an even keel. Your health is just as important! It does not make you a failure at all. Should you choose to stay the course with medication you are giving your future child a mum who knows how to look after herself and do what she needs to do to keep herself on an even keel.

I'm 27 weeks currently and baby is looking great, I've had no problems and he's checked out just fine at my scans. The risks I believe are very low - and I have been on citalopram the entire time, and before as this was a surprise baby!

Good luck, I hope you can find something that works for you!

[Ristar]

I normally take Venlafaxine, changed to sertraline during my first pregnancy as apparently it is ok for breastfeeding. Was referred for CBT and a psychiatric review during pregnancy. I started having panic attacks again about 4 months after and was changed back to my usual medication.

Second time I decided just to stay on my Venlafaxine and formula feed with the blessing of both doctors and midwives.

Best to speak to your GP and midwife about it.

[HelloViroids]

Try to get referred to the perinatal mental health team, they know about both pregnancy and MH. My GP told me to come off my meds and When I eventually got referred the perinatal mental Health team said that was the worst thing to do. FWIW I’m 35 weeks and have stayed on my medication, and it’s really been a life saver.

[Matwood]

I'm another person on sertraline - I've been on and off it since I was 17 (now 32). I'm currently 27 weeks pregnant, and all the scans have been fine and all the medical professionals throughout my pregnancy have been very supportive of my decision to stay on it. About a year before I started TTC I tried coming off it but it just didn't work out - and now I've finally made my peace with staying on the low dose I'm on for the rest of my life.

An SSRI antidepressant such as sertraline is considered fairly safe - in fact a friend of mine was started on it during her pregnancy, for pre-natal anxiety. I believe it has had the most research done into how safe it is during pregnancy and breastfeeding. I also find that it works really well for my anxiety, not just my depression, though everyone is different. I would however warn you that it can make you feel very sick for the first week or two - but that does pass.

Citalopram is also an SSRI antidepressant but I can't say I've done any research into how safe it is in pregnancy.

Finally, good luck! The best thing for any baby is that you keep yourself happy and healthy and be realistic about what you need to help you stay that way.

[HavelockVetinari]

Generally speaking most ADs are ok during pregnancy - there are a couple that are dangerous but citalopram isn't one of those.

I took venlafaxine throughout pregnancy, but reduced my dose drastically in the last few weeks of pregnancy because it's physically addictive and I didn't want DS to be born addicted to it. It was all fine, and despite a stupid midwife trying to stop me breastfeeding (she was misinformed, and thought it appropriate to wake me at 3am to tell me I shouldn't bf) I fed DS till 2.8 with no fuss or issues.

If you're planning to bf make sure you look into it beforehand - ask to see a consultant specialising in medicines during pregnancy and breastfeeding. I did, which gave me the confidence to tell the midwife that I'd discussed it and would be breastfeeding in line with my consultant's advice.

[CatWhisperer86]

I had to come off citalopram and had a really bad time, but was due to start taking fluoxetine once I’d tapered and come off citalopram completely. During this time between meds I found out I was pregnant and it was the absolutely the worst thing that could have happened at that point.

I was encouraged to go back onto meds even though I didn’t want to because I was worried about the effects on the baby, so stuck to just 20mg which did help eventually, and I stayed on them all the way through the pregnancy. My baby is now 2 weeks old and absolutely perfect, I’m breastfeeding aswell and still taking them on gp and midwife advice. My little one is doing just fine.

If you need them, take them. It will only benefit you and help you take care of yourself and your baby all the better. Good luck

[weegiemum]

I came off sertraline to ttc #1, and was back on it 4 weeks after Dd1 was born, I had really nasty pnd (which I expected, I've been depressed since I was a teenager. Successfully fed Dd1 while on it for a year.

I remained on it all through pregnancy with ds and fed him till 15 m, got (unexpectedly) pg with dd2 (coil fell out!!) and so was on it still for her pregnancy and bf her till age 2.

All of them are happy, healthy young adults now (20, 18 and 16), have done well in school and are great fun. I'm sure a lot of that is down to having a stable, non-depressed mum.

So if I were you I'd stay on some kind of AD. Have you been getting any counselling/therapy/CBT or anything. I had some great talking therapy with a psychiatrist after dd2 was born which really made a huge difference to me.

I remain on a different antidepressant and a mood stabiliser now. I'm just one of these people who needs a boost to my brain to make the right chemicals.

[BarbaraGordon]

I came off citalopram before ttc, but once pregnant really struggled in the first trimester (not that you necessarily would). Went back to Dr, got put on fluoxetine and felt so much better. Baby not due for another couple of months but scans have been fine so far and everything seems to be going as it should.

[citalofan]

Gosh, thank you everyone for the positivity and advice, I am feeling much better about speaking to the GP now. I will see what they recommend based on my current issues but may ask about sertraline. My previous experience with fluoxetine was good but I didn't have panic attacks back then so it depends whether the GP thinks something else would be better.

I have had talking therapy and CBT in the past but not for a while, imagine I'd be low down on waiting lists at the moment with everything going on. But I am also using meditation and planning to look into yoga very soon.

[imabusybee]

OP I was on 25mg fluoxetine through both my previous pregnancies. I had pretty bad PND with my second child and was only just starting to feel better when I fell pregnant again. I'm 9 weeks pregnant and continuing with the 150mg sertraline I've been taking as I have only been feeling better for the last 3/4 months.

Your mental health is as important as your physical health. If anything, its more important that you prioritise it because it's invisible to others and if you don't advocate for yourself you may find yourself in a risky place. Taking medication to ensure your mental health is stable in pregnancy (& beyond) is equivalent to a diabetic taking insulin. Look after yourself

[RedXIII]

Hi OP,
I was taking 250mg citalopram 6/7 years ago for depression and anxiety. I became pregnant with my first and my obstetrician told me I should come off citalopram without giving any specific reason apart from "don't want baby to be addicted" around about 12 weeks. Cold turkey not even weaning off!
I wasn't sure this was a good idea as I had been struggling really badly and the meds kept me going but I did as he asked.
It was horrible. Absolutely horrible. My moods went all over the place. It was vile. My poor boyfriend saw a completely different person and it almost ruined our relationship. It ruined pregnancy for me and ultimately ended up in post natal depression and anxiety. I still struggle with my feelings for my first born even now 6 years later.
What was even worse, was about 34 weeks pregnant, I was told I shouldn't have come off citalopram. Too little too late.
Not a positive story but I'd advise to stay on your meds to prevent pnd/a. It pretty much broke me and even though my relationship with boyfriend worked out (went on to have another baby now 8mo) it, to me anyway, affected my relationship with my 6 yo daughter.
Mental health is so important. I went onto sertraline after my first and the difference was amazing!

Slight positive note, I'm not on any anti deps now and haven't been for 2 years. Not sure if that applies in your situation but all I can say that there is always light at the end. Good luck!!

[balloonsintrees]

Was on 200mg of sertraline through both pregnancies, both babies were fine and my head stayed ok.
Good luck

[NotAnEMERGENCY]

I was on fluoxetine 40mg for moderate depression. I also tried to come off it when I was TTC. (GP advised alternate days.) Didn't work - I was a sobbing, unfunctioning wreck so went back to full dose.

Eight months later, when we finally did manage to conceive, I thought I'd try coming off it again. Tried tapering much more slowly this time. Still was a wreck. I too felt incredibly guilty and like a failure as a mother ('to be') for not even being able to come off ADs for the sake of my unborn child.

We saw a consultant paediatrician to get specific details on exactly what the risks were to the child if I stayed on the meds. Turns out the risks weren't nearly as bad as we had thought and the consultant said the child would be much better off having a healthy mother.

So I continued with 40mg throughout the rest of the pregnancy and while BFing for 3 years. My daughter was absolutely fine. We did have to stay in hospital after the birth for 3 nights so they could observe her for withdrawal symptoms but there were actually no issues.

She is now 11 years old and I'm still on ADs (sertraline and mirtazapine) but functioning relatively well.

Good luck with your TTC journey and pregnancy!

[Mimimama75]

I took venlafaxine throughout pregnancy and breastfeeding my daughter (8) discussed with doctor and decided pros were worth the negligible risk. All was fine.

[Hannah9176]

Please don't let the GP fob you off. There are drugs in pregnancy specialists who can advice GPs in these circumstances. Maternal health is so important and drugs shouldn't be withheld on the basis of pregnancy alone.

[FishInCarparks]

Just to add I take 40mg Citalopram and came off for both my pregnancies and regret it with all my heart. I wish I had been supported to stay on my meds.

I was a horrible mess both times, the second was extra hard as I had a 2 year old and look back with so much guilt as what a utter mental bitch I was for 9 months.

My SIL in Canada stayed on (in Canada they didn’t even discuss with her to stop taking them as they valued her mental health) and has a happy healthy daughter.

Please look after yourself.

I ended up with huge PND first time around and I genuinely believe it wouldn’t have happened if I’d stayed on citalopram.

Good luck and congratulations! X

[BadAlice]

Very rarely is if a good idea to.cole off medication or reduce it during pregnancy although obviously if you can find the right balance whilst TTC this is great. Pretty much all SSRIs are considered reasonably safe. Fluoxetine is completely fine if that works for you. Promethazine is increasingly being used for anxiety and panic attacks in pregnancy so might be worth considering (not an SSRI).

BUMPS (best use of medicines in pregnancy) is a really useful website. You might also find the ’table of lower risk medication’ on pg. 4 of this document useful/reassuring: www.sussexpartnership.nhs.uk/sites/default/files/documents/perinatal_prescribing_-jan_18_update-final-_0218.pdf