Mirtazapine in pregnancy(11 Posts)
This is definitely going to be a bit rambly but deep breath here goes:
I've always been prone to anxiety and low mood when the anxiety gets its claws in. I've been on 20mg of citalopram for 12 weeks now but don't really feel its having much effect. A few years ago I had a horrible episode and the only thing that helped was mirtazapine and psychodynamic therapy for a year. The mirtazapine had a wonderfully sedating effect which really helped me to sleep better and get control of my rampant destructive thoughts. I'd have stayed on the drug forever were it not for the insatiable appetite and the 3 stone I rapidly gained.
The GPs who I have spoken to are only willing to try fluoxetine, sertraline or citalopram as long term evidence seems to show no negative effect on the foetus (obviously RCTs would be unethical). I've vehemently stayed away from Dr Google but have been repeatedly told by midwives that maternal stress is known to have a negative effect on the foetus. So my quandary is do I ride it out (potentially risking the effects that stress may have on my baby girl) or push for a mirtazapine prescription knowing its likely to dramatically improve my frame of my mind but the effects of my foetus are unknown (again I haven't researched as I don't know where to start)?
As an aside I normally use high intensity exercise as a cure all for my frame of mind but my body just seems to say no, and so listening to it I've started antenatal yoga and walking but they don't seem to have the same rapid mood lifting effects.
I just wondered if anybody had any knowledge or experience in the area and could talk me through it. Unfortunately my trust doesn't seem to have a maternity mental health team but I have been referred for IAPT CBT as first line and a consultant obstetrician appointment to discuss my mood where I hope to be able to articulate both how I feel and ask for treatment which would be best for my baby. Any and all thoughts welcome.
20mg is quite a low dose still.
There isn't any official data for any AD for depression in pregnancy as it's not ethical to do the studies, as you have said.
I've come off sertraline as i'm well enough but Dr at Scan assured me, it was relatively safe in pregnancy, so if I do need it, it is an option. I know ADs are likely again sometime in the future
Discuss doseage with GP and try to get referral. How far along are you?
I'm 23 weeks, but the SSRIs the GP are happy to describe don't have much effect. I guess I want a definitive answer if the risk of mirtazapine is less than the risk to the foetus of my anxious sleepless state, but noone can provide that answer
Not much effect is better than no effect at all.
Does your dose need tweaking ??
What happened with the Ob appt? Can they refer you beyond GP?
i was on 30mg of mirtazapine before i got pregnant and continued it throughout the whole of my pregnancy. i was always told by the doctors that it was better to take nothing or a lower dosage but i tried and felt really unstable. i have a healthy baby girl now and don't regret taking them at all because of how much better i felt.
if you are planning on breastfeeding it's better for the baby to wean them off after birth.
don't worry too much and if you feel like you need it just do it, pregnancy is stressful enough without depression getting on top of you too. good luck!
BNF does suggest that mirtazapine can be used in pregnancy with caution, and if the baby is monitored for withdrawal. So, I think you need to push GP to consider, or refer you to MH services e.g. psychiatrist
Thanks all, I'm at the GP on Wed and OB consultant in 2 weeks, I'll refer them to the bnf and see what they say
Thanks arbBrighton I just assumed the bnf would say the drug is contradicted in pregnancy but have found the BNF info and will refer the GP to it
My (very renowned, experienced) psychiatrist told me in no uncertain terms should I fall pregnant while on mirtazapine. That view is obviously balanced out by advice others have received, but thought I'd share it. I was also on citalopram and he wasn't as concerned as there have been more studies carried out with this drug. Would you consider increasing your dose first and see if that helps? I only functioned without mirtazapine on 40mg citalopram. Agree with others above though, looking after your mental health is priority. Good luck.
Fassbender - My (very renowned, experienced) psychiatrist told me in no uncertain terms should I fall pregnant while on mirtazapine.
Sorry my grammar is crap, did he say you shouldn't fall pregnant on mirtazapine?
I'm hoping as I'm 23 weeks it might change the prescribing advice
I am nearly 30 and am looking to have a baby in the next couple of years, I have recently been prescribed mirtazapine. I did say I wanted a pregnancy safe AD but citalopram failed on me and the doctor said getting me better was priority and as I had lost a lot of weight and sleeping was a problem for me she said she thought mirtazapine would be best. But I am terrified of going through another drug change and the possibility of another drug not working. But don't read much positive stuff about taking mirtazapine in pregnancy, so so would love to know what you decided to do in the end?
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