Anti-depressants and pregnancy (and breastfeeding) confusion...

[Podpod]

Hi all,

Just thought I would throw out a rather personal question in the hopes that I could hear some experiences from other mums and mums-to-be that might help me with a rather difficult decision.

I am on 20mg fluoxetine/prozac and almost 6 weeks pregnant. My GP said there is no definitive evidence on the risks of continuing the fluoxetine through pg, and that I should weigh up the risks and come to whatever decision I feel comfortable with... If only I knew what that was!!

I have been on 20 mg fluoxetine/prozac for a almost 5 years following a bout of moderate to severe depression. Life was continuing to get rather rocky (redundancies at work, financial worries, my frail mum with dementia) and I felt the fluoxetine wasn't working anymore, so I changed to sertraline for almost a year. Things settled down a bit, and I decided to go off the ADs at the beginning of 2009.

Whilst I was still on the contraceptive pill at this time, I wanted to slowly but surely ease the chemicals out of my system as we were starting to think about TTC.

Well, what followed was a slow and spectacular meltdown over 2009 which saw me crying at a drop of a hat, not coping very well and being signed off work for 2.5 months from November 2009 (first time I was signed off!) Sadly, I then went back on the fluoxetine. It really helped, but I was saddened that I couldn't 'do it' on my own....

I came off the pill early 2010 and am now 6 weeks pregnant.

I am really confused about the conflicting information and the advice to weigh up risks to the baby with risks to my mental health. Whilst I know that I am prone to wobbles, I can't measure it against the baby's needs as I don't know what the risks are for the baby..

I would really welcome ANY experiences and advice that Mumsnetters may have... How do I weigh up the risks to the baby when I am not even sure that medical profession knows? What would the risk to baby ACTUALLY be? Organ development? Cognitive development? ....

Is any particular AD 'better' to take during pg if you decide to continue with medication?

And what about breastfeeding? Are there different medications that are 'better' when breastfeeding in that they don't transfer in the breastmilk?

Oh dear... long post, sorry.

Bit overwhelmed by this all. Want to the right/best thing for baby, but don't want to lose myself in the process (as I won't be any good to anyone at that stage!)

So looking forward to any comments..

So glad I found these discussion boards..

[cinnamongreyhound]

I'm sorry I have very little experience of depression and certainly no idea about the effects of anti-depressants. I just didn't want your post to go unanswered and to say that from the little I know it's really not about doing it on your own or not, you wouldn't try to do it on your own if you were asthmatic or diabetic so don't feel bad at all.

I hope someone comes along soon who can give you a better response. Congratulations on your pregnancy

[Podpod]

Thanks cinnamongreyhound - was starting to worry that perhaps my post was TMI and I wouldn't get a response....

You're so right about the comparison to taking meds for asthma or diabetes.... I guess that with anything of a mental nature, its just easier to think that people just need to get over it, than think it may really be a chemical problem needing medical treatment..

Thanks for the post and the wishes...

[Funkycherry]

Hiya.
I was on anti-depressants (Efexor XL) when I got pregnant and have been for 7 years.
It is really difficult to get decent imformation, because clinical trials aren't conducted on pregnant women. If you search the internet for long enough, you can find bits and pieces out, but you can never be too sure how accurate any of it is.
What I found out about the drug I was on, is that there's no evidence to suggest that it causes abnormalities. However when 'sprog' is born, it would have gone through 'cold turkey withdrawal.'
With that in mind, I made the choice that with the help of my GP, I wanted to reduce the dose as much as I could. Pleased to say, I've been off it completely since about 26wks and I'm now 33wks.
My moods are pretty up and down now and its difficult to know how much of that is pregnancy and how much is the depression coming back. I'm very consious that I may need to go straight back on them as soon as she's born
Something that might be worth baring in mind, is that there IS a lot of research about the effect of stress in the mother on unborn baby. I think this is why no-one wants to say for definate come off the drugs, because that COULD be worse for the child depending on how depression affects you.
Obviously, if the depression gets so bad that you either try to, or do, top yourself, that's no good for either of you!!
I have my fingers crossed that having 'sprog' will change my outlook and thought processes enough that I won't need medical help to cope anymore. Guess only time will tell.
Know I haven't given you concrete info, just hope it helps to know you're not alone.x.

[japhrimel]

Motherisk are probably the top international experts on drugs whilst pregnant or breastfeeding:

www.motherisk.org/women/updatesDetail.jsp?content_id=687

www.moth erisk.org/women/drugsDetail.jsp?category_id=152&title=Antidepressants

www.motherisk.org/wo men/updatesDetail.jsp?content_id=683

Fluoxetine is the most recommended anti-depressant to take if needed.

You may want to consider trying to come off them now and see how you do to at least try and be on them for as little of the 1st trimester as possible.

[weegiemum]

I know that Sertraline is fine in pregnancy and breastfeeding (took it 3 times through bf and twice right through pregnancy). My kids are a bit crazy but I think that is just me!!

[Cosmosis]

you're not alone, there are a few of us around who were on anti-ds when we got pg. I was on (my mind has gone totally blank can't remember what it's called not fluoxetine though) and was referred to the consultant. They didn't seem to think it was an issue ( possibly becuase I was actually already weaning myself off them). As above I have heard that fluoxetine is ok to take though pregnancy. Not very helpful advice from your GP though, can you ask to be referred to the mental health team for more constructive help?

[juliec26]

I too am 7 weeks pregnant was taking citlopram and had reduced my dose to 1 a week - In the last 10 days my depression has consumed me and i can say I have never felt so down and numb - I so wanted a baby and thought long and hard about it - I have 1dd age 4 I started taking citlopram when she was 6 months - I went to GP friday and she advised to start taking again - for me I not sure If i could cope without it at the moment - good luck

[Podpod]

Thank you all SO MUCH for the responses - it's really heartening to know that there are others there thinking through the same issues..

Funkycherry - I like the idea of tapering off towards the end to avoid any withdrawal for the baby. Although, I could probably handle withdrawal symptoms better than I could any malformations that are as a result of taking the meds in the first trimester!

Japhrimel - thanks for the links to motherisk. Had never heard of them, and the links were very, very informative. I am glad to hear that fluoxetine is regarded as one of the safest SSRIs for use during pregnancy. I am just trying to find out more about usage during the first trimester... Is is best to avoid use in the first trimester if possible? (P.S: Just seeking your thoughts here, I know full well that medical advice is to be taken elsewhere )

Weegiemum - I guess I could look at going back on sertraline as an alternative. I am just really worried about coming off the meds (particularly as some of the research shows that PND often begins antenatally, and with my history, I wouldn't want to tempt fate!!). I did have some ghastly head pains coming off setraline last time due to the shorter half life of the drug compared to fluoxetine.. As for craziness - I saw a card recently at WHS Smith. It said, "Craziness is hereditary..... we get it from our children!!"

Cosmosis (love your username!) - I will definitely ask for a referral, or maybe ask my sister as she happens to be a child psychiatrist - I hope she could get access to some info for me from colleagues?? I know she is more inclined to have me continue the meds as the risk to me is probably more likely than the risk to the baby. But we haven't actually spoken much about it as I have found this all out while she is on holiday abroad. I still posted to MN as I really value the experience of other mums. I will post more as soon as I find out anything useful.

juliec26 - sorry to hear that the depression wobbles are back. Your GP's advise sounds sensible. Japhrimel's links above post to some research that conclusively shows unwell mothers pose a great risk to unborn babies. Neither of us would be any good to our babies if feeling down, numb and in a deep dark place. Thanks for sharing - and here's sending lots of light and supportive squeezes your way. Let us know how you get on....

I have also done some additional googling and have come across the following NICE guidelines that may be of interest:
guidance.nice.org.uk/CG45/PublicInfo/doc/English

From what I can understand, it seems tricyclics are better during pregnancy and breastfeeding with fluoxetine being the best within the SSRI range. It also seems to advise not continuing SSRIs beyond 5 months into pregnancy.

Gosh - got to stop googling. Getting square eyes!!

[japhrimel]

It's best to avoid all medications during the first trimester if possible, because 1, MC is more likely anyway and 2, as the baby's organs and neuro system are being formed, it's easier for things to go wrong, so it's safest to stay away from anything that increases your risk. But if the meds are needed, then that often outweighs a potential increase in possible risk.

During the 3rd trimester, the issue with many meds is that if the baby is born with them in its bloodstream, it might cause health problems. But babies are born to women who have to be on really strong meds - it may just mean that you and the baby need more medical attention.

[juliec26]

hoping mine is hormones and will just pass, thanks for the words of support - just want to feel excited again - usually a new nail varnish does it, but lately nothing can bring any feeling! x

[Cosmosis]

Citalopram that's what I was on! good luck with it all xx

[TheArmadillo]

About the latter part of pregnancy - I was put on fluoxetine at around 25 weeks. In general I was told the risks were lower than in the first trimester. However there can be problems at birth - though the odds of these are very low. Plus they are writing to the consultant for when I give birth to inform them so they are aware and can monitor me.

Any medication has to be balanced against the risks of not taking it - i.e. depression in the mother and the resultant stress can also have a negative affect on the baby.

Also because of previous depression problems you are probably at a higher risk of post-natal depression - taking an anti-d will help protect you from this as well.

Difficult decision to make though.

[Funkycherry]

On a more positive note (why do people think us depressed people can't do this???!!!) I think that although we are undoubtedly more at risk of getting PND, I also think we are in much better positions to deal with it.

We already know the signs to look out for.
We've already had to learn some coping stratergies.
The people around us are prepared and also know what to look out for.

You've really got to feel sorry for those people that have never suffered from mental health problems. PND must hit them like a truck!

[Cosmosis]

I totally agree funkycherry!

[blondecat]

Hello

A bit late to the thread but here's my experience.
I was (after years of depression) beginning of taper off on venlafaxine (effexor) when got pregnant. Had a long discussion with psychiatrist.

Same things as you found on studies - they simply cannot do them on pregnant women so to avoid lawsuits all anti-depressants are marked class C or D. Shrink told me of another client he had who could not taper off - she brought tons of studies which generally sow that the older generation anti-depressants have v little risk (apart from baby going cold turkey - and in fact if you breast-feed it might not).

For mine the best I found was that in a study following mothers who were taking it anyway there was no increased incidence of still-birth/ miscarriage etc. In an animal trial very high doses (per kg/ cm3) - probably above therapeutic show small decrease in pup weight on birth.

Overall shrink's advice (40+ years experience), agreed with by consultant ob-gen was to continue even with my low doses. Both agreed they never saw problems as a rsult of anti-depressants. Little critters can be tough., just take your folic plus supplements.

In the end the bump made the choice for me - every dose ended up in a bucket/ with me struggling through 10+ hours of nausea. So I had to stop and am fine if classed as high risk of PND. But would have absolutely continued if not for being unable to stomach it.

Your baby needs you to be well, podpod. And there are medicine combinations you can take with minimal to no risk. Don't feel bad. Only those drugs classified D (US) are actually shown to be a danger, Cs - which your pharmacist would still tell you not to take - mean they are not proved safe. Fluxoetine / prozac are some of the safest around.

What is definitely not safe is a baby marinated in stress hormones - cortizol etc as Funkycharry points out.

[ihearttc]

Im a bit late as well but Im on dosulepin 75mg and Im nearly 8 weeks pregnant. I have a 5 year old DS and I have been taking it since he was 6 months old. The plan was to try and wean myself off it before ttc but it actually happened very quickly and I got pregnant before I even got a chance to speak to GP about it.

My old GP tried me on Fluxoetine first of all when DS was tiny but it actually made me feel worse (if that was possible!) and I was having panic attacks all day and all night which was awful (which wasn't even the problem in the first place!) so they changed it to Dosulepin which is a very old AD (used to be called Dothiepin/Prothiadin) and it has made a huge difference to me.

I went to GP in a panic when I found out I was pregnant and after checking she said that she would rather I take fluxoetine but there is no way she'd change me to that now and that out of all the other ones the one I was on is a better one to have because its so old if that makes sense.

Have also been seen in EPAU because of a huge cyst I have on my ovary and MW's there and Dr's have all said its ok to take and baby seems to be doing well at the moment.

I do feel very guilty because I literally took nothing when pregnant with DS but at the end of the day I need to get through this and nobody else can. Its taken me a hell of a lot to get to this point (mentally/emotionally I mean) and nobody else can to it for it. I have got to see my MW for the first time next week so will talk to her about it but am planning on gradually reducing the dose to 50mg and then 25mg as pregnancy progresses.

[leepod]

TheArmadillo - thanks for sharing your experiences of fluoxetine. The idea of slipping into a depression again scares me senseless, and the idea of doing that at a time when there is a tiny little baby dependent on me for its every need scares me doubly so! Interesting to hear that there may be a small likelihood of problems at birth if fluoxetine is used to the end of pregnancy. I was hoping to have midwife led care in a birthing centre, but I guess that based on the advice you were given, it may be better to have consultant led care and give birth in a hospital.

Funkycherry - I agree with you, it must be absolutely to have PND never having experienced depression before. That said, while I know we are able to better spot the signs, I don't think its any easier for people who have experienced depression before. Personally, I felt really bewildered when I was slipping into my second depression in a 10 year period. I was frustrated that I couldn't stop it, I was embarrassed that inspite of great improvements to my quality of life using CBT techniques, I would still 'need' to take the anti-depressants again. That thought in itself depressed me!!

^blondecat* - certainly not too late to be sharing, thank you. You're right, I won't be doing myself, my baby or my partner any good if I am a wreck. Interesting what you say about the cortisol. I have had a particularly stressful couple of years (which contributed to my depression) and I read about a condition called 'Adrenal Fatigue', which results when you are in a constant state of stress and your body is awash with cortisol. Not healthy at all.

ihearttc - thanks for the info. Do keep us posted on what the MW says. And please try not to feel too guilty - you certainly are doing the best you can. And the more I read around the topic, the more I realise that the harm cause by ADs during pregnancy is far less likely than the definite harm caused through the lack of baby-mom bonding if the mother is depressed.

Most recently - I have read this: priory.com/psych/adspregnancy.htm

Thanks again to all for sharing. I know this can be a really personal issue (well, it feels like that for me sometimes) and I appreciate all your comments and sharing...

Warmest wishes all round!

[podmumlet]

Hi there,

Just wondering if I could once again tap into the wisdom and experiences of other Mumsnetters...

I am now 35 weeks pregnant (where did the time go since my original post??) and still on the fluoxetine/prozac. Baby seems to be developing well, I am loving my pregnancy and everything is on track so far. The consultant I was referred to even stated in my notes that it would not be a problem for me to have a Birth Centre birth...

Thing is, I am thinking about breastfeeding, and getting really conflicting advice here too, and I was wondering whether others could share their thoughts/experiences?

I found the following useful document on the Breastfeeding Network - www.breastfeedingnetwork.org.uk/pdfs/Antidepressants_and_Breastfeeding_March_2009.pdf

This is not the first place I have seen it mentioned that in the few weeks before baby is due, the pregnant mum should switch over from fluoxetine to another SSRI such as sertraline. I am not really wanting to change, but on balance, I want even less to harm baby and cause unwanted side effects like lethargy, colic etc due to the longer half life and possible accumulation. Seems I could switch back after 4 months...?

The consultant (aside from saying I was fine) was not much help unfortunately. Whenever I even mention antidepressants, he just shakes his head saying its fine to continue with fluoxetine, and not really speaking through any of the implications or options so that I can take an informed decision.

Have any other mums continued with fluoxetine through to breastfeeding?

[podmumlet]

Just came across the following thread too. Great info from Japhrimel and others....

LactMed also has the following info that may be of use to others..

All that said, boggles the brain as to why no-one has spoken to me about switching over to a different AD?

[jellyhead188]

Hi - I was told by one doctor that I could take fluoxitine (was on 20mg per day) throughout my pregnancy but that there were risks to the babies heart if I did and that I would have to come off them before giving birth as the baby would be born addicted and if I wanted to breastfeed I def couldn't whilst taking them.

A different doctor told me it was relatively safe to take them throughout pregnancy but def not whilst breastfeeding. This doc told me that I could take beta blockers (as I suffer from anxiety) whilst breastfeeding as that didn't tranfer to the milk!

However, my sis in law was told 20mg fluoxitine was safe to take during pg its called a maintanence dose apparently (not sure if she is going to breastfeed)!

That probably doesn't help much, but just wanted to show that the advice is very conflicting - I was basically told to do whatever I was happy with! I was actually at a point where I felt like I could come off them which I did and thankfully not been too bad, but I will consider the beta blockers when I have had baby if my PND does return.

HOpe you get some answers. xx