ADs while pregnant?

[onalow]

DH and I want to try for a second baby (DD is 2.5). Been on and off Citalopram for about 10 years - every time I come off it I get depressed within weeks. Last time - when pregnant with DD - it went downhill really badly and I was referred to CMHT and went back on ADs in the 6th month of pregnancy - I improved so much and combined with therapy I've been fine ever since. Swore I'd never stop taking them again but of course GP wanted me to come off them to try for a new baby. In fact, the nurse at the practice refused to take my IUD out before that.

While cutting down on the ADs (and eventually stopping them altogether) I did everything I could to prevent depression, like going to the gym a lot. But last week it happened very suddenly that I stopped coping. All the familiar signs are there - anger, irritation, loss of patience & sense of humour, extreme fatigue, isolation, etc. In the space of a few days I've already had so many arguments with DH and been impatient with DD. I called my GP this morning who said she'll contact an obstetrician to find out about side effects of citalopram on fetus. I used to be on 20 mg but I told her I'd probably cope on 10 mg. What if she rings back to say I can't try for a baby while on ADs? I haven't even had the IUD taken out yet. All I know is I can't live like this. I have no strength to cope with anything and I've already had a mini breakdown that sadly my daughter witnessed. I'm normally a good mother I think and although I desperately want another baby I will not do it at the cost of everything else. I know now that my brain cannot function normally without ADs, I've been through this so many times before.

So, what I was wondering was: has anyone here been on ADs while pregnant? How much and during what stage of pregnancy? What did your GP say about it? Was your DC fine afterwards? Or did anyone struggle through pregnancy without ADs? Are you happy that you did or do you wish with hindsight that you'd done it differently? Sorry this is long and thank you if you made it this far.

Hi there

This comes up frequently in my practice- I am a neurologist and have many paitents on various medications who wish to become or already are pregnant. No drug company will fund a trial exposing 1st trimester pregnancies to drug X, so evidence is all anecdotal. In my experience all antidepressants are safe in pregnancy. All medications come with company info saying do not take in pregnancy, because then the company is absolved of all responsibility. A lot of past evidence for problems is also flawed eg data from animal trials at doses 50x what humans take!

I would say keep on the same and do not worry. The older these drugs are the more data come through and nothing bad has been identified for citalopram to my knowledge. If I was treating you I would reassure you to keep it going.

Citalopram is also one of the commonest medications. I recently gave a talk about these drugs in pregnancy and the rate of congenital malformation (which is what everyone gets worried about) was the same in the treated group compared to the control population. I think the risk-benefit ratio is very much in favour of you staying on them, but would urge you to discuss fully with your GP first.

Palegirl, thank you so much for your reply, it's helpful to get a medical practitioner's perspective on it too. One thing I didn't mention is that my own mother was depressed while pregnant with me. She didn't take anything for it and I often wonder whether my brain didn't somehow get enough serotonin as a result? My mum doesn't have a depressed personality normally and it's only ever been as a result of very difficult life situations that she's struggled. As opposed to me, whose depression will kick in when I stop taking ADs no matter how great things are and how well things are going in general.

I would consider moving to a different practice where a) the GP doesn't expect an Obs to tell them whether or not you should have ADs and b) a nurse doesn't think she has the right to force you to wear an IUD

madmouse I see what you mean although in the past they've been really good at the practice. I think the nurse wanted to wait for the doctor to make a decision (i.e. either approval for me to continue with ADs or for me to stop taking ADs) before taking the IUD out. So if GP puts on my file that it's ok to take it, I think she'll agree to take it out during my appointment next week. But if not, I'll have to think about what to do. That's why I came on here as well, to see how safe people think it is. I obviously don't want to do anything that could harm my baby (if ever I get to have another one).

Sorry but coming to this as a human rights lawyer - the doctor cannot force you to wear an IUD any more than a nurse can. Whether it would be wise I'm not going into here but it is your human right to conceive and start a family. What you were told amounts to forced contraception.

Oh ok well that's interesting. I pleaded with the nurse to take the IUD out several times, saying I'd stop the ADs, but she refused. She said I needed to see my GP first. I assumed there was some code of practice that meant she could be responsible if I become pregnant and there's something wrong with the baby because she "enabled" me to become pregnant...

Just to add a slightly different thought I am an anxious person naturally and when I took seroxat in the past it made such a difference but I came off medicine before I got pregnant and I felt quite happy and relaxed to my surprise! I think it has been proven that serotonin levels can naturally go up during pregnancy. It might be worth seeing how you get on without them if you get pregnant ?

onalow I was on Citalopram 40mg during pregnancy when GP switched me to Sertaline only cos I wanted to breastfeed (at 7 months onwards, and as per then NICE guidance). Fabulous little boy was born. Still on the ADs. Doc thought it wasn't a good idea to take me (depressed person!) off the ADs. Seriously, lots of women have pre and post partum depression - taking ADs is not at all that unusual. Please do discuss with your GP.

Hi I am in a similar dilemma. palegirl do you know anything about the us of quetiapine in pregnancy? Any information hugely appreciated.

onalow I had terrible depresson and anxiety in pregnancy and took chlorpromazine from about 5/6 months to help me sleep. Was told at the time it had been used for over 60 years in pregnancy.

I am also a bit gobsmacked about your nurse's reaction to the IUD thing. Do they do this with smokers/drinkers/recreational drug users I wonder?

I've been on Citalopram for years, and I'm currently 24 weeks pregnant. Still taking 20mg a day and no issues have arisen. My GP said he would rather keep me on it, than end up with a mother in crisis.

Just a little update: it's the third day I'm back on Citalopram (although 10 mg rather than 20 mg) and what a world of difference it makes from just a few days ago!! I thought it would take at least a week to get back to my normal self but in any case I feel great! DH and I had a chat and decided we're going to try for a baby regardless of what my GP says (she hasn't gotten back to me yet). I have my appointment next Monday to have the IUD taken out. No doubt my GP has put on my file that I'm back on Citalopram and I'm a little anxious that the nurse will refuse to take it out again...

You will have to be very firm with the nurse if she tries it on again.

1. I as your patient have the right to refuse further treatment with this IUD and to have it taken out. You cannot force me to keep wearing it. I want you to take it out now.
2. If you refuse to remove it I will report you to the NMC for misconduct. Forcing me to use contraception against my will is against the law.

Thank you madmouse. Do you know of a website that states this right in case she doesn't believe me?

OP, if the nurse is being ridiculous, go to your local family planning clinic and have the iUD removed.

BTW, I had my second pregnancy taking 20mg Fluoxetine all the way through and breast fed on it for 11 months. Nearly four years down the line DS2 seems great.

Well to keep it simple let's start with your right to refuse or stop medical treatment:

[http://www.adviceguide.org.uk/england/your_family/health_index_ew/faq_index_health/faq_health_can_i_refuse_medical_treatment.htm here]] and www.nhs.uk/chq/Pages/899.aspx?CategoryID=68&SubCategoryID=156

And here is a bit about Human Rights. It talks mostly about marriage, but Art 12 is very specific about you having the right to marry and start a family

You can only be forced to have medical treatment if you are detained in hospital under the Mental Health Act.

But you really should not need this. A polite assertive reminded that you make your own family planning decisions should suffice.

Ak sorry for the messed up links:

here

and here

Hi again

Sorry I missed the bit about the nurse refusing to take out the IUD It is not clear to me why she/he would do this, but you have the right to demand it's removal. Patients are legally entitled to make their own informed decisions, even if the medical fraternity thinks it is unwise- but that is not the case here.

If you meet resistance to staying on citalopram you are entitled to a second opinion- ideally from a psychiatrist with a special interest in pregnancy, but my view is there is plenty of evidence indicating no increased risk to you or the baby. In fact, the opposite is probably the case, given your history and past experience. Of course I am not your doctor and am only speaking in a general sense.

You asked about your mum being untreated when she was pregnant with you- I do not think that would have caused an imbalance in your brain; it is far more likely you both have the same biological/social tendency to the disorder.

Hope that helps!

@racingmind

I did a quick literature search re: quetiapine in prenancy- seems there is no definitive evidence to guide its use, but there is a registry in Australia that may have some new information. One article recommended the medication to continue if a woman was already on it and found themselves pregnant.

It is in a different drug class to citalopram, so I am not familiar with it. Suggest you also obtain a second opinion. One option is to resume the chlorpromazine as it seems you were on it previously without problems. As always, I am not your medical carer so these issues must be discussed with them.

Hope that helps!

Thank you palegirl that was very good of you to find that info and respond. Have appointment with pysychiatrist coming up but not for another month as my GP doesnt feel qualified to advise me. Thanks for your help x

Just as an additional idea to palegirl, who has given very sound advice, there are obstetricians around with a special interest in mental health. Many are happy to see patients for pre-conception counselling and although some have different ideas about which ADs are safer during pregnancy, I don't think any would advise you to stop taking them if you need them. At our trust we have a specialist midwife for mental health too.

Might be worth a quick look at the NICE guidelines for perinatal mental health www.nice.org.uk/CG45

Bravo, squished egg (!)

What women need is common sense about these issues, not hysteria about medication use in pregnancy.

@racingmind no worries hope it all works out- I would be interested in what the specialist recommends!

Thank you all for your comments. I have still not back heard from my GP after I rang her on Monday. The more I think about the whole thing, the more annoyed I feel. Not just about the nurse but, as someone said at the beginning of this thread, the GP shouldn't really have to email the local hospital to ask whether it's ok for me to try for a baby whilst on citalopram. She should know what the guidelines are - even if they are vague and no-one knows exactly what the risks are, surely she should at least know that?

What my previous GP (who was brilliant and referred me to a wonderful therapist when I had antenatal depression) said was that if the risks involved in not taking ADs outweigh those of taking them, you should stay on them while pregnant (he put it in a much more articulate way of course :)) Now, my present GP knew my history and I told her that in the 10 or so years I've been taking ADs, every time I've come off them I've become depressed within weeks. And she still was quite adamant that I should come off them, there wasn't much of a discussion. Of course I understand that as a doctor she has to be careful about the sort of advice she gives when there's potential pregnancy involved but looking at my previous history, I think it was pretty clear what was going to happen. I'm just so nervous about Monday, I've been waiting to trying for a baby for a year now (DH wanted to wait for various reasons) and I just want to get cracking, especially as it took a while for me to conceive last time. Thank you madmouse for the links, I will bookmark them on my phone in case the nurse starts getting difficult.

Sorry to hear you are still having trouble with yr GP. I would not expect yr GP to necessarily know the latest on drug safety in pregnancy, but I would expect him/her to ask advice from someone who does know or to refer you for specialty opinion, or both!

A quick call to the practice manager might speed things up if you feel frustrated by a lack of progress. It might be easiest to ask for a specialty psychiatry referral to discuss the latest evidence and then make your own informed decision.

Hope that helps!

IUD's out - yay!! Before taking it out, the nurse asked me to confirm that I was now off Citalopram as discussed with my GP (obviously my file hadn't been updated) and I said yes .

Glad it's out

Not so glad that cow of a nurse still thinks it's ok to bully people about their family planning decisions. Will you consider a complaint?