**definitive advice needed on ADs in pregnancy, please help!!**

[rainbowgirl]

i've posted on this before and got a mixture of replies.. i'd be really interested in people's experiences and views. i have suffered on and off with depression and anxiety for years and had bad PND after i had dd 4 years ago. i'm 26 weeks pg and should definitely be back on the ADs as i'm feeling a lot of symptoms of depression and am in a tough situation (dp not living with us, too complicated to go into right now but basically i'm pg and coping with a demanding 3 year old alone). i would like to be taking them BUT have read a lot of conflicting information about antidepressants and pregnancy/breastfeeding. the AD which works best for me is citalopram but the midwife gave me this scary research about how rats had been fed citalopram at the end of pregnancy / start of lactation and the mortality rates of their pups apparently shot up. i know people say prozac is 'safe' but it's not the one recommended in breastfeeding. after i researched it all loads about 6 weeks ago, i asked to be prescribed a tricyclic, preferably amitriptaline, but my doctor won't prescribe a tricyclic because he says there are too many side effects. i'm in a real pickle about it all. please, please advise, i can't go on in the way i am. i just want a drug i can take as safely as poss for the rest of the pregnancy and while i am breastfeeding or i may lose the plot totally

I am 34 weeks pg and was prescribed citalopram when I was breastfeeding my youngest and now was told it was fine to still be on them when pg.

there's no definitive answers, as prescribing ADs in pregnancy depends on balancing the risks to the baby with the risks of untreated depression/effect on quality of life of the mother.

having got the unhelpful bit out of the way, I can only mention my experience. I ended up on a low dose of Prozac at 30 weeks PG, and then took it whilst bfing (which only last a few weeks for reasons unconnected to the Prozac). My problem as OCD/depression, so tricyclics other than anafranil were out of the question anyway. Noone had any issue with me taking Prozac whilst bfing - including the obs/gynae consultant, the psychiatrist, and the pharmacist that worked alongside the psychiatrist. I was told that research (as of end 2003) had shown that tiny traces of Prozac went into the breastmilk, but they had no effect on the baby. In fact I was actually encouraged to breastfeed by the psychiatrist to reduce any possible withdrawal symptoms after the birth.

There have been studies on effects of SSRIs in human pregnancies - I would not rely on a mws account of an animal study as being the be all and end all in terms of research. If you look on the bbc web site and do a search you should be able to get some information yourself on SSRIs in PG/research.

I took Sertraline at 20 weeks with dd1 and carried on taking it while I was bf. It was fine. Apparently if you are depressed you make a lot of Cortisol which can have an effect on the fetus, in which case it may be better to take anti ds. The shrink told me that anti ds can make the baby arrive a bit early (yeah yeah! DD arrived 10 days late!) and they can make the baby a bit shaky for a day or 2 when it arrives. Apparently depression can cause growth problems for the unborn baby, so the baby may be smaller than it would otherwise have been (I don't know how they know this). the doc or psychiatrist would be the best person to talk to. I'm on Sertraline again and I think I am starting to feel a bit better. The anxiety is horrible. Hope you feel better soon!

When I was pregnant I was in hospital for over a month and could feel my anxiety setting in again, (suffered with panic attacks and anxiety for 4 years on and off). They sent a nurse to see me that deals with ante and post-natal mental health issues and she said that Sertraline was the best performing AD whilst preg. Apparently it works best with the placenta. I did not end up going on them as I delivered a few days after seeing her, so dont have any feedback on them whilst pregnant. But I did take them prior to pregnancy and they were much milder than other AD's to come off and gave me less side effects. (been on citalopram before aswell). She also told me Sertraline is good for B/F'ing aswell.

Best of luck with your pregnancy. X

hi rainbow.

i was on prozac in my last pg woth no ill effects,and have been taking it since week 12 with this one.my gp said that she wouldnt have given me it if i'd been intending to bf though?i was also told early on in the preg that amitriptyline(sp?) was known to be safe in preg and was offered that before prozac.
just thought i'd add my experience of ad's in preg.

i have felt better since taking omega 3 oils,though i dont know if its just co-incidence i have heard alot of people say it helps with depression and it wont do any harm so could be worth a try as well.

I took zoloft while bfing ds1 and throughout all but the last 3 weeks of pg with ds2. The only side effect, if you take it all the way through the 3rd trimester is that the baby can have some withdrawal symptoms. But I would really like to know if those were found in only ff babies or also in bf babies. I weaned off very gradually that last trimester and my OB seemed to feel that even if I had to stay on a really low dose it would probably be fine. The info I saw didn't mention dosage but presumably would be higher than my weaning dose.

HTH

jabber

thanks ladies that is really helpful; i don't think my psych is being very helpful at all with it, from the research i've done (which is much more than reading the midwife's account of the animal tests they've done by the way; think i've become somewhat obsessed by this topic in recent weeks!) it seems to me that amitryptaline is the safest AD but i'm not being allowed it and that fluoxetine would be the best to go onto now in terms of an SSRI, but that it might affect my breastfeeding in some way.. i really hope to breastfeed again as last time i really liked doing it well maybe like is too strong a word, but it went quite smoothly anyway, and i think it's good for the baby who will have been thru quite a lot with the amount of stress i'm under.

i just don't know what to do.

feel like there is no way out.

that is probably because i'm so depressed!!

see - vicious circle

diva - thanks for posting - i'll give the omega 3s a proper try - i take them on and off but not regularly enough at the moment, i've heard the same thing about them, worth a go..

trouble is, they've done very little direct research into SSRIs during pregnancy except for prozac. for citalopram there are only 2 studies both really limited.

will your doctor or mw refer you to a psychiatrist to talk through your concerns about drugss? some areas have psychs that specialise in antenatal and postnatal care, so they would be really clued up on all the things you are concerned about.

I preferred to go onto Prozac when I was PG as it appeared to be the drug they had most info about re:taking it in PG. what are you particular concerns about Prozac and breastfeeding?

bump

fluoxetine appears in the highest quantities in breastmilk mainly because it has the longest half-life of all the SSRIs. citalopram comes a close second. for that reason fluoxetine and citalopram aren't recommended in breastfeeding though i'm sure most of the time the baby doesn't suffer too much; the other SSRIs appear in much lower quantities in breastmilk. for citalopram, they recommend you replace 2 feeds a day (the 2 after you take your pills) with formula. i don't like the idea of that much. but i think for now i am going to have to go back on my ADs and make a decision further on down the line. maybe i just won't breastfeed not the end of the world i guess

What terrible side effects are there from TCA's? I was on Amitryptiline all through pregnancy, prescribed by a maternal psyhc.

Only side effects I had, were whenever the dose was increased I had constipation and very hungry for 3 days, and then fine. Load of bollocks if you ask me. Where is your psych coming from, shouldn't this be a shared decision.

If he/she continues to be a pain, I know Sertraline is considered next safest after Prozac. However Amitryp, Imipramine, and Nortriptiline are all considered safest as these have been around for so long, there is lots of data on them

I went to see my doc with pnd and was bf. She said she would have to research ads and bf and to tell reception I needed emergency appointment for the next day and she would research when surgery closed. This in inself made me a lot calmer about taking ads and bf. A GP that would go the extra mile and look into it in their own time!! I was prescibed lustral and found it fantastic. DD is now 6 and doing excellent at school, articulate, caring etc so no probs.

sertraline is meant to be fine in breastfeeding but look at this on SSRIs in late pg.. 'Treatment of Pregnant Women During the Third Trimester: Neonates exposed to ZOLOFT and other SSRIs or SNRIs, late in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding (see PRECAUTIONS). When treating pregnant women with ZOLOFT during the third trimester, the physician should carefully consider the potential risks and benefits of treatment. The physician may consider tapering ZOLOFT in the third trimester.'

This is copied from the pharm company's own notes.

Fizzbuzz i agree totally with you i got really angry with him! his new argument is that if i want to breastfeed, an SSRI would be safer.

so it looks like i need to somehow get thru the end of the pregnancy, then go onto an SSRI and maybe half breast/bottle feed... i'm trying omega 3s currently!

really fed up

Can't you ask to see someone else...not easy when you feel like shit, I know.

HI

Your probs of ADs sound just like mine at the beginning of last year. At first my GP wouldn't give me anything but after strugling to get to 20 weeks I just went back and demanded they give me something. I was given Dosulepin. I have now had my baby and have been bf her for 13 weeks. She appears to have suffered no side effects of the ADs. The only thing I suffer is they make me quite tired so I just take them before I go to bed and I'm alright in the day.

Please Please keep pestering the GP if you feel you need something I'm sure you do. Also on a positive note I suffered alot after my son was born but this time I have coped alot better I think as a result of being on the ADs during the pregancy.