Conflicting information re: pregnancy and AD's, please tell me about your experience

[claireinthecommunity]

Hello everyone, I'll try and condense this a little.

I've suffered with bouts of depression since my late teens, sometimes quite severe with hospital admissions. Have been on various medication over the years.

Currently, I'm taking Citalopram, I started with 20mgs back in September then up to 40mgs. Throughout, I have spoken with my GP about mine and my DH's plan to start ttc sometime soon. The time before last I went to see my GP she said that it was not advisable to get pregnant whilst taking AD's/Citalopram - but not impossible. I saw her again yesterday and she has said that if I was or wanted to get pregnant she would prefer me to be taking Fluoxitine/Prozac, I have taken this in the past, without much success. She also said that I should not breastfeed whilst taking any AD's.

I looked up threads on here relating to the subject and found that others have been given very different information, I also 'googled' and found more conflicting info. I'm very confused.

What are your experiences? Thankyou.

I think your Gp might be over cautious (covering her back)
there are ad's that are regularly prescribed for depression during pregnancy/breastfeeding - sertraline is the one I took on the advice of my specialist -

maybe ask your gp to liaise/refer you to a perinatal psychiatrist so that you can have the most specialist and up to date information.

citalopram is not recommended during breastfeeding and usually dr's like you to have come off of prozac before the birth to avoid withdrawal in the newborn.

personally, i was happy to take ad's (once I was reassured they were ok to take)as I knew that a well mummy would be the best thing for my baby

Thank you for your reply Ouch.

My DH and I thought that my GP might be being over cautious and as you said covering her back. I will contact my GP again and discuss with her further and ask about seeing a perinatal psychiatrist.

Thanks again

I took Fluoxetine throughout my pregnancy and my GP advised me to continue with it afterwards even if breastfeeding.

I've recently read that Sertraline is the safest one to take while breastfeeding so I asked my GP to switch me onto this which she was happy to do though couldn't understand why it should be any different from Fluoxetine since they're from the same group of drugs.

Thanks for your reply Weepootle, It's reassuring to know that others have been on AD's through their pregnancies and whilst breastfeeding .

I'm finding all this conflicting Information quite shocking/surprising, I even considered not ttc at one point because of what my GP had said about the medication and pregnancy/breastfeeding.

Fluoxetine is only recommended over the other SSRIs in pregnancy because more people take it (particularly in the US) and so there's more data available on it. In general, if a patient is stable on a different SSRI drug (sertraline, for example) they can stay on that.
There is some new research indicating a slight risk of a condition called persistent pulmonary hypertension of the newborn (PPHN) in babies whose mothers took SSRIs in late pregnancy, and because of this some doctors may want to try to wean you off the ADs at around 20 weeks, but the risk has to be balanced against your health at the time. My consultant wants to try this with me.
If you don't come off the drugs at 20 weeks, the next time to consider it is around 37 weeks to avoid withdrawal in the baby after birth. I have a friend who took fluoxetine right up to delivery at 41 weeks with no ill-effects though, so again it depends a lot on your individual circumstances, dosage, how ill you are.
This info came from the Regional Drug and Therapeutic Centre at the RVI in Newcastle and my consultant psych got it for me. She works in a mother and baby unit so hopefully it's fairly reliable
There are also several ADs you can take when breastfeeding - I've been on at least three different ones
HTH!
Olissa (8wks pg with third baby and a long term depression sufferer!)

Thanks so much for your reply Olissa, It has helped greatly.

I'm digesting all the new information I'm finding, before making another appointment with my GP, where I'll explain what I've found and ask to see a specialist - very nicely of course .

I've found this website which has answered some of my questions, aswell as contradict my GP!

cks.library.nhs.uk/depression_antenatal_and_postnatal/management/quick_answers/scenario_pregnant_on_ an_antidepressant

I've made an appointment to see her on Monday, I'll discuss it with her then.

Thanks again to those who replied to my post

Ok, so my GP told me no to prozac (which was what I had had before), but that citalopram was ok

I started taking setraline when I was 12 weeks pregnant with DD and took it throughout the rest of my pregancy. I breastfed her for 10 months, and took sertrlaine until she was about 18 months.

I am also a long term depression sufferer - have been cutting down my citalopram for a bit now - am down to 10mg now.

I had PND with my dd1 and was given Citalopram. I stayed on this for 4 years (I was quite bad with PND) then when I got pregnant with dd2 I was swapped to Fluoxetine for the pregnancy then back to Citalopram after the birth for breast feeding. When dd2 was born she was rather jittery for a week or so, which the docs said was due to the fluoxetine being in her system - my psych had wanted me to stop the fluoxetine 2 weeks prior to due date to try to avoid this but I was not well enough mentally to stop so I carried on, hence the effect on dd2. Having said that it was short lived for her and she's fine now and I'm back on Citalopram because my psych said that was better for BF. Sorry for rambling...!

I was on sertraline while pg and while pg.
One of the GPs I saw (who is renowned for being shite) practically told me I was deliberately harming my baby. Utter crap. My own GP was happy fo rme to stay on it (and consulted two psych consultants and pharmacology) and remain sane and reasonably well, thankfully. While in maternity, a (very lovely young registrar spent a great deal of time checking over the safety during bfing and was happy to tell me that it was considered safe enough to do so and was still preferable to ffing.

WHile it is far from conclusive evidence, I can say that ds is a happy, healthy wee boy. My pg was healthy too. Had I taken the advice of the first GP I say, I shudder to think the state I might have got into.

SOme GPS are cautious - understandably so - but if you feel that you will nose dive without ADs, then you need to seek a second opinion and ask for specialist advice if necessary.

Good luck.

Thank you to all the new posters.

Ok, so I had the appointment with my GP on Monday, I explained to her that I'd been looking further into pregnancy and breastfeeding whilst taking AD's. I gave a brief account of some of the experiences of women on MN, then told her what the NHS website CKS states in these circumstances (link in above post). As both accounts completely contradict the information she has been giving me, I tried to be polite and calm and not seem confrontational (even though I felt a bit angry about it all) She did seem a little uncomfortable though, with a lot of backtracking and saying that each case is different...well yes obviously. This doesn't change the fact she told me I would need to change from Citalopram before or when I'm pregnant and that no AD's would be suitable whilst breastfeeding, completely different to the NHS website!

Towards the end of the appointment I said that based on the new information I had found, I was confident enough to stay on Citalopram throughout pregnancy and during breastfeeding. My GP said that would be fine! I feel if she was more knowledgeable on the subject, she could of told me this a few months ago and avoided me the anxiety and worry of the situation - ironic really, considering what I was being treated for in the first place!

I'll be able to get the next couple of months worth of meds on repeat prescription, then I think I will ask to see another Dr, as I've lost faith and respect for the one I have been seeing .

Anyway, I've gone on a bit now, on a happier note it does mean that DH and I can start TTC now . It was good to read of all the healthy happy babies that have been born to mothers who'd been on and are taking AD's. Thanks again for posting your experiences, it really has helped .

Briefly - for some quite serious reasons I have also suffered recurent depression.

Was not depressed through pg with dd1, but went "down" at baby blues stage and never came up again.

Took Sertraline then while bf for a year, while pg with ds, while feeding ds (15 months), while pg with dd2, while bf dd2 (2 years). Was off for a while but now back on.

Both obstetrician and psychiatrist said sertraline was safest in pg/bf. Not sure where that came from.

Thanks weegiemum, yes it states on the NHS website CKS that Sertraline is one of the preferred AD's in pg along with Citalopram and fluoxtitine. With Sertraline and one other (name escapes me) recommended for bf. However if the women has been successfully taking Citalopram or fluoxitine during pg, then it would be appropriate for them to stay on these meds rather than change to another.

I only found this out by my own research, my gp told me I would need to change from Citalopram before or if I became pg and that it wasn't recommended to take AD'S at all whilst bf. Of course I later found that this was not the case at all!

Over the past few months I've been concerned about having to change to a different AD (I've been feeling so 'well' on Citalopram) and the thought of not being able to take any meds whilst bf really concerned me. I even considered not having children, thinking that with the issues I have and the need for meds maybe it would be for the best . To then find out that my GP was misinforming me, well it's been quite difficult to take in.

It's reassuring to hear from someone who suffers from recurrent depression and who has gone on to have 3 children .

Hello choklit thank you for posting, I hope you start to feel more yourself very soon. Congratulations on your pregnancy too .

I now feel comfortable with taking Citalopram whilst ttc and during possible pregnancy (DH and I have started ttc now).

I've been a long term sufferer of depression (since I was a teenager) and have only been up front about it with people in the last couple of years (I am 33 now). It's difficult at first to know what people may think about you, It's also quite amazing to find out how many others suffer or know someone that suffers with depression, once you start to open up about it. People really can be very supportive in real life as well as on mumsnet!

All the best to you and take care .

I've got a very similar history to the OP. Was on venlafaxine for seven years leading up to my first pregnancy. I'd been reducing the dose while TTC, and was on the lowest possible dose when I found out I was pregnant. I started weaning off it and had gotten to taking 1/4 of the tablet a day when I miscarried.

I then decided to just stop completely and go through the withdrawal since I wasn't starting my new job for a bit, and felt like I was handling the miscarriage well. This was a HUGE mistake. I was okay for a few months, like I always am without ADs, but things spiraled downward (as they always do).

I got pregnant again three months later, and by 9 weeks was so depressed/anxious I couldn't work or leave the house. They tried me on 10mg of fluoxetine 10mg for two months, which did nothing. Then citalopram 10mg--still nothing. Then upped the dose to 20mg and I finally started to feel like myself again.

The Breastfeeding Network has a great factsheet on antidepressant use postnatally. I found it quite straightforward and reassuring. I am 30 weeks now, and plan to stay on the citalopram for the rest of the pregnancy and while breastfeeding.

Hi

I have had postnatal depression to a greater or lesser degree for the past three years. I finally got proper help last summer and was started on fluoxetine. About a month later I discovered I was pregnant ( a minor miracle considering what ADs do to your libido!).

I was advised by my GP to stay on Fluoxetine but take half the dose, which fortunately seemed to maintain my mood sufficiently to keep me sane-ish! She did say that she thought I may not be able to bf on Fluoxetine though.

I then saw a psychiatrist at the anti natal clinic ( at about 32 weeks ) who advised me to come off the fluoxetine as I was doing so well because its not recommended for bf. The reason for this is that when you take it when youre pregnant your liver processes the drug efficiently enough that it doesn't get through to the baby in large quantities, but once the baby is out and breast feeding, the drug is present in your milk and the baby's liver is unable to process the drug well enough to prevent it being affected by it. Hope that makes sense.

He then advised me that should I need to recommence ADs after the birth then I could go onto something like citalopram as it is safer than fluoxetine.

There is so much conflicting information out there and it can be so confusing. Unfortunately , because ethically trialing drugs on pregnant women is dodgy ground, there is insufficient concrete evidence to give really conclusive advise.

I wish you all the best for your future and that you stay well and get pregnant soon!

Hello YanknCock (your name made me laugh) and bigbluewhale, thanks so much for posting your experiences.

YanknCock, so sorry to hear about your miscarriage but pleased to hear you are now 30 weeks pregnant and feeling more like yourself on the Citalopram. I also feel much more like myself with this AD, much more so than any other I have tried. Thanks also for linking The Breastfeeding Network factsheet, I've bookmarked it and shall have a proper read of it later.

bigbluewhale, I know exactly what you mean about AD's and libido! I understood your paragraph about a baby's liver not being able to process meds etc completly, It's the first time I've read an explanation why It's not safe for some meds over others. Have you had your baby yet? Thanks also for wishing me well, this is our first month of ttc, I seem to have had a bit of an increase in libido the last week or so .

I hope people keep posting their experiences on this thread, it has helped me greatly to know others are going through or have been through a similar situation to me, hopefully it will help others too .

Very interesting thread and good to know I am not alone as long term depression sufferer. I have been on dothiepin for several years now and have taken it during pregnancy and breastfeeding with both my dds without problems. There is a lot of misinformation about isn't there - you really do have to do your own research. Claire - very best of luck with TTC!

Thanks so much francesrivis, I did exactly that - my own research and went along to see my GP armed with it . Good to hear you didn't have any problems from the meds you are taking, whilst pregnant and breastfeeding your dds. Hopefully it won't take too long for me to fall pregnant!

Hi Claire

I have had my baby - a little boy! He is now three weeks old and is gorgeous if a little naughty at nights. I have been a bit wobbly at times and fear that I may end up going downhill again but it tends to be when I am really tired, so I am trying to stay rational. My DH , GP and family and friends have been great, and I have appointment to see the psychiatrist again in a couple of weeks so i feel that lots of people are looking out for me should I descend into depression again.

Well done for taking control of your situation and arming yourself with info. Have you got a good support network? Because it really does make a difference when you are pregnant and have young children. I was very isolated when I had my first but I found that making myself go out and meet other mums really helped though it was the last thing i felt like doing.

Take care

Congratulations bigbluewhale on your little boy that's fantastic news.

I can empathize with feeling lower when tired, I've found since being on Citalopram I need even more sleep to keep 'on track'. Unfortunately, unlike you, I don't have the support of any family (which has been something I've been coming to terms with over the last few years) but I have an extremely supportive husband, who is the first person to take the time to understand me and my ups and downs . I've also started to open up to certain friends and neighbours, which I've found very difficult to do in the past and found those people to be very supportive and caring, I don't need to 'pretend' when I'm with them that I'm ok when I'm not iyswim? which has been much easier on me - and them probably.

All the best to you at this very special time.

Thanks for the congrats Claire

I'm really sorry to hear you don't have family support - my dad died when i was pregnant with my first, and my mum lives 300 miles away but she is really supportive. For day to day practical support i do rely on friends and neighbours, and when I started being more open about my depression, those that I told have been fantastic, especially towards the end of this pregnancy and since the birth. It's so nice not to have to pretend isn't it especially when you just want to cry, or not talk at all!
It's great that your DH is supportive - it makes such a difference. When I was at my worst I just kept pushing my DH away, but he was great and stuck with me, and we are alot closer now than we were before.

All the best x

bigbluewhale, I also used to push my DH away, it was very difficult for him in the early days of our relationship, he would think that he'd done something wrong and that I wasn't happy being with him. We've been together for 6 years now with some very tough times, but like you, he stuck with me and we are also much closer and stronger because of it - I really would be lost without him!

I was sorry to hear that your Dad died when you were pregnant with your first child, I can't imagine what that must of been like at such an emotional time.

I do have family, just not near to me (distance wise) and they've never really been 'there' emotionally for me either. It's been tough to deal with but it's getting easier year by year. It sounds a little cliche but it's like continually grieving for the relationship you never had and knowing you'll never have, but you desperately needed. Opening up to people has helped a lot and I find I'm surrounding myself with people who do care about what happens to me, the fact that they aren't family is becoming less of an issue for me.

Starting to TTC is a big step forward for me, having our own little family will be such a special thing.

Take care