Restrictions on certain ADs for women of childbearing age

[Pekka]

This is a really interesting article, I do hope the professor has been misquoted. I would like to think HCPs don't share her point of view. ADs can be so helpful, I have seen that first hand.
www.telegraph.co.uk/women/womens-life/9631088/Women-of-childbearing-age-should-not-be-allowed-to-take-antidepressants.html#

I was refused antidepressants on the basis that I was considering whether or not to try for DC3. Better advice might have been to put me on the antidepressants, get my head straight, then think about whether I wanted a third child or not. Fortunately it worked out ok, but looking back that was ridiculous on the GPs part.

She has it all ass backwards. The emphasis should be on women of childbearing age being encouraged to be extra vigilant if they're taking drugs which can have harmful effects on a foetus. It's not just antidepressants, theres loads of drugs that are potentially harmful in pregnancy. Should women be denied those, too, because some doctors evidently can't trust them not to go out getting pregnant then not even notice it for a couple of months? [hhmm]

She's actually got a point about drugs like sodium valproate - I wish the GP who stuck my friend on it had thought about that.

I agree there are drugs that are harmful to foetal development. That shouldn't be a reason to ban these drugs for all women.

Indeed, but it is important that doctors actually think about the patient in front of them. If that patient is a woman of childbearing age, they should consider whether drug x really is the best drug for that patient, or whether there's something else that is less teratogenic. They should always have a conversation with a woman of childbearing age, explaining the potential benefits and risks of the drug (they should have this conversation every time they prescribe but should remember this factor particularly).

You'd think it would be blindingly obvious to a doctor to mention it if they are giving a woman something that could cause foetal malformation... but sadly no, some doctors are rubbish. I was lucky when I was diagnosed with epilepsy to live practically next door to a major hospital with a big neurology dept. My friend lived in a small town with no neurologists at her local hospital and none in her primary care trust area - it took 18 months for her referral to a neurologist to come through. Her ignorant GP stuck her straight on sodium valproate even though she had three kids and for all he knew could have been planning another one. Maybe it was the only anti-eplipetic drug he'd heard of...

Sodium valproate is also sometimes used in depression (several anti-epileptic drugs are). I'd say unless there's a ruddy good reason, it should never be first-line treatment in a woman of childbearing age and if there is a good reason, the woman should be warned of the potential disastrous effects for an unplanned pregnancy.

This is really an issue about doctors paying fecking attention, not about denying women drugs.

Well actually the GP/consultant should always let their patients know about possible issues with taking a drugs, whatever the sex, age etc... of the patient.

But my experience is that it is rarely the case. It is much safer to read the leaflets from the packet to get an idea of what could be the risk associated with the medication.

Ugh. This is a mental health stigma thing isn't it. If a patient needs ads then they need them. GP need to explosn the risks as I'm directory need to for epilepsy or diabetes or whatever medication.
Ass backwards is a brilliant analogy!

Disturbing to hear stories about doctors not explaining the risks of getting pregnant while on these drugs. If a patient isn't made aware of these risks, it's unreasonable to expect them to be making a special effort to avoid pregnancy.

Why isn't she putting more emphasis on getting doctors to check that women on ADs are using reliable contraception before the doctors prescribe the drugs?

FFS.

Anti depressants are prescribed to counter a chemical imbalance in the brain.

Shall we just stop call drugs for women of childbearing age?

One of the most mental health stigma ridden load of bollocks I've read in a while.

I know someone who was advised to continue with valproate through her PG. With disastrous consequences.

She is saying that drugs contraindicated in pregnancy should not be prescribed, not that no antidepressants should be prescribed.

I agree with Edam re: sodium valproate. But this is an epilepsy drug, it isn't regularly prescribed by a GP for bog standard depression. It can be prescribed as a mood stabiliser for more severe or chronic MH problems, but usually by a psychiatrist

As far as I'm aware, most anti-depressants are contra indicated in pregnancy NOT because they are known to definitely effect the foetus, but because no one has done the relavent tests on pregnant women. So the side effects or lack of side effects are not proven. Some ARE ok to take in pregnancy.

What has annoyed me most about this article is that they're banging on about anti-depressants, but the only drug they actually refer to is an epilepsy drug not an anti-depressant (but is sometimes used as a mood stabiliser - but that's different).

But what is really being said is... We don't trust women to understand the risks even when we tell them, which doesnt sit right with me.

And why pick on antidepressants? What about LOADS of other drugs... I'm on a shed load of drugs which am sure would be terrible for a fetus, so is the next step to stop all women having any medical care that may harm a fetus even if she is sure she's not pregnant. Makes me fume... Which am sure was the point of the article... Which makes me fume more!

"But what is really being said is... We don't trust women to understand the risks even when we tell them, which doesnt sit right with me. "

I'm not sure that that is what she is saying, having an unplanned pregnancy doesnt mean that someone cant be trusted, these things happen.

The reason that the article mentions antidepressants and mood stabilisers is probably because the person quoted is from the Institute of Psychiatry. There is a precedent for what this article says with other medication, for example with Roaccutane, were women of childbearing age are asked to use contraception while taking it.

But being asked to use contraception is different from being told you can't have medicine that you need?

I was refused volpoarate despite a roomful of doctors agreeing that it woukd be the best idea. Because I am childbearing age, and, despite the fact that I would be at almost certain risk of several horrific complications anyway or other reasons and so DH has had the snip, I can't be trusted and apparently 'women make bad decisions about these things'

I was rather annoyed.

Luckily another drug worked in the end, but ARGH

She's actually said that ADs with a known risk to the foetus shouldn't be used! Not all ADs shouldn't be used. None are proven safe in pregnancy some are classed as extremely low risk.

The drug she has chosen to discuss is not even a common AD! I think things like this should be discussed before prescribing.

Sometimes I think people forget that just getting pregnant holds its own risks. There is no guarantee all babies are going to be ok, drugs or no drugs.

If an accidental PG occurred, is the outcome - for both baby and woman, both physically and mentally - better or worse if a known teratogenic drug was bein taken around the time of conception?

It is a good thing to remind doctors of the care needed in prescribing drugs to women of child-bearing age. If doctors cannot be trusted to advise patients appropriately, then what does need to be done.

Thalidomide is less harmful - it doesn't cause as many deaths - and new (non anti-emetic) uses have bern found for it. But it's still not prescribed in child-bearing years.

Unless there is no other possible drug, it seems a no-brainer that a less hostile one is used. And that is what the article is talking about.

When. Was refused valporate, I was in mental hospital and they were only going to let me out with extra medication. I wasn't allowed lithium because I am too scared of needles so they didn't think I would be good enough a the regular blood tests (fair enough). So it was basically valporate, with comparatively little side effects, or anti psychotics, which I had already tried three types of and all of them had made it impossible to work or study, and have been proven to have a much worse effect on general health and lifespan. Arguing for valporate was me arguing for my quality of life.

Luckily the episode subsided enough for me to be let out and I could see my own doctor who was more used to me and the way I researched every option carefully, and we just increased the medication I was on (lamotrigine) and I am completely fine now as long as I am careful to eat and sleep properly. I still can't have children though - I couldn't have children if I was an olympic millionaire.

And every drug I have ever been prescribed has m with 'if you decide to try for a baby or get pregnant, consult a doctor immediately' and often a verbal warning from the doctor.

Maybe I just look dangerously fertile...

I've refused anti depressants many times. I don't believe they are very helpful.

Talking therapies, CBT, yes - marvellous. They actually work, long term.

They cost more though - much more. ADs can have dreadful side effects, make things worse, and are never guaranteed to make you any different to when you started them. They are just a sort of 'storage' concept - they put you into a false state of 'ok' when in fact the problems have not even been looked at, let alone sorted.

I've seen the benefits of long term therapy on both of my (incredibly dysfunctional, once) parents. And I've seen far too many people have enormous problems with ADs.

I haven't read this article yet but I do think ADs are a poor idea for a great many people, and should be given far less - the pressure to take them from my psychiatrist (many years ago when I was seriously underweight) was IMMENSE - he tried every trick in the book. Finally I took them home and put them in a cupboard. I took one, it stuck in my throat, literally, and I never took another. I just didn't want to.

I recovered within a few years and because I did it without meds, I think it was a better, and sounder recovery - I have stayed a decent weight ever since, though I still have problems with eating - but they are managed.

I think if I'd taken these drugs it might have messed me up even further tbh.

Disclaimer: this is purely my own experience and these are my opinions, they might not be correct.

I'm really pleased for you, but I can vouch that is not the situation for everyone.

Most people go on anti depressants for a short time to give them strength to deal with things properly.

Some people, like me, are just wired wrong in our brains. I have had years and years of therapy, meditation, art classes, hospital treatment, exercise, nutrition advice, everything. They all helped a bit, and are good strategies for alongside the meds, but the meds have made me so much better that what I thought was normal now seems ill.

I had a while of not complying with medication, because I thought I was in control. I wasn't.

Lamotrigine has got me to a state of stability that I have never known. I thought the mood swings, lack of impulse control and hallucinations were what everyone had, or sometimes I thought I was just clever than them so I oukd see things they couldn't..

Yes Britta, of course - for some people medication is the right answer and I would never dispute that.

I didn't mean to sound smug. I am still far from Ok, in many respects, but for me, I don't think ADs would help. Possibly if I was having symptoms of psychosis, hallucinating etc I'd want to take drugs for that. I certainly don't blame you!

Is Lamotrigine given for depression? I didn't know it was an AD...perhaps we're talking about different things here, sorry, I'm not sure.

I was talking about ADs given for depression...you know, the usual stuff, Sertraline, Fluoxetine etc.

Lamotrigine is used as a mood stabiliser, like valporate (the drug in the article). It does tend to be used more to help the low part of bipolar.