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've been on ADs for almost 20 years (with gaps, that tended not to last very long and ended badly) - tried a lot of the talking things both NHS and privately early on in my journey, they really didn't do anything; my depression isn't 'about' anything, it just is. I tried cutting down in the last trimester with DS; it fairly quickly became obvious that it was a bad idea; OB insisted I actually increased the dose slightly instead (there's more blood sloshing around when you are pregnant so blood levels of drug tend to be lower - and depressives at more risk of PND. So I had two babies, and breastfed them, on sertraline (for depression) and lamotrigine (for epilepsy), and they were and are both fine.

However before they came along I lost a baby, conceived despite use of contraceptives, while I was on sodium valproate (for the epilepsy). Nobody had specifically told me about the risk - though I was living in a country where sex outside marriage is illegal, and wasn't married - but it wouldn't have made any difference if they had, as I had no intention of getting pregnant. "Luckily" (it didn't feel at all lucky) that baby didn't make it to 10 weeks.... but if he or she had survived, and been damaged by the valproate, that would have been heartbreaking; and so unnecessary given that I could have been on the lamotrigine from the start.

So I absolutely agree that if it's possible to prescribe a drug that isn't going to cause problems for a foetus, that should be the first choice for a woman in her childbearing years - things don't always go according to plan.

therapy on its own will only work for those people who are not too depressed to take in what the therapist is saying- and who are not at serious risk of killing themselves before the next therapist appointment

in dd's case, it is only because the ADs that she can actually access the therapy, before she had it she was far too ill

of course nobody likes prescribing medication with horrendous potential side-effects to a child, any more than you would want to prescribe such medicine to a woman who might get pregnant, but there are times when you can't afford not to take risks

Righto, I'll report my own post up-thread then and ask MNHQ to change how they phrase it.

I can see both sides of the argument, but I agree with edam's initially made point: woman of childbearing age like all adults should be given the benefit of being allowed to think for themselves. Of course this means they should be counselled well about the potential benefits and pitfall of certain meds....

FWIW my DSIL found herself pregnant (was TTC but had not saught any preconception advice, but that's another story ) and in a kneejerk reaction stopped her Fluoxetine. Well. Total and utter hell for her, my DB, our families ensued whilst her OCD spiralled out of control and she came close to serious self-harm due to her terrible mental distress.
Back on meds, good pregnancy, healthy baby now aged 5. Just sayin' - I know the plural of anecdote is not data, but these things need to be looked at case by case.

Young woman are given Roaccutane for severe acne: they get written and oral warning about how important it is to avoid pregnancy, they MUST be on a form of reliable contraception and they have a pregnancy test done at each check. They are still allowed to have it. As they should.

No time to read it all, but had a look at the article in the link. Being denied medical treatment because you are a woman is shocking.

"Sorry, you are unwell and we have drugs that can help you. But we won't treat your illness because, well, you can't be trusted with contraception because you are a silly woman. So fuck off and stay sick".

This would be better:

"You are unwell and we have a suitable treatment. However, this treatment is really not suitable in case of pregnancy. Would you consider a long acting contraceptive such as the coil or the implant to ensure you are highly unlikely to conceive on this drug?"

I don't necessarily think, or know, that ADs are a 'bad thing'. What I intended to get across in my initial post was that I think they are often pushed at people who would benefit much more from different things such as CBT, simply because of the cost.

Katandkit
If you had read it all you would have seen that that isnt what it says.

I have re-read it. I am seriously sleep deprived here! I can see that it is some shit journalism as they are talking about specific drugs and not general ADs such as SSRIs. All the same, they should not say "don't prescribe to women of childbearing age". They should say "if prescribing to women of childbearing age, counselling about the risks is necessary and provide contraceptives as required".

To me, the first paragraph of that article still reads "no young woman should have these drugs in case she gets pregnant"

The writing isnt especially good, but if you look at what the woman quoted actually said, its clear that it has been reported in a sensational way.

@Pekka

Sorry for those who are offended by the title of this thread. I took it from the article, I should have added "certain" before the ADs. That would be a fairer representation of the article. I have nothing against ADs and I am not suggesting women should stop using them.

Hi there
We will edit this title to avoid any confusion and change the discussion of the day.
Thanks
MNHQ

Lamotrigine is an anti convulsant, and used as a mood stabliser for bi - polar disorder.

Lofepramine is an anti depressant, but not that commonly used these days.

AD have really valuable role and literally save lives and aid recovery
talking therapies require a certain level of participation and engagement
severe depression doesnt respond to talking therapy but AD can give that lift

This reminds me of a chemical plant I read about in America at which women were not allowed to work in case they got pregnant and the foetus was damaged by the chemicals. It is discrimination pure and simple.

In the end the company that owned that plant allowed a small number of women to work there but then said they would lose their jobs if they didn't get sterilised. Unbelievably, some women, desperate to keep their jobs, went through with it. Several months later they were all made redundant! (This was in the 80s, but even so ). (They sued the company but didn't win - the judge held that they'd given up their fertility of their own free will ).

I've had a flick through the article and it's not nearly as hysterical as the article in the Mail. The Mail was saying that the newer SSRIs cause all sorts of things (bad of course) and women should not take them. Ever. Of course there are balances to be had, and the article qualified itself by saying the chances of something going wrong were very slim. All medicine involves risk. So does crossing the road.

did wonder if Dr Howard was being misrepresented
life is a risk.pharmacy is a risk
risky if you take meds,risky if you dont

News has to be exciting to sell papers, so it is likely. Journalists get cheered and reveered if they raise a few heckles and get people talking. About anything. The human race continues to reproduce. The outcome of life is death. Hmmm.

Wow, just when i thought I'd heard it all. So all women between, 12 & say 46 must be denied any drug which has side effects on unborn foetuses, 'just in case'.

This is nuts. When I was prescribed Roaccutane on the NHS (it's a very powerful acne drug that causes miscarriage and severe birth defects) I had to take a pregnancy test and agree to use the pill while on it before they would give it to me. I also had to sign a special consent form saying that I'd been informed of the teratogenic effects and that I knew if I became pregnant the medical advice would be to terminate. If they can do it for one drug, I don't see why they can't do it for others.

Well, women, now you know. If you belong to the childbearing class, don't expect to get the medical treatment you need, because a potential foetus is more important than your health.

edam - major teaching hospital in London, and four separate consultants. It's apparently the 'official' advice that they have to give. FWIW, all of them privately agreed that it was fine, and thought that I should be breast-feeding for a range of reasons. I'm still breastfeeding 3.5 years later and no signs of SJS yet...

I come from a family full of doctors so I tend to see them as partners in care rather than dictators!

I did reduce the dose at the beginning because of the possible tiny increased risk of cleft palate - but only because my niece was born with one.

The hospital did arrange specialist cardio scans and a senior sonographer level 3 anomaly scan because of the meds which was nice of them but a little suprising.

The Epilepsy Society were so incredibly helpful when I rang them.

Just a thought; how do they propose to treat PND ?

Who?

I meant GPs.

Probably as they usually do?

Newer SSRIs are more dangerous because research hasn't been done. Many of the disablities that valproate is alleged to cause are not discovered until a child is 2 or 3 and some children are only recognised as being affected in their early teens.

There were always warnings on the PILs for valproate but they were about congenital malformations at birth and that is what the research is usually based on. So when you look at the stats for valproate that include learning disabilites the risks are sky high (some report up to 90% reduced IQ!) compared with the 2 or 3 percent major malformations.

The doctor in the Telegraph article probably comes up against people with questions about this every day and she probably has no answer to give them. Drugs companies aren't doing research and the Drugs Agency MHRA doesn't seem to want to put two and two together.

In addition to this we have a slight conflict of interest going on with the medical departments. The neurologists don't ever get to meet the offspring of their valproate clients, the obstetricians are trained to look at MCMs and obvious health problems in utero, and the poor old paediatricians end up dealing with the result of disjointed thinking.

A court case last year ended up with 250 families losing funding for their high court battle against the makers of valproate. There are hundreds more out there, probably thousands of children undiagnosed.

Most of this would be preventable if government manned up to these drugs by funding cases and suing them for every penny that these hundreds of families are now costing the taxpayer. Only a beefed up legal system will prevent these problems.

Oh dear that was a bit of a rant. But I think what the doctor is saying in the article is - until decent tests are made we really don't know what the risks are with these drugs. Valproate is particularly difficult because of the mechanism by which it is teratogenic however it is a very old drug and there was plenty of time for it to be tested thoroughly.

mrschanning who mentioned lofepramine, i cant find it? I'm on it for chronic depression, though happen to also be postnatal. My doctor specifically chose it over anything else because I'm breastfeeding. I was on low dose citalopram while pregnant, but it stopped working. Tbh, after last nights performance by me, I'm not convinced the lofepramine is working either.
But re being pregnant, i'm on the (mini) pill anyway, but the warning in the paperwork is no different to any other AD, or that on my NSAIDS too - "Do not take in pregnancy or while BF" (actually that is written on everything anyway)