Are any anti-depressants safe for use in pregnancy and breastfeeding?

[BettyBi0]

I'm asking for a friend btw. I'm worried that she might have some kind of proper chemical imbalance/ psychiatric symptoms going on and think it might be time she sought proper help as well as just me and her husband supporting her and worrying.

Some history: We've been friends for over 10 years and I know her really well. She is just not herself lately. We had our first babies around the same time and went through pregnancy and mat leave together. She is a great mum and lovely person normally but lately she is really withdrawn most of the time, having horrible out of proportion angry reactions and emotional outbursts and is really low and tearful a lot of the time. She is 8 months pregnant with a much wanted second baby. Normally she is a really good communicator and emotionally literate, talks about feelings and deeper stuff. I've tried talking to her about what is going on but she just says she is 'a bit low' lately and really tired.

She had some treatment for depression in her teens but nothing since and is very very wary of Drs/ pharmaceuticals/ having anything on her medical record as her teenage history caused mega embarrassing problems during HR medicals for a job she went for a few years ago.

Anyway, her husband started talking to me about it on a play date for out toddlers the other day. She had stayed home to sleep. He was nearly in tears himself saying he was besides himself with worry about her but she won't go to the Dr. She says she know she needs medication but doesn't want to put the baby at risk for the sake of cheering herself up. It is way more than the normal pregnancy tiredness and moodiness. She is just kind of absent/vacant a lot of the time and then teary or angry and snapping at her toddler. I just want to do the right thing and support her.

I thought maybe if I knew of an anti-depressant that was safe I could talk to her about it and she could ask her Dr for it. It might make her actually go to the Drs whereas now she just says "What's the point? They'll either not prescribe me anything or prescribe me something harmful and either way I don't want the whole health visitor/ social services/ permanent record of it on my file again."

What can I say to reassure her? How can I help? I'm desperate not to do the wrong thing and upset her and make her feel like she can't open up to me anymore

Also, I'm just a couple of months behind her pregnancy wise, so although we'll be on mat leave again together soon, I know I won't be there for her for a little while in the same way as I am now if that makes sense

You sound like a lovely friend OP, your friend is really lucky to have someone who cares about her health like this.

I think you're right to encourage your friend to seek professional help. However, I don't think you need to suggest a medication she could ask for in order to do this. There are several anti-depressants which can be prescribed to a woman who's pregnant or breastfeeding but only a doctor could advise your friend which one might be suitable for her. She doesn't need to ask her doctor for a specific anti-depressant, she only needs to explain the symptoms she's having and then let the GP suggest the treatment that's the most appropriate - be that medication or something else. You could also let your friend know that medication isn't the only treatment for depression - it's possible that being referred to a psychologist or counsellor could also help her to learn ways to deal with her symptoms without the need for medication.

If your friend is worried about the impact of medication on her baby then you could also remind her that doctors won't prescribe medication that they know to be harmful to a baby if a woman is pregnant or breastfeeding, so she doesn't need to worry at all that she'll be prescribed something that's unsafe. If they were considering prescribing a medication that might affect the baby in any way then your friend would have the opportunity to discuss the potential impact on the baby and make an informed decision about whether she wanted to accept the medication or not.

Could you also let your friend know that lots of areas have specialist pre-natal / post-natal mental health specialists who have lots of experience in treating pregnant women or new mums who have mental health problems. She could ask her GP for a referral if there's something like this in your area.

It doesn't sound like there's any reason for your friend to be worried about social services being involved. She and her husband are clearly able to care for their children perfectly well despite her illness, so I can't imagine there would be any reason for social services to be involved.

One other thought - some people find it easier to see their GP if they have someone with them to advocate for them. Could you maybe offer to take care of their children so that your friend's husband could go to an appointment with her? Or even offer to go to the appointment with your friend if you think she would find that helpful.

I think the above gives fab advice, however I'm pretty sure Sertraline/Lustral is safe in both pregnancy and breastfeeding. However she would need to be assessed for the right drug for her.

There are lots of medications which treat anxiety and depression and which are safe- and there are others which might carry low risks, but which are still encouraged because the alternative risk to maternal mental health far outweighs any risk from the medication

Medication may not be the answer though (or it may be only part of the answer)- you and her DH should encourage her to see her GP. Poor woman, my heart goes out to her.

Can anyone help with advice re: her fears of the whole medical record/ Drs and health visitors involvement? I'm not sure if she is just being overly paranoid or if they really would be too involved in an official kind of way. She is understandably very reluctant to loose control of who/how much help she'll accept

It's impossible to give her that reassurance because we don't need the full details or the extent of her problems. the starting point is that our medical history is confidential, but this can be trumped where child welfare becomes a matter of concern. I would hazard a guess that, unless her behaviour is harming the child, and her husband's presence does not provide adequate safeguarding, then it is highly HIGHLY unlikely that her doctor would involve any outside agencies. Lots of women receive treatment for depression and anxiety when pregnant and post-natally- it is not a red flag in its own right.

If your friend sees her GP then information about her health would be noted in her medical records. However, there shouldn't be any reason for anyone other than her to access her medical records so that hopefully shouldn't be a concern.

There wouldn't be any reason for the GP to involve social services unless it was thought that your friend was at risk of harming herself or her children. It doesn't sound like that's the case, and it also sounds like she has good support from her husband who presumably could take care of the children if your friend's illness became so severe she was struggling to do so.

Fears about social services involvement or 'having the baby taken away' are a common part of pre-natal or post-natal depression. If your friend is worried about this she could call PANDAS (Pre- and Post-natal Depression Advice and Support). This is a UK charity that could probably answer some of her questions about what treatment might be available and help reassure her that there won't be any terrible consequences if she seeks help. They have a free helpline that's open every day and their advisors might be able to give your friend the reassurance she needs to ask for help. Their website is: www.pandasfoundation.org.uk/index.html

I am on sertraline and have been since dc4 was a few weeks old, he was ebf till I started weaning. I had severe anxiety before he was due and PND after he arrived, the drs and health visitors have been fabulous and have in no way questioned or interfered with my ability to look after and care for not only my baby but also my other children in what were incredibly difficult circumstances. Sertraline may not work for everyone but for me it has helped lift the dark clouds so I can see clearly again.

Also, regarding the point about being scared of losing control, unless your friend was so unwell that she was at risk of harming herself or someone else, it would remain entirely her choice whether she accepted any treatment that was offered.

She could see her GP and then decide that actually she doesn't want whatever help that's offered. She could see the GP and decide that she doesn't want medication but she does want to see a psychologist. She could see a GP, accept a referral to a psychologist and then decide that she doesn't want to attend the appointment, etc, etc. At all times it would be her choice whether she accepted any treatment that she's offered. In almost all circumstances all doctors can do is to advise on the best treatment and offer it, they can't force a person to take it so your friend would always be free to walk away at any point if she changed her mind about asking for help.

Agree with everything KnitsBakesAndReads has said. Definitely worth a conversation with her GP - and if possible - it sounds like it would be helpful if you can go with her for support.

I'm almost 6 months into my pregnancy, have a history of recurrent depression. I'm on some antidepressants which are working really well for me. Pregnant mums should be prioritised for other types of care (such as talking therapies) and if available should be offered a referral to an perinatal mental health specialist (I see mine every 6 weeks). Either a GP or midwife will be able to set up these referrals, although it sounds like the first step is to get a diagnosis via GP.

Best of luck

Many antidepressants are safe during pregnancy and breastfeeding. Sertraline is considered one of the safer ones - it doesn't enter breast milk in high concentrations (unlike, say, Prozac.) even Prozac isn't expressly contraindicated . The risk to the mother/baby is much higher from the untreated depression than from any drug side effects. In fact, the only side effects seen from SSRI use are a slight increase in jitteriness in the baby just after birth. To put it in perspective, this is on the level of heavy caffeine use. Antidepressants do not cause damage in the sense of birth defects.

Unless she's considered an imminent danger to herself/the baby, she won't have issues with ss, etc. You have to be in a pretty bad way to get even inpatient care these days :(

Suggest she asks for sertraline and a talking therapy. You sound like a good friend - keep checking in on her.