Antidepressants and Pregnancy: your story

[thingamajig]

I want to do some research into this area, I am a Pharmacology graduate and have the prospect of some funding to find out more. I have a bee in my bonnet about the way a lot of women are taken off their ADs or changed to a different one and the consequences that has. Often there is no proof that staying on the same one would do any harm to the baby.
The other concern I have is the lack of information available about the effects of different ADs in pregnancy and breastfeeding.

I am on a high dose of citalopram, which I stayed on (and increased) during my pregnancy. My midwife believed that I should be moved onto sertroline, my GP didnt know, My psychiatrist didn't really either, but thought that the balance between the benefits to me and the risks to the baby should be thought through. I asked the midwife to get the pharmacist at the hospital to look up the relevant facts. If I hadnt persisted I would not have got this information. Much the same story on the question of breastfeeding.

A couple of friends of mine have not been so well treated, and it has caused them a lot of pain and suffering at a very emotional time in their lives.

I was wondering if you could help me and what thoughts you had on these issues, and what your experiences were. This will help me see if this is a wider problem. Specifically, I would like to know:
-what AD you were on pre-pregnancy
-what you were changed on to (if applicable)
-who made this decision (GP or psychiatrist etc)
-whether you remained well mentally throughout pregnancy and breastfeeding.
-anything else you would like to add.

Thank you, I really want to do something useful in this area.

-Prepregnancy I was on Prozac
-I wasn't changed at all
-I made the decision to stop taking the prozac, as I didn't know whether it would be safe an I felt well
-I did not remain well at all. I became the most depressed I have ever been in my life. I now feel that I should have discussed my options with my doctor a lot sooner, and taken an antidepressant that was known to not harm unborn babies throughout my pregnancy. Hindsight is a bittersweet pill.

I take paroxetine (for anxiety but I know it is also an AD)

I am 24 weeks pregnant so I can only go on how I feel up to now.

My last pregnancy 6 years ago was horrible as I was very anxious (undiagnosed no drugs) and on the verge of agrophobia. The last few weeks I rarely left the house.

This pregnancy, I discussed with my GP whilst TTC. I said paroxatine had changed my life and I wasn't willing to get pregnant unless it was safe for me to continue taking it. This sounds extreme but I have other children to consider.

He told me it wasn't ideal but the potential side effects are slim and asked me to come back when I was pregnant.

Pre-pregnancy I was quite lax about taking my meds, I could go a few days and I didn't notice any difference in my state of mind. Now if I miss a dose I know about it as I feel slightly on edge the following day.

However, so far I have been great and all scans suggest baby is fine. This is my 4th baby and during the last 3 I suffered with anxiety quite badly, touch wood I am controlled this time.

I'm usually worst in the 3rd trimester though so maybe I need to wait and see!

I had prozac during pg (two sep pregnancies, one from 14 weeks, the other about 20wks) Both times was told to stop it before baby due, which resulted in severe PND both times, and apparently ptsd one of the times - traumatic pregnancy, lost twin, huge chance of losing the [surviving] baby and scans weekly for multiple problems. Then given Sertraline - after battles, told not to breastfeed and had to fight to continue (when I wasn't strong enough DH fought for me because I loved bfing and it was my reason for living) Still on Sertraline 100mg and the youngest child is 4yo, no success coming off it and now cant see me reducing it again any time soon.

Coldtits, I hope your baby is well, and I'm sorry you have been so poorly. The trouble seems to be that there is no 'proper' research as it is unethical to do studies on pregnant women.
You can never be 100% sure that anything won't hurt your baby, and calculating the risks is so hard. Some studies have shown an increased incidence of problems around birth when prozac is continued but others haven't.
Do you think that the doctor could have been more proactive in helping you? And what else could have helped you before you gave up the ADs?

katnkittens, I'm glad to hear all is going well for you and baby, and its good to hear that you have an understanding GP. Its all very well emphasising risks, but you have yourself and your other children to think about too.

gigglewitch, Hi, I think Ive seen you on the twilight threads. I used to follow those but got scared off by the CVQ thing. I'm so sorry to hear what you were told about coming off prozac pre labour, a friend of mine got post-puerpal psychosis when they did this to her. It must make you glad that you managed to bf despite all the negativity.

Thank you very much for your stories, I have to go to bed now but I'll be back tomorrow.

yes, you've spotted me! Come back to the twilight, tis very quiet and troll-free these days

thing - baby is now 3.9 and showing no il effects.

I don't think the doctor could have helped me because when I am well, i don't want to be pestered by the medics at all. It feels like interference. So I have an agreement with my doctor (that I always honour) that when I feel myself sinking, I will go and get some antidepressants.

-what AD you were on pre-pregnancy

Venlafaxine (specifically: Effexor XL) Was on the downward spiral of weaning myself off very slowly when I found out I was pregnant and had reached 17.5mg per day down from a whopping 225mg.

-what you were changed on to (if applicable)

Fluoxetine 20mg. Waste of time! Been there and done it and so binned it and took the risky decision to go it alone without pharmaceuticals as I didn't like the huge grey area in conflicting research findings I was coming up against constantly. It made me uneasy!

-who made this decision (GP or psychiatrist etc)

The switch was suggested by a very happy clappy 'oh you'll be fine' psychiatrist but the decision to BIN came from input from a fantastic local pharmacist and my GP after chasing up my 'unease'.

-whether you remained well mentally throughout pregnancy and breastfeeding.

I'm currently 30 wks pg and I am worried about how I will progress particularly post-natally as I had PND after my first child quite some years ago. So far I've been ok with the odd wobble but I feel my wobbles have been about some quite major RL challenges as opposed to my mental health issues per se. Time will tell on this score.

-anything else you would like to add.

So much more research needs to be done. It really is unnerving when health professionals don't know their arse from their elbow or even worse are totally blase about something that could potentially have serious implications long term. Good on you 'thingamijig' and good luck with your research!

-what AD you were on pre-pregnancy

Fuoxetine 60mg

-what you were changed on to

Didn't change, reduced dose at 35+3 to 40mg, will be going back to 60mg postpartum.

-who made this decision

Myself with the information provided by the psychiatrist about balance of risk.

-whether you remained well mentally throughout pregnancy and breastfeeding.

Well I'm 36 weeks today, I have coped less well with the minor discomforts and have found the hormonal swings difficult. I also have had braxton hicks from very early which (apparently I found out on Monday) are a common side effect, but for me caused huge anxiety. I don't think I was given enough information or input from my Psychiatrist. And they certainly didn't pass on information to the midwives or my GP. I am hoping to breastfeed and baby will be monitored for withdrawal and problems with AD coming through in my milk.

-anything else you would like to add.

More collating of information available definitely needs to be done, and that information needs to be shared. I'd be more than happy to help you with your research if it has a chance to help other Mum's to be in the future. Good luck with your research.

I was on Dosulepin, also called Dothiepin.

I stayed on it throughout.

I used to work for a psychiatrist and asked her advice. She said that as it's a tri-cyclic there has been a lot of research done on it and there has never been any proof that it's contra-indicated in pregnancy nor while breastfeeding, nor has any adverse effects been reported. She told me that as the SSRIs were much newer there wasn't the same amount of evidence.

I was happy with that, went to see my GP who is pretty good anyway, and he agreed that the risks of me getting ill again by far outweighed any risks of continuing to take it.

I think I dipped a little while pregnant, but not the extent of time or work or not coping. I lasted 5 days with breastfeeding due to a complete lack of support and bad advice . But once dd was on bottles I sailed through the early days, bar about one week of what I call wobblees.

Hello, i would also like some detail's on this, i have 2 children and had bad PND with both, i have been on Ad - citalopram for about 4 months with has dramatically changed my life for the good, i am on 20mg.

Me and my husband would like to ttc very soon but i am so worried about the effects of the AD as i know i wouldn't cope with out them.

Please help.

A huge thank you to all of you ladies for your stories. Its really important that decent, evidence based research gets out there, so many of you have been so confused.
Katy, I remained on 40-60mg of citalopram throughout pregnancy and bf; from my own inquiries I have gathered that if not risk free it is not too bad. If it keeps you well, and you say it has changed your life, I would stay with it. A Swedish study of 364 women on citalopram showed no difference in birth defect rates to normal. (see here for more; the rat stuff is alarming but in humans it seems ok)
Disclaimer: I am not a professional and at the moment all I can do is look at the data in the public domain.

Thank you, that is very reassuring. I'm off to see my doctor next week and hopefully she will not scare me in anyway :-)

has anyone else got any stories?

I was on Prozac and Ariprepizol pre-pregnancy. Came off both when I found out (week five). Started to struggle around week 15. Waited until mid-term scan to check that everything was okay as was warned that Prozac could possibly affect baby's heart. Went back on Prozac week 22. Little boy born five days early, perfect and wonderful. 11 weeks old now, am breastfeeding and still on my ADs.

I have BPD and have been on some form of medication for a few years now. And although I managed without for a little while, I needed to go back on them.

I should probably also say that during pregnancy was in the process of the transfer from CAMHS to adult services. Both were very supportive of my decision to go back on my medication, as was my midwife, and the specialist consultant I saw at the hospital before I restarted my meds. It was (and is) the best decision for me.

I was on Fluoxetine until week 6 when I told my GP I was pregnant. They then refused to prescribe me anything as they said that they didn't know the effects and that I would probably 'never forgive' myself if there was something wrong with baby and I'd taken ADs.

Tried 5 different doctors at the surgery, all refused, asked midwife who spoke to obstetrician and he said no.

This has been the most difficult 8 months of my life. They have sworn I can go back on them when baby is born.

They had no reason to take me off them at all. I have very bad PND from my first DS.

meds taken

paroxetine 60mg

this is my third pregnancy and i did experience problems with gp in the first - they wanted to take me right off and change to low dose of fluoxetine, which does not help my depression. i have been on this dose for several years and it took years to get the right medication in the right dose, anything else and i can become very ill with depression, to the extent of hearing voices and being unable to function.

luckily i was able to see my psychiatrist in first pregnancy who recommended staying on dose til just before due date then cutting down in time for birth. this did override gp, but it was made clear to me that they not happy. caused a lot of stress and anxiety at time

i wasn't as well (mentally) as usual during first pregnancy, but coped. cut down at 38 weeks, but without supervision. i ended up being induced at 40+ 6 as was getting in a right old state, unable to accept evidence of movements and scans that baby not dead etc

birth not good, i was very frightened and not mentally very strong, so not able to really help myself much. was a ventouse delivery, son fine. dh ready with 60mg before placenta delivered.

i felt so much better almost immediately, bit of a high after the birth, then meds kicked back in. breastfeeding went well, bonded really well with ds, no pnd, though lots of support from specialist health visitor to reassure me i wasn't kidding myself on this one.

in fact worst thing after the birth was feeling everyone watching to see if i would become post natally depressed.

overall, bar last couple of weeks and the birth itself, i coped well with pregnancy and motherhood, and my depression wasn't an issue, which i had always thought i wouldn't be able to do. very confidence building.although mil still going on about 'how bad you were when first pregnant'. she saw me twice, very briefly during bad bit.

during 2nd pregnancy i had changed gp, was referred to consultant neo-natal drug specialist and also seen several times by psychiatrist for support/monitoring. all felt much more professional and less judgemental, i was spoken to as an expert on my own condition instead of as an irresponsible drug user.

specialist very good, all on for staying on dose, no need to reduce or change, discussed research available, his own experiences. some risk of baby withdrawing, but he not concerned, would give chlorpromazine post natally to baby if having withdrawal reaction affecting ability to feed. he wrote to all other parties to explain a care plan in place. i had to stay in post birth 3 days to have baby observed, he came to see us himself day after birth.

i actually did cut down to 20mgs, very very slowly and only after due date, but this was my own choice, wanted to feel i'd given dd same effort as ds. still difficult, but not as bad at all, induced 40+14. i wasn't top form mentally for birth but not as bad.

again all so much better afterwards, quite wired and sleepless at first and but then fine, breastfed fine, no pnd etc. same circus watching afterwards, constant visitors from healthcare people first week after getting home to check i was okay.

i am now 29 weeks with dc 3. i still get the @i see you are on 60mg, ...., most irregular....you need to come off...' at every appointment, even when nothing to do with pregnancy, eg ENT. but neo-natal guy been involved again, sent out covering letter and again says he doesn't think i should even reduce for birth.will stay in for 3 days again to be observed. i won't cut down til due date, if i go over i'm not sure.

i definately get some depression which increases as pregnancy increases, i have been told this is because i am effectively experiencing a dose redution as some of meds is lost to placenta, some diluted in extra blood etc. dose can't be increased as already at maximum. can have short term valium if really bad, did have a couple of times in last pregnancy when couldn't sleep due to depressive thoughts. may do again, not sure.

sorry for essay, hope it helps.

in my case, being given all the information, being taken seriously as both a patient myself and as a good, caring parent as well really helps me to cope and to make clear decisions.

i will not be having more children as i do not feel i could mentally cope with another pregnancy, it is a very hard time for me. i do not believe i would have escaped post natal illness and difficulties bonding with my babies if i had not had medication during pregnancy, the trauma and consequences of unmedicated pregnancy would be really serious.

Tottallyandutterly That's terrible!! Am really quite angry for you. In fact, very angry. They have no right to refuse to prescribe a medication for your health if you have decided you need to continue with it during the pregnancy. I know I've been very lucky with my doctor, but am absolutely disgusted... You poor thing. However - be proud of yourself for doing so well. Stay strong, you're nearly there. x

That is terrible!!

I'm off to see my doctor on wednesday so fingers croosed she will say it's ok to start trying, ill be so upset if she sais i have to come off them because i know i wont be able to cope so there for wont be able to have another child :-(

-what AD you were on pre-pregnancy

Fuoxetine 30mg

-what you were changed on to

Stopped taking it altogether

-who made this decision

Me ultimately but recomended to do this by GP

-whether you remained well mentally throughout pregnancy and breastfeeding.

Not really, very hormonal and unstable and paranoia came back in spades - was self harming at times as well. Mood swings very bad and towards the end of pregnancy before I went onto matleave got very depressed, couldn't stop crying etc. Actually went back to GP at 34 weeks who again encouraged me NOT to go back on Fluoxitine although he did have to look up the official guidance in a book as he didn't know it off hand.

-anything else you would like to add.

More information is required. I've been told by GP that if I want to go back on fluoxitine once baby is born, I should stop breastfeeding first. Recomendation was to breastfeed for a month then switch to formula which I bitterly do not want to do - leaves me in a very stressful/difficult situation. There is a lot of conflicting advice.

I've been on almost every AD over my life. I was on citalopram for a couple of years until I thought about becoming pregnant. My GP recommended I switch to lofepramine (a tri-cyclic), as this was 'safer' - which I did. I've had a horrible time with it (been on it 6 months now): anger, depression, bad sleep etc. I was considering changing back, but I have just got pregnant. I talked to my doctor this morning about changing back WHILE pregnant - after the first trimester when organ-formation is going on. I am concerned that changing back after the baby is born will be worse - but he is concerned about my health during my pregnancy. I am confused and would love to hear what you think.

Ladies, thank you very much for all the info. There are some terrible stories here, but also some good ones. I am particularly impressed with violet eyes' treatment in her second pregnancy. This is how we should all be treated. It seems to be a huge postcode lottery, as with so many things.
Katy, the GP shouldn't make you stop taking citalopram to start ttc, nor should he make you stop it during pregnancy and bf. The dose that you are on is not high and if you cannot cope without it, your health should come first.
Erika Maye, I am glad things are going better for you; keep up the good work with the breastfeeding. There is an argument that receiving a low dose of ADs through breastmilk stops the baby from getting withdrawal at birth.
SWWhippett, in my opinion it is possible to breastfeed while on fluoxetine, but sertraline or similar are thought to be better.
Hope, I don't know what to say. What a horrible decision to have to make. I guess if the lofepramine is not helping you, it can't be much worse. But still, changing ADs is never good and would be worrying during pregnancy. Do you have good support, CPN etc?
Totallyandutt, that is frankly appalling, I am so angry for you

Hi, i went to the doc's today and she said she would like me to wait to ttc for atleast 6 months to give them a chance to work better, even though i feel really good. then she said she wants to wean me off before we concieve and if i need help during pregnancy she want's me to try prozac :-( i really don't want to change tablets as these ones are perfect, it's no so much the deppresion i worry about it's the panic attacks as well. feel a little dissapointed as i was hoping she would say all will be ok :-(

Excellent to hear about more potential research. Obvs it's quite hard to do ehtical blind studies on pregnant women....

-what AD you were on pre-pregnancy
venlflaxine 225mg; mirtazapine 45mg; sleeping tablets. Also supported by weekly psychotherapy.

-what you were changed on to (if applicable)
1st pregnancy: saw psychiatrist at 6 weeks. he recommended a gradual reduction to zero over about 3 weeks.
2nd pregnancy: I decided to go cold turkey at about five weeks. My psychiatrist didn't know. My husband wasn't that thrilled with the idea but he kept a good eye on me. I'd done a bit of research and knew that those ADs have a relatively short half life - but I really don't recommend that anyone else tries it unsupervised / without consulting a professional first.

-who made this decision (GP or psychiatrist etc)
1st pregnancy - Psychiatrist
2nd pregnancy - me. Although psychiatrist has said that there could be an argument for me being on something. I have promised to be honest with him and again, DH is very observant.

-whether you remained well mentally throughout pregnancy and breastfeeding.
Sadly I miscarried at 10wks with my 1st pregnancy. I do not believe that the ADs had anything to do with it. Indeed, I do not believe that I would have fallen pregnant without them!! I gradually reintroduced the ADs but it took me about 2 months for me to "normalise" to them again. Some of this may have been grief though.

2nd pregnancy - going cold turkey was truely horrid. But within about 3 days, I found myself singing in the kitchen once more! I believe that although the ADs were stopping the bads being so bad, I think they were also muting the good: squaring the sine wave if you will. It's so nice to notice the good stuff and to "feel" things once again which is I believe a result of not having the ADs. However, at 22wks, I am still getting fairly dark days, still anxious/paranoid, still getting waking nights - but I am aware that tierdness and diet have a major impact.

-anything else you would like to add.
I know I am very lucky to have had talking therapy support throughtout all this (thank God & hubby's job for private healthcare!!) which I believe has enabled me to go without the meds - although sometimes, i wish I still had the medicinal support - but then I notice the random little good things that I now appreciate without the meds (colours, light, a joke on telly) and I believe that I've made the right decision for now. I just hope that I can avoid PND,

Ad in pregnancy: 20mg seroxat. I'd been on it for 12 years previously, and am still on it now (DS is 16 months).

The decision was made by myself, my GP and my obstetric consultant. My previous GP had requested information and data from GSK when I first started ttc-ing and the risks were unsubstantiated, tiny and the control group were predisposed to hard drug use and smoking/drinking.

I developed antenatal depression/ severe OCD during pregnancy and had a small breakdown immediately after the (traumatic) birth. My dose was increased and within 2 weeks I was fine. I have not experienced postnatal depression and am stronger mentally now than I was before pregnancy. However, that increase in dose led to stopping breastfeeding on the advice of both my midwife and psychiatrist.

I don;t really have anything else to add!