SSRI use in pregnancy - experience, stories and advice?

[Trekkie]

I have been on SSRIs since mid-2009. I was initially prescribed 10mg Cipralex per day.

A few months before we started TTC I asked my doctor to wean me off it. Over a period of about 6 months we slowly reduced my dosage and then stopped completely. I did not do well and am now back to 5mg per day. Honestly, I feel like I am not coping. I want to go back to 10mg per day but I am worried about the potential effects should I fall pregnant. We are still only in the TTC stage and I think the fact that it is taking us so long is not exactly helping the situation.

Anyway, that's my story in a nutshell. Do you have any experience with SSRI use in pregnancy? Did you stop? Were you fine when you stopped? Did you stop when you fell pregnant or before? Did you continue? Was your pregnancy fine? Is your baby fine? Did you breastfeed?

Any experience with this - yours, your friend's, your dog groomer's - would be greatly appreciated.

 

[monkeyprincess]

Hey Trekkie, I imagine this is somewhat of a sensitive topic for some people. I don't have any personal experience with this, but I know that my sister-in-law (my brother's wife) was on an antidepressant when she was pregnant with their second baby. I'm not sure exactly which brand/type, but I want to say it was Zoloft maybe??? She had some post-partum depression after their first baby was born and was still on the meds when she got pregnant the second time. Anyway, I remember we were all a bit skeptical and were thinking she should try to wean off of the medication, but her doctor told her that because there was low risk of any harm to the baby, she was probably better off staying on the low dose of the medication because it was better for her and the baby if she was not depressed. Her baby is now almost three, and is perfectly healthy. I'm pretty sure she was breastfed while she was on it (but I'm not sure if this is a good idea or not)

Have you talked to your doctor about all of this? I'm sure he/she will be able to advise you whether the benefits outweigh the risks in your case. I'm sure some meds are safer than others, so it would be good to make sure you are on one of the lower risk kinds. It's smart that you're looking into all of this now before you get pregnant because, at least in my case, early pregnancy is a high anxiety time, so the more prepared you are, the better. Hopefully someone with personal experience can chime in and give you more useful information.

 

[Pandora II]

My sister took Prozac throughout her last two pregnancies and breastfed both for a year. No ill effects whatsoever - both bright kids. With her first baby she was obsessional about what she ate and drank and wouldn't take any meds of any kind... her daughter was born with a cleft palate.

My SIL took Lustral throughout her pregnancy and breastfed for 3 months. No issues at all.

SSRIs have a very good safety profile in pregnancy - being depressed and anxious can have long-term consequences of their own (and increase the risk of PPD)

Not SSRI's, but I took Lamotrigine and Tramadol throughout my pregnancy (decreased Lamotrigine for first 14 weeks) - DD was born opiate dependent and we were in hospital for a week to manage withdrawal, but she had Apgar scores of 10 and 10 and she is extremely clever and hits all milestones well ahead of her chronological age. I've breastfed for nearly 3 years now with no issues.

One of the girls on PS is an expert in this area - hopefully she'll pop in.

 

[Trekkie]

Thank you, MonkeyPrincess. Yes, I have discussed this with my doctor. He feels that it would be best for me to come off the SSRIs if I can. Clearly I can't, yet. I am reluctant to postpone TTC as my DH is nearly 40. I feel like time is running out for us.

Pandora, I was hoping you would comment on this thread. Your stories give me hope. I am really hoping I'll be able to breastfeed but am worried about the risks involved. Yes, practically anything a woman does carries risks, but I am terrified I'll somehow screw up my child for life because I'm on happy pills.

If anyone else has anything to say, I'd like to hear that too.

 

[Circe]

Hi, Trekkie - no SSRIs, but I did go on Wellbutrin about a week after I found out I was pregnant.

I know, backwards from what most people do - in my case, I'd had a later-term loss and when I got pregnant again, I was so anxious I would just start crying whenever anybody said anything about the baby to me. It was when I burst into tears at the gyno's office when her nurse asked me how I was doing that she gently asked me to consider taking something.

At first she asked me to think about Prozac, because it has a long history of being used in pregnancy, but - purely anecdotal evidence - I know a few too many people who've had a hell of a time getting off of it. We discussed all of the studies carefully and settled on Wellbutrin as a specifically targeted anti-anxiety drug with a good track record: far fewer studies have been done on it (I think by, like, a factor of ten compared to Prozac), but those that have been done have been pretty uniformly positive.

I started out at the lowest possible dosage, and inched my way up as my blood volume changed throughout pregnancy: we discovered that the immediate release and even SR versions just made me really happy for an hour and then I was back to being my anxious self, but the XL versions worked like they were supposed to.

By the end of the pregnancy, I was up to a "normal" dosage of 300mg a day. My pregnancy was drama-free, my labor had to be induced but it went very well, and my son is a healthy little boy of five months and change now - big for his age, alert, and very, very merry. I'm still on Wellbutrin, after, again, reading numerous studies: there was one that showed a correlation between mothers taking Wellbutrin and breast-fed babies having seizures, but that was also linked to being smaller than average. To me, it seemed to correlate with the fact that high doses can cause seizures in underweight adults, and given the specifics in our case, I and the doctor judged the risk to be very, very low. I am hoping to gradually reduce my dosage, if I can, so that when I'm pregnant again I don't have to have a correspondingly higher dosage with newly increasing weight.

That said, I think I'll probably be on Wellbutrin for the rest of my life - the difference it made in my outlook is remarkable. I used to think that everybody worried like I did - and if they didn't, it meant they didn't care. Used to drive me crazy when my husband went about things like moving calmly: I thought it meant he wasn't taking it seriously! But with this stuff, I can have a worrisome thought, and just ... put it aside! Without obsessing! Like magic, I tell you.

I've read up on SSRIs, too - my best friend is on both types of antidepressant, and hoping to get pregnant in a year or two - and from what I can tell, current research indicates that it is safe (adjusting for individual weights and dosages - like all the commercials say, consult your doctor). But I don't think you should feel bad about how you manage your health: like Pandora mentioned, being depressed or anxious during pregnancy carries its own set of risks, too. Bottom line: do what's right for you.

 

[Puppmom]

That said, I think I'll probably be on Wellbutrin for the rest of my life - the difference it made in my outlook is remarkable. I used to think that everybody worried like I did - and if they didn't, it meant they didn't care. Used to drive me crazy when my husband went about things like moving calmly: I thought it meant he wasn't taking it seriously! But with this stuff, I can have a worrisome thought, and just ... put it aside! Without obsessing! Like magic, I tell you.

Um, are you in my head?

My SIL took Pristiq (which I think is an SSRI) most of her pregnancy and all is well. My nephew is a healthy two year old and she had a normal pregnancy/birth. She did not breastfeed but for other reasons.

She started taking Pristiq 18 months before getting pregnant and attempted to wean off in her first trimester without success. They put her back on it and she took it the remainder of her pregnancy. I don't know what her dose was.

 

[MichelleCarmen]

Hey Trekkie, I imagine this is somewhat of a sensitive topic for some people. I don't have any personal experience with this, but I know that my sister-in-law (my brother's wife) was on an antidepressant when she was pregnant with their second baby. I'm not sure exactly which brand/type, but I want to say it was Zoloft maybe??? She had some post-partum depression after their first baby was born and was still on the meds when she got pregnant the second time. Anyway, I remember we were all a bit skeptical and were thinking she should try to wean off of the medication, but her doctor told her that because there was low risk of any harm to the baby, she was probably better off staying on the low dose of the medication because it was better for her and the baby if she was not depressed. Her baby is now almost three, and is perfectly healthy. I'm pretty sure she was breastfed while she was on it (but I'm not sure if this is a good idea or not)

"
Zoloft is being sued...

Here's one quick bit I found:
Zoloft birth defects highlighted in studies

The recent focus on Zoloft birth defects has come about mainly because of several studies and an FDA warning that have been released over the last few years. In 2006, the FDA issued a public health advisory about all selective serotonin reuptake inhibitor (SSRI) antidepressants like Zoloft, stating they may increase the risk of birth defects like persistent pulmonary hypertension of a newborn (PPHN). That same year, the New England Journal of Medicine published a study that showed women who took SSRIs during the first trimester were six times more likely to give birth to a baby with PPHN.

Studies followed in 2007 and 2009 showing a risk of heart defects with SSRI antidepressants, and in 2010 the American Journal of Nursing linked SSRIs with congenital heart defects. In 2011, speculation arose concerning the FDA’s classification of Zoloft. The drug is currently classified as Category C, which means that animal studies have found an increased risk of harm to fetuses. A move to Category D would mean that human studies also show evidence of harm."

 

[monkeyprincess]

Hey Trekkie, I imagine this is somewhat of a sensitive topic for some people. I don't have any personal experience with this, but I know that my sister-in-law (my brother's wife) was on an antidepressant when she was pregnant with their second baby. I'm not sure exactly which brand/type, but I want to say it was Zoloft maybe??? She had some post-partum depression after their first baby was born and was still on the meds when she got pregnant the second time. Anyway, I remember we were all a bit skeptical and were thinking she should try to wean off of the medication, but her doctor told her that because there was low risk of any harm to the baby, she was probably better off staying on the low dose of the medication because it was better for her and the baby if she was not depressed. Her baby is now almost three, and is perfectly healthy. I'm pretty sure she was breastfed while she was on it (but I'm not sure if this is a good idea or not)

"
Zoloft is being sued...

Here's one quick bit I found:
Zoloft birth defects highlighted in studies

The recent focus on Zoloft birth defects has come about mainly because of several studies and an FDA warning that have been released over the last few years. In 2006, the FDA issued a public health advisory about all selective serotonin reuptake inhibitor (SSRI) antidepressants like Zoloft, stating they may increase the risk of birth defects like persistent pulmonary hypertension of a newborn (PPHN). That same year, the New England Journal of Medicine published a study that showed women who took SSRIs during the first trimester were six times more likely to give birth to a baby with PPHN.

Studies followed in 2007 and 2009 showing a risk of heart defects with SSRI antidepressants, and in 2010 the American Journal of Nursing linked SSRIs with congenital heart defects. In 2011, speculation arose concerning the FDA’s classification of Zoloft. The drug is currently classified as Category C, which means that animal studies have found an increased risk of harm to fetuses. A move to Category D would mean that human studies also show evidence of harm."

MC, I'm not 100% sure, but I think that is what my SIL took. I should ask my brother, but it's kind of a sensitive subject. At any rate, my niece was born perfectly. Obviously Trekkie should discuss this with her doctor and do her own research. I was just sharing my second-hand experience.

 

[monkeyprincess]

Trekkie, I was curious about MC's info, so I quickly did some research on this issue. As I suspected, the scientific evidence is not as alarming as the class action attorneys suggest. I'm often skeptical of these class actions because a large part of my law practice is spent defending against them, and often the science does not back up the attorneys' claims. This is the reason I continued to use Yaz despite the class actions regrding an increased risk of blood clots. Obviously, nobody wants to knowingly put their baby at an increased risk of birth defects, but it definitely seems that the incidence of birth defects in woman using SSRIs is still very low.

Conclusions
"Our findings do not show that there are significantly increased risks of craniosynostosis, omphalocele, or heart defects associated with SSRI use overall. They suggest that individual SSRIs may confer increased risks for some specific defects, but it should be recognized that the specific defects implicated are rare and the absolute risks are small."

http://www.nejm.org/doi/full/10.1056/NEJMoa067407

“The specific heart defects that were linked to sertraline and paroxetine, for example, occur in about 5 out of 10,000 babies, so a doubling of that risk means they occur in 10 out of 10,000 babies, and a tripling means they would occur in 15 out of 10,000,” he says. “So even a tripling of the risk still amounts to a very small chance that a baby will be born with one of the defects linked to these drugs.”

http://www.bu.edu/bostonia/winter09/happy-pregnancy/

 

[Pandora II]

I would back monkey princess's post entirely.

When a statement is made that a woman has 6 times the risk of x, y or z, it's always worth asking what the baseline risk is to start with. Something that goes from a chance of 1/10,000 to 6/10,000 is not something that I would worry about.

Can you get your psychiatrist to access the latest research? I did this with my meds - I was even on the Lamotrigine Pregnancy Register to contribute to the research. There were a lot of studies done in 2009 on SSRI use in pregnancy IIRC.