Posted by Sunnely on March 6, 2001, at 21:48:38
In reply to Please help!! major concern, posted by Preggo Leah on March 5, 2001, at 23:12:32
Hi Preggo Leah,
I believe the following is the latest opinion regarding antidepressants and pregnancy.
ANTIDEPRESSANTS APPEAR SAFE DURING PREGNANCY
Women who use antidepressants during pregnancy are not significantly increasing the risk of congenital malformations in their infants, according to results of a large prospective study.
Dr. A Ericson of the Centre for Epidemiology in Stockhom and colleagues followed 969 women who reported antidepressant use at a prenatal visit around weeks 10-12. There were 980 births, including 11 sets of twins. The incidence of birth defects was 4% and the incidence of infant mortality was 0.7% - no different from the rates in the general population.
The data came from the Swedish Medical Birth Registry, which includes information from prenatal visits, delivery, and the first pediatric examination.
Five hundred thirty-one women used SSRIs alone during pregnancy, 15 used SSRIs in combination with another antidepressant, and 423 used a non-SSRI antidepressant alone. The SSRIs used were citalopram (Celexa), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft). The non-SSRIs used were amitriptyline (Elavil), clomipramine (Anafranil), imipramine (Tofranil), lofepramine, nortriptyline (Pamelor), maprotiline (Ludiomil), mianserin, moclobemide (Manerix), trimipramine (Surmontil), and venlafaxine (Effexor).
Citalopram, for which no previous data on congenital malformation effects exist, was the most popular antidepressant and was used by 39% of the women. Congenital anomalies did not appear more frequently in the infants of these women than in infants exposed to other SSRIs.
Over 40% of the women reported using other medications during pregnancy, including other psychotropics, analgesics, anti-asthmatic drugs, antibiotics, anti-inflammatory drugs, sex hormones, thyroid hormones, anti-epileptics, and insulin. There was no correlation between use of other medications and use of any class of antidepressant.
Dr. Zachary Stowe, Director of the Pregnancy and Postpartum Mood Disorder Program at Emory University, commenting on the above study, agreed with the suggestion of Dr. Ericson and colleagues that untreated depression can expose the mother and the child to risks associated with substance abuse, poor nutrition, and suicidal tendencies. He stated, "If they have a history of being able to come off (their antidepressants) and be OK, then do it. But if you take them off the medication and they get sick and need to go back on it, you're exposing the fetus both to antidepressant and to untreated depression." In his view, this is the worst of both worlds.
In a recent multicenter prospective study by Dr. Stowe, 112 women were taking antidepressants when they became pregnant, and all discontinued medication as soon as they discovered their pregnancy. Around 70% of them developed depressive symptoms in the course of pregnancy, and by the time their babies were born, 50% had started taking antidepressant again.
Even if a woman is able to stay off her antidepressant for the duration of pregnancy, it may not help that much. Most women don't know they're pregnant until week 4 or 5, and even then if they stop taking medication immediately, it takes another week to clear the system, he explained. By that time, organ formation is well underway and the critical period when antidepressants could have affected fetal development is over. (Stopping the antidepressants can also lead to withdrawal symptoms. Effexor is notorious for rapid-onset and very nasty withdrawal symptoms.)
Another reason to keep women on antidepressants is Dr. Stowe's own finding that both SSRIs and tricyclic antidepressants have incomplete placental passage. A fetus receives a very low dose of these drugs, compared with other drugs - antibiotics or anticonvulsants, for example - that have complete placental passage.
In Dr. Stowe's recent study of 90 women who took fluoxetine (Prozac), paroxetine (Paxil), or sertraline (Zoloft) during pregnancy, all three medications showed incomplete placental passage. All the babies born were healthy, with normal weight and a complication rate well below the national standards.
Hope this helps. Wish you the best - pregnancy and baby.
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> I've been on effexor for a little over 2 years now, and honestly, it's probably saved my life. I've tried other drugs, but they either seemed to have no effect or just left me feeling "glazed over."
> Anyway, I just found out that I'm pregnant---btw 4-6 weeks---and I'm very concerned because I've been on a pretty high dosage (300 mg/day). I'm definitely going to get off effexor for the time being--until I've delievered and finished breastfeeding--but am concerned that perhaps I've already done some type of damage to the baby through my meds. I haven't been able to find any information on effexor and pregnancy (except "don't take this if you are pregnant..."), and am really pretty nervous. Please help!!
poster:Sunnely
thread:55661
URL: http://www.dr-bob.org/babble/20010302/msgs/55782.html