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Re: Could be pregnant should I stop meds?

Posted by Larry Hoover on January 5, 2003, at 11:08:44

In reply to Re: Could be pregnant should I stop meds?, posted by Noa on January 5, 2003, at 9:24:58

> I recently talked to my doctor about my medication and pregnancy. He had told me I would need to get off the effexor before the pregnancy--that first trimester is highest concern. However, I also read in a book about women and depression ("When Words Are Not Enough: The Women's Prescription for Depression and Anxiety"
> by Valerie Davis Raskin), that it takes a few weeks for the blood vessels to develop through which medication in your system would transmit to the fetus. But talk to your doctor NOW.

Good advice.

> BTW, my doc also said that if I got very depressed mid-pregnancy, after 1st trimester, I could go back on the meds--still risks to fetus but not as high as 1st trimester, when the major stuff can go wrong. Still, if I were on effexor when baby is born, baby would go through withdrawal. Now, I have had a taste of withdrawal symptoms when I forgot to take my meds one day and skipped the day, so I would hate to put a baby through that.

Post-delivery withdrawal is definitely observed in neonates exposed to antidepressants in utero. However, as antidepressants also pass into the milk, breast-feeding will prevent acute withdrawal.

>Also, I worry about not just the major malformations, but also what if the medication causes subtle damage to the brain during later pregnancy, when the cortex of the brain is developing--could my kid turn out with learning disabilties, ADHD, etc.?

That doesn't seem likely, although the issue is by no means settled. The first abstract below involves a follow-up to 71 months of age, showing no adverse effects from antidepressant exposure during pregnancy. In contrast, it should be pointed out that untreated maternal depression *does* adversely affect the development of the child (probably due to reduced interaction and stimulation).

The link presented here is to the Expert Concensus Guidelines to antidepressant use during pregancy. It requires Adobe Acrobat to view the file.

Am J Psychiatry 2002 Nov;159(11):1889-95

Child development following exposure to tricyclic antidepressants or fluoxetine throughout fetal life: a prospective, controlled study.

Nulman I, Rovet J, Stewart DE, Wolpin J, Pace-Asciak P, Shuhaiber S, Koren G.

Motherisk Program, Division of Pediatrics and Psychology and the Reseaarch Institute, The Hospital for Sick Children, Toronta, Ont. Canada.

OBJECTIVE: Previous work suggested that first-trimester exposure to tricyclic antidepressants or fluoxetine does not affect adversely child IQ and language development. However, many women need antidepressants throughout pregnancy to avoid morbidity and suicide attempts. Little is known about the fetal safety of tricyclic antidepressants and fluoxetine when taken throughout pregnancy. The goal of this study was to assess the effects of tricyclic antidepressants and fluoxetine used throughout gestation on child IQ, language, and behavior. METHOD: In a prospective study, mother-child pairs exposed throughout gestation to tricyclic antidepressants (N=46) or fluoxetine (N=40) and an unexposed, not depressed comparison group (N=36) were blindly assessed. The three groups were compared in terms of the children's IQ, language, behavior, and temperament between ages 15 and 71 months. The authors adjusted for independent variables such as duration and severity of maternal depression, duration of pharmacological treatment, number of depression episodes after delivery, maternal IQ, socioeconomic status, cigarette smoking, and alcohol use. RESULTS: Neither tricyclic antidepressants nor fluoxetine adversely affected the child's global IQ, language development, or behavior. IQ was significantly and negatively associated with duration of depression, whereas language was negatively associated with number of depression episodes after delivery. CONCLUSIONS: Exposure to tricyclic antidepressants or fluoxetine throughout gestation does not appear to adversely affect cognition, language development, or the temperament of preschool and early-school children. In contrast, mothers' depression is associated with less cognitive and language achievement by their children. When needed, adequate antidepressant therapy should be instituted and maintained during pregnancy and postpartum.

Am J Psychiatry 2002 Dec;159(12):2055-61

Outcomes of prenatal antidepressant exposure.

Simon GE, Cunningham ML, Davis RL.

Center for Health Studies, Group Health Cooperative, 1730 Minor Avenue #1600, Seattle, WA 98101, USA.

OBJECTIVE: This study evaluated the effects of prenatal antidepressant exposure on perinatal outcomes, congenital malformations, and early growth and development. METHOD: Within a group-model health maintenance organization, all infants with apparent prenatal exposure to tricyclic or selective serotonin reuptake inhibitor (SSRI) antidepressants were frequency matched to an unexposed comparison group by year of birth, maternal age, and mother's lifetime use of antidepressant drugs and mental health care. A structured blind review of mothers' and infants' medical records examined perinatal outcomes, congenital malformations, and developmental delay. RESULTS: Tricyclic antidepressant exposure was not associated with any significant difference in perinatal outcomes. Exposure to SSRIs was associated with a 0.9-week decrease in mean gestational age, a 175-g decrease in mean birth weight, and a 0.29 decrease in mean Apgar score at 5 minutes, but differences in birth weights and Apgar scores were not significant after adjustment for gestational age. Differences in gestational age and birth weights were unrelated to length of exposure, but differences in Apgar scores were limited to those with third-trimester exposure. Neither tricyclic antidepressant nor SSRI exposure was significantly associated with congenital malformations or developmental delay. CONCLUSIONS: The authors found no association between tricyclic antidepressant or SSRI exposure and either congenital malformations or developmental delay. SSRI exposure during pregnancy was associated with earlier delivery and consequent lower birth weight. Third-trimester SSRI exposure was also associated with lower Apgar scores. Women considering taking SSRIs during pregnancy may balance any higher fetal risk against the risk of persistent or recurrent depression.




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