Psycho-Babble Medication Thread 134239

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Could be pregnant should I stop meds?

Posted by Noelle on January 2, 2003, at 23:41:44

My husband and I have been realtively uncareful this month and I'm worried that I might be pregnant although its too early for a test. I am currently on 75 mg of effexor xr, Neurontin 300-600 mg and anywhere from 20-50 mg of Adderall a day. Perhaps this is careless of us but I don't know if I should just weight untill I can take or test or if the damage will be done

 

Re: Could be pregnant should I stop meds?

Posted by Calaway on January 5, 2003, at 0:16:30

In reply to Could be pregnant should I stop meds?, posted by Noelle on January 2, 2003, at 23:41:44

I don't know if you are planning on children at all or anytime soon, but I would talk to my Dr. right away.

I spoke to my Dr. prior to both of my pregnancies to make sure what I was taking was ok. In my case (anafranil with my first and Paxil with my second) I was fine and my children are perfect and beautiful.

 

Re: Could be pregnant should I stop meds?

Posted by Noa on January 5, 2003, at 9:24:58

In reply to Re: Could be pregnant should I stop meds?, posted by Calaway on January 5, 2003, at 0:16:30

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.

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. 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.?

BTW, My doctor had actually recommended to me that if I do decide to get pregnant, I should do so in vitro so that we can control the timing of conception, so that I won't have to be off my medication for an extended period of time while trying to get pregnant. But that is because my fertility potential is an unknown factor and because I am in my 40's. It doesn't sound like this is an issue for you.

 

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.

http://www.psychguides.com/DinW%20during%20pregnancy.pdf

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. simon.g@ghc.org

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.

 

Re: Could be pregnant should I stop meds? Larry Hoover

Posted by Noa on January 5, 2003, at 15:13:31

In reply to Re: Could be pregnant should I stop meds?, posted by Larry Hoover on January 5, 2003, at 11:08:44

Thanks for the articles. I will read the full article one later. The study that went up to 71 months looks hopeful. But that is only 6 years. What about higher level cortical thinking skills that don't really show up till later in development. I hope they will continue to follow these kids to see if they start showing any written language problems, or problems with abstract thinking, etc.

 

pregnancy and meds

Posted by Kar on January 7, 2003, at 7:30:04

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

Noelle- that's scary, huh? Are you experiencing any pregnany-related symptoms? Please let us know what your doc said. I've taken many a pregnancy test before while on meds and it's so worrisome to think that you might be. I can't help ya with the drugs you're on, though...don't know enough...

Noa- Maybe I should've started a new thread...Mind telling me what else you're on? We're going through a similar thing. I'm going to go see a high-risk Ob/gyn soon who apparently has lots of experience with psychoactive drugs and pregnancy. Thanks for the book title though. I'll check it out. We're in the process of switching my meds around a bit to the less damaging ones but I'm really worried about Trileptal and lamictal. i know the chances of birth defects are definitely higher with 2 mood stabilizers...we'd cut it to one and maybe even then go to a safer one...

>depressed mid-pregnancy, after 1st trimester, I could go back on the meds--
Yeah that's what my pdoc said too. but what about pre-pregnancy? it freaks me out to think that I could be really low just while trying to get pregnant (and if I am then I won't want to have sex anyway!)

I'm really torn here. I don't want to have a baby and then not be able to take care of it, you know? We've considered adopting..it's still an option I guess but I would really like to have a baby.

>could my kid turn out with learning disabilties, ADHD, etc.?
I see that we're both worry warts! Re: the language disorders, ADD, etc...God, you'd never know really what might cause them. Even if they've studied that (have they?), there's nothing to say that a wee one wouldn't have one of those disorders anyway (without a mom on meds, i mean). I'm a speech therapist and work with babies. Parents always want to know what they did wrong. How they could've prevented it...we don't know any of this stuff yet. We know that there's a much higher incidence of these things if it's been familial, but. Well, we're jumping ahead, aren't we? I know, can't help it. neither can I.

In vitro- hmm...I haven't heard this mentioned yet. I will mention it to this specialist guy that I'm seeing. oH sorry- I just read the rest of your post and the fertility part.

Have you startedd taking prenatal vitamins? I've been taking Folic acid for a while but also started with the others. Altho I compard them to my multivitamin and there are hardly any differences. iron and some of the B vitamins I think.

How close are you guys to doing this? i have some links to studies from NIH about drugs and pregnany if you're interested. i have a friend down there who's a geneticist/pediatrician. I actually haven't checked out the links yet. I'm getting weary of reading all of these studies. i think I'm going to have to have faith in my docs. Be well informed but not obsess about more and more studies...

 

Above meant for Calaway...sorry Noelle (nm)

Posted by Kar on January 7, 2003, at 11:46:46

In reply to pregnancy and meds, posted by Kar on January 7, 2003, at 7:30:04

 

Re: pregnancy and meds

Posted by Noa on January 7, 2003, at 17:58:13

In reply to pregnancy and meds, posted by Kar on January 7, 2003, at 7:30:04

Hi, Kar.

I take Effexor xr, Serzone, Adderall xr. I also take a very small amount of ativan to sleep, but that would not be a problem to stop, because I only take it to counteract the activating effects of the Effexor.

My pdoc recommended the in vitro as a way to eliminate the possibility of being off meds longer than absolutely necessary.

I am single, and haven't tried yet. If I do decide, it would be with donor sperm, an idea that I am only getting used to now (I still feel a little uncomfortable with having a kid who essentially has no identifiable father--but I don't feel nearly as uncomfortable with the idea as I used to). I have just started exploring this as a possibility, and am not sure if I will pursue it, or look into adoption. And even if I pursue it, I don't know if I will be able to conceive.

There are the med issues, but also the depression issues, like you mentioned. There are also other health issues and age to sort out. I know people older than me who have had kids, but I don't see this process happening that fast, and when I think about the feasibility in a few years, well, I have more doubts. And then there are the financial concerns.....you get the picture.

But before this last near-decade of hard-to-treat depression hit me, I had always envisioned myself becoming a parent. Now, I have many more doubts about being able to handle it, but I don't want to give up the dream.

 

Good luck and don't give up, ya hear? (nm) Noa

Posted by Kar on January 8, 2003, at 12:31:10

In reply to Re: pregnancy and meds, posted by Noa on January 7, 2003, at 17:58:13

 

Re: Good luck and don't give up, ya hear?Thanks (nm) Kar

Posted by Noa on January 8, 2003, at 16:42:04

In reply to Good luck and don't give up, ya hear? (nm) Noa, posted by Kar on January 8, 2003, at 12:31:10


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