Antidepressants in pregnancy and breastfeeding

Can anyone point me to any good web resources on antidepressant use in
pregnancy (and, while I'm at it, while breastfeeding)? (Just in case
anyone was wondering, I'm asking professionally and not personally...)


TIA,

All the best,

Sarah
--
http://www.goodenoughmummy.typepad.com

"That which can be destroyed by the truth, should be" - P. C. Hodgell

When I found out I was pregnant the first time, I was concerned because I
was and am taking 75 mg of Effexor per day. The doctor said it was better to
be in a good state of mind than off the drug and being up and down mood wise
for me and the baby. There has only been one study done (she showed me in a
medical book nothing from the net) and that study was done using Prozac.
There were no ill effects and I didn't find any either. In fact, it helped
with any post partum depression I may have had as well. Effexor is milder
than prozac in that there aren't as many side effects as I have seen with
Prozac.

--
..oO rach Oo.


"Sarah Vaughan" wrote in message
...
Can anyone point me to any good web resources on antidepressant use in
pregnancy (and, while I'm at it, while breastfeeding)? (Just in case
anyone was wondering, I'm asking professionally and not personally...)


TIA,

All the best,

Sarah
--
http://www.goodenoughmummy.typepad.com

"That which can be destroyed by the truth, should be" - P. C. Hodgell

"Anne Rogers" wrote in message
...
Effexor is milder than prozac in that there aren't as many side effects
as I have seen with Prozac.

I don't think "milder" and "stronger" are particularly helpful descriptive
words when it comes to antidepressants in the same way that they would be
with, say, opiate based painkillers. In this case it's not even a direct
comparison as Effexor is an SNRI, whereas Prozac is an SSRI, and start
doses will be different to account for the difference in effect from the
same dose, so for Effexor, the initial dose is 75mg, whereas for Prozac
it's 20mg. Effexor is still low down the preferred list for breastfeeding,
but generally tends to be viewed as ok if necessary whereas Prozac would
be avoid if possible for breastfeeding. So if someone is already on
Effexor, there is probably no indicator to change, but it would probably
fall in the category of one you wouldn't commence use in pregnancy or
breastfeeding unless other drugs had proved unhelpful.



By milder I meant it doesn't have the effects that Prozac does. Prozac has
been known to make people worse - much worse along with hallucinations and
allergic like reactions. Milder is what my DOCTOR described it as and she
would know, right? Also, a few friends of mine have tried Prozac... some
with great results but many with horrible results yet no one I know on
effexor has had the problems of Prozac. From the documented in formation
she had me read about the tests done on Prozac and pregnancy/breastfeeding
there were no ill effects of it and Prozac is the only drug they have done
tests on. Like I said and like she (the doctor) said, I would rather be a
calm pregnant lady and breastfeeding mother than a complete wreck. How is
being depressed enough to kill yourself or riding the waves of anxiety
helpful to anyone?

Can anyone point me to any good web resources on antidepressant use in
pregnancy (and, while I'm at it, while breastfeeding)? (Just in case
anyone was wondering, I'm asking professionally and not personally...)

I think kellymom comes up about the best

http://www.kellymom.com/health/meds/...hale10-02.html

I seem to recall there was a fairly detailed page on the breastfeeding
network site too.

Neither of those directly cover pregnancy, Hales would have slightly more
detail for pregnancy, but still only very minimal, certainly nothing like
the choice hierachy of breastfeeding. As I'm sure you know, it's not
something you want to be switching around without clear need, either not
working or side effects too great, so when selecting a drug for pregnancy,
there needs to be a long term plan for breastfeeding as well, which then
leave sertraline as the drug of choice for pregnancy as well as
breastfeeding, and it's risks in pregnancy seem to be very very slight
increase in neural tube defects, so taking the higher, precription only dose
of folic acid upto 12 weeks may be adviseable, but I don't think there is
any research that confirms that in this particular instance it reduces the
risk (note, it's not adviseable to take it beyond 12 weeks, there is no
benefit and an increased risk of breastcancer), the other was a slight
increased risk of IUGR, but even with a history of IUGR, that slight risk
was not enough for me to not take sertraline, the risks of not taking it
were probably much greater, as it turned out that baby didn't have IUGR.

Prozac would appear to be the drug of choice for pregnancy, simply because
it's been around longer, so there is more data, but everything points to
other ssris actually being better.

http://www.womensmentalhealth.org/topics/pregnancy.html looks like a pretty
good article for pregnancy, but doesn't mention doses, the max dose can be 4
or more times the min dose, so you'd expect there to be a difference, it
also doesn't mention breastfeeding, but I do feel that in choosing a drug
and a dosage when pregnancy is being considered you have to consider early
breastfeeding.

The other thing to consider (I'm sure you've thought of this anyway), is
that if the pregnancy is planned, or rather the planning of it is mentioned
to the care provider then that is when there is most chance of making some
kind of chance actually having an effect on outcomes, even it it's just lets
see how you get on with a lower dose, whereas if the women doesn't present
until early pregnancy, the congential defects side of things has probably
already been set in stone and if there is a need for high doses, it may be
that waiting to reduce at 37 weeks if possible would have exactly the same
effect as reducing doses from that moment, with much less risk to the mother
and they can then increase the dose again if desired straight after
delivery.

It's also worth noting, that even if you feel care can remain in the hands
of the GP, it should still be possible to contact, say, the hospital
pharmacist about prescribing, as they have the most uptodate information and
in my case, it was them and not any psychiatrist who knew that sertraline
was the drug of choice for breastfeeding mothers, I may be remembering
wrong, but they also seemed to indicate it was the drug of choice for
postnatal depression, regardless of breastfeeding.

Cheers

Anne

Effexor is milder than prozac in that there aren't as many side effects as
I have seen with Prozac.

I don't think "milder" and "stronger" are particularly helpful descriptive
words when it comes to antidepressants in the same way that they would be
with, say, opiate based painkillers. In this case it's not even a direct
comparison as Effexor is an SNRI, whereas Prozac is an SSRI, and start doses
will be different to account for the difference in effect from the same
dose, so for Effexor, the initial dose is 75mg, whereas for Prozac it's
20mg. Effexor is still low down the preferred list for breastfeeding, but
generally tends to be viewed as ok if necessary whereas Prozac would be
avoid if possible for breastfeeding. So if someone is already on Effexor,
there is probably no indicator to change, but it would probably fall in the
category of one you wouldn't commence use in pregnancy or breastfeeding
unless other drugs had proved unhelpful.

Cheers

Anne

By milder I meant it doesn't have the effects that Prozac does. Prozac has
been known to make people worse - much worse along with hallucinations and
allergic like reactions. Milder is what my DOCTOR described it as and she
would know, right? Also, a few friends of mine have tried Prozac... some
with great results but many with horrible results yet no one I know on
effexor has had the problems of Prozac. From the documented in formation
she had me read about the tests done on Prozac and pregnancy/breastfeeding
there were no ill effects of it and Prozac is the only drug they have done
tests on. Like I said and like she (the doctor) said, I would rather be a
calm pregnant lady and breastfeeding mother than a complete wreck. How is
being depressed enough to kill yourself or riding the waves of anxiety
helpful to anyone?

I'm not critisising you taking it or anything, so there is no need to be
defensive, you were already on it, it was working, it makes no sense to
change and as you say there is no evidence of it being a problem in
pregnancy (though there have been cases reported of temporary problems in
newborns). Perhaps as a substitute for the word milder, something like more
benign might be appropriate, just because a doctor describes it as something
doesn't mean it's a good way to describe it, it's possible that a doctor
justifying a choice of drug by saying it is milder would make them feel as
if there depression is not being taken seriously, when what they really mean
as that it's less likely to cause side effects.

One problem with prozac is that the generic has been available for a longer
time than other SSRIs and there are very many producers of the generic, so
even going to the same pharmacy, you may not get the same formulation each
time and some formulations are more prone to the common side effect, nausea,
than others. Of course it has the well publicised increase in suicide with
Prozac, but it is not something that affects solely Prozac, Effexor
apparently doubles the suicide risk and similar is true for most many
antidepressants, which just emphasises the importance of closely watching
any person who is prescribed antidepressants.

There is no one antidepressant which is the first choice prescription for
all patients and what is right for one person may well not be right for
another, and whilst it's possible to have a ranking for preference when
considering one thing, such as breastfeeding, even when that is the
situation, it doesn't mean that it's the right thing to take the one from
the top of the list (Zoloft). Also, doctors are influenced by pharmacutical
companies and are likely to go through phases of regularly prescribing one
particular antidepressant, possibly without any clear evidence to do so.
Prescribing in depression is complex and I suspect that over time the move
will be towards having specialist prescribers, possibly a specialist nurse
amongst a group of doctors, etc.

Anne

Sarah Vaughan wrote:
Can anyone point me to any good web resources on antidepressant use in
pregnancy (and, while I'm at it, while breastfeeding)? (Just in case
anyone was wondering, I'm asking professionally and not personally...)

During pregnancy

http://www.motherisk.org/index.jsp
http://www.mayoclinic.com/health/ant...ssants/DN00007
http://www.hc-sc.gc.ca/ahc-asc/media...2006_11_e.html

And while breastfeeding http://neonatal.ttuhsc.edu/lact/

Elle

Anne Rogers wrote:
Effexor is milder than prozac in that there aren't as many side effects as
I have seen with Prozac.

I don't think "milder" and "stronger" are particularly helpful descriptive
words when it comes to antidepressants in the same way that they would be
with, say, opiate based painkillers. In this case it's not even a direct
comparison as Effexor is an SNRI, whereas Prozac is an SSRI, and start doses
will be different to account for the difference in effect from the same
dose, so for Effexor, the initial dose is 75mg, whereas for Prozac it's
20mg. Effexor is still low down the preferred list for breastfeeding, but
generally tends to be viewed as ok if necessary whereas Prozac would be
avoid if possible for breastfeeding. So if someone is already on Effexor,
there is probably no indicator to change, but it would probably fall in the
category of one you wouldn't commence use in pregnancy or breastfeeding
unless other drugs had proved unhelpful.

Cheers

Anne

I have been taking "Effexor" for 8 yrs through 3 pregnancies. To date
there have been no negative side effects through the pregnancies or
breast-feeding them for a yr (excluding the youngest who is ten months
and still breast-feeding). and to have to switch to a new drugI would
have had to not take anything for 2 weeks and dealt with pregnancy
hormones which would have been impossible.My dr had remarked that some
"Effexor" babies can be a lil jittery when there born. I didn't find
this to be so maybe because they were still receiving a minute dose in
my breast-milk. Can't quite be sure. BTW the initial dose for "Effexor"
is 37.5mg.
Anne Rogers wrote:
Effexor is milder than prozac in that there aren't as many side effects as
I have seen with Prozac.

I don't think "milder" and "stronger" are particularly helpful descriptive
words when it comes to antidepressants in the same way that they would be
with, say, opiate based painkillers. In this case it's not even a direct
comparison as Effexor is an SNRI, whereas Prozac is an SSRI, and start doses
will be different to account for the difference in effect from the same
dose, so for Effexor, the initial dose is 75mg, whereas for Prozac it's
20mg. Effexor is still low down the preferred list for breastfeeding, but
generally tends to be viewed as ok if necessary whereas Prozac would be
avoid if possible for breastfeeding. So if someone is already on Effexor,
there is probably no indicator to change, but it would probably fall in the
category of one you wouldn't commence use in pregnancy or breastfeeding
unless other drugs had proved unhelpful.

Cheers

Anne

I have been taking "Effexor" for 8 yrs through 3 pregnancies. To date
there have been no negative side effects through the pregnancies or
breast-feeding them for a yr (excluding the youngest who is ten months
and still breast-feeding). and to have to switch to a new drugI would
have had to not take anything for 2 weeks and dealt with pregnancy
hormones which would have been impossible.My dr had remarked that some
"Effexor" babies can be a lil jittery when there born. I didn't find
this to be so maybe because they were still receiving a minute dose in
my breast-milk. Can't quite be sure. BTW the initial dose for "Effexor"
is 37.5mg.

37.5mg is an available dose, I looked in up the BNF a pharmaceutical guide
for doctors in the UK and it gave the starting dose as 75mg, but as divided
doses due to the short half life, so 37.5 twice a day. Some people may end
up on 37.5mg (particularly when it's being used for treating anxiety), but
it was pretty clear that in the absence of any mitigating circumstances 75mg
would be the starting dose. Its possible that a similar guide in America
doesn't give the same recommendation, though other online sources suggest
75mg as the starting dose too, so maybe there has been some confusion
between daily dose and per taking dose, I had to use daily as prozac is
usually taken once a day.

I've always wondered about the impact of breastfeeding on protecting
newborns from side effects, but I've never been able to get any answers.

Anne