Posts Tagged ‘ genetics ’

Antidepressants While Pregnant–Follow Up

Thursday, August 25th, 2011

Fi and me on beach

It was so reassuring to know I’m not alone in my conflict of staying on meds while pregnant. And even though I know I’m making the right decision for myself, I do worry at times. How could I not? Someone who read my blog recommended a Reproductive Psychiatrist at NYU. This is an extremely specialized department on the cutting edge of research.

I saw the psychiatrist this week and I wanted to pass along what she told me. Knowledge is power, right? I’m going to take another leap here and even include the actual meds and dosages I’m on. Here goes:

At conception, if you’re taking antidepressants, then the baby is exposed. As she put it, “Exposure is exposure.” Meaning, going off at 3, 6, 9 months etc. is not going to make a difference. It’s the first couple months that are the big development stages.

I asked her about the studies that say there’s a 1-2% chance of cardiovascular/pulmonary issues in your baby if you take an SSRI (like Lexapro, Zoloft, Prozac, etc.). She said there is no conclusive evidence that those drugs cause higher risk under certain dosages. For example, the recommended maximum dosage for Lexapro while pregnant is 20-milligrams. (I’m currently on 5 mg, which I went down to on about the 3rd month of my pregnancy). She explained that those same risk percentages (1-2%) exist in the general population of pregnant women. Factors such as age, smoking, diet, etc can potentially elevate those risks. But not necessarily SSRI’s taken at the recommended dosages.

She also said to stay the course with what works mentally. You want to avoid huge ups and downs and being a human yoyo. It is better for you, but more importantly—the baby.

I’m also on Wellbutrin. The studies show there are no known or proven higher risks when taking while pregnant at the recommended maximum dosage. It is 300 milligrams or less on the extended release tablets. I’m on 150 milligrams.

Having said all this, studies have shown that the more drugs you’re on, the greater risk for some sort of issue/problem. That kind of follows logic, right? If she had met me before I got pregnant, she probably would have increased my Lexapro and taken me off Wellbutrin entirely. That way, I’d only be on one drug. But she assured me it’s really nothing to be concerned about. She’s had women with far more complicated drug combos than mine who have had beautiful babies.

When it comes to breastfeeding, the risks go down even more. The breasts act as a secondary filter (the body/blood being the first filter). She said tests were done with breastfeeding moms at a 20 mg dose of Lexapro and 300 mg of Wellbutrin. Those tests showed zero trace of the drugs in the baby.

And finally, bottom line: healthy, happy, anxiety-free mom = chances for the best baby. All the evidence supports that.

I thought this was some great information to have. If any of you have other information, I’d love to hear it.

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Dealing With Depression While Pregnant–Your Comments

Friday, August 19th, 2011

It’s almost the weekend and I’m just getting up to speed after having my computer crash. It crashed right after I posted my blog about taking antidepressants while pregnant. I was able to read all of your comments and then boom. I was in the dark. Until now.

I was so incredibly blown away by how much we all opened up to each other. The thoughtful, lengthy, heartfelt comments really touched me. Thank you for taking the time. For all of us who are struggling, let’s commend ourselves for having the courage to open up. We shouldn’t be living in a day and age where there is still a stigma attached to mental health issues.

Some of you are still battling the beast. Others have risen up to see the light after weeks and months spent in darkness.

Was curious to hear from @Meredith about what your doctor said in your follow up visit. You mentioned you were feeling pretty down again towards the end of your pregnancy and wanted to see if he/she offered any ideas.

@Heather actually gave me a name of an amazing reproductive psychiatrist at NYU who I’m going to see. I have taken my dose down in the past 2 months and I can feel the pull to the dark side. I can handle it at this level, but any lower, and I fear I’d be miserable.

@Mae—you and a few others made the excellent point that if you were diabetic during pregnancy you would take insulin; if you had a heart condition you would take medication. Why is treating depression any different? For those who haven’t experienced it before, I can tell you first hand it’s not a choice any of us make.

I would urge @Jessica to consider that analogy. Are you saying people who have depression and need meds shouldn’t have a baby? Remember, it’s a proven chemical imbalance. A problem that is treatable just like the examples above.

There were a few nasty comments, of course. It wouldn’t be a proper blog without. To those who have clearly never struggled with depression and said that if we take pills for it, then we shouldn’t have children, I’ll happily tell you my opinion: your judgment is incredibly small minded and cruel. Not to mention ignorant.  I’m not commenting any more than that, as I don’t think it’s worth wasting my energy on.

I’ll end with two comments from my readers. And @Liz you are welcome. It was an honor to put my story out there, especially when I discovered I have kindred spirits like all of you by my side. But for the grace of god, go I…

By Liz

Thank you for being a voice for those who may suffer in silence due to fear of the unknown. Going through a severe depression myself, which began, in early pregnancy I can totally relate. I would not have gotten through it without the help of medication. Depression is a serious illness that one can only truly understand if they have been through it themselves. The risk of what could have happened had to seriously be weighed against the risk of what my anxiety and depression could have done to my unborn child. And FYI she is a healthy happy baby girl.

By Emily

I was just reading in The Economist of all places about research showing that babies born to mothers who were depressed or under extreme emotional stress during their pregnancies have actual changes in their brains that make them more prone to anxiety and fearfulness. I don’t have the article handy now and can’t remember the exact scientific details, but the gist of it is that there is a STRONG argument to be made for treating depression and anxiety by any means necessary during pregnancy, not just for the moms’ relief and ability to function, but for the babies’ functioning later in life. I started Zoloft when my youngest was 18 months old, and my oldest was 3, and my only regret is why did I not start sooner? I was functioning more or less OK, but experiencing no joy in life. What kind of mom is that? So glad I got over my fear of side effects (which have actually been non-existent, as far as I can tell) and can now enjoy life!


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Taking Antidepressants When Pregnant

Wednesday, August 17th, 2011

Enjoying the beach with my baby

Enjoying the beach with my baby

Full disclosure:

I take antidepressants.

I will continue to take them through my pregnancy.

I took them while pregnant with Fia.

Internal conversation:

I can’t believe what you just revealed. Hurry. Duck and run for cover!!

No. I’m not going to. It’s time to get this conversation on the table.

You sure? You will be nailed to the cross on this one. Judged and deemed unfit for motherhood.

I don’t believe that. I think women are terrified of talking about this. I think many will feel relief that I’m admitting my own dirty little secret. They may carry the same secret. And it’s okay.

Do what you will but don’t say I didn’t warn you…..

Alright, it’s out there.  And I’m not shying away from it. It is my truth.

In my post about my dying mother, I mentioned her bipolar disorder. I breathe a deep sigh of relief that I don’t have that. But I do struggle with depression. And anxiety. For years I just “dealt” with it. With herbs and holistic medicine; with therapy and exercise; with meditation and yoga. Didn’t matter. Nothing changed how my chemical brain worked. I still do all those things, but now I take a small white pill everyday.

When I began taking it I felt this huge cloud lift. I felt less anxious. And far happier. I didn’t become an emotionless zombie. I became much more present in life–not in my head.

I went off of them a few times to see if perhaps I was “cured.” It can happen. Not me. That familiar dark cloud would start to drift into my periphery and I knew the storm was coming.

When I got pregnant with Fia, I struggled with my decision to stay on my meds. I even tried to wean off again. I felt the pit coming almost immediately. So I made my decision and stuck to it. I had to stop googling all the horrible things people talked about. I know it’s a risk. So is breathing the polluted air of NYC. So is going through the x-ray machine at the airport. So is my secret love of Taco Bell’s #3 with a diet Pepsi.

What I will say is more studies need to be done so women can have the facts. For a variety of reasons, there is just not a lot of conclusive data out there on taking antidepressants while pregnant. As an article in the NYT points out, pregnant women often aren’t part of drug studies. Therefore, a lot of the data is inferred, not proven. And even the most ardent studies have holes in them. I have an excellent OB and psychiatrist, both of whom agree: going through my pregnancy depressed and dark is far more dangerous than sticking to what works. (Also, during my pregnancy with Fia, we moved to LA for a bit. I saw 3 different OB’s/specialists. They all had the same unanimous opinion.)

What is proven is that some people have chemical imbalances. It’s in their genetic makeup.  And sometimes medicine is the only thing that works. Yet when taking those meds, the judgment from others can be severe. I guess that’s why women like me don’t disclose this. But today I’m feeling brave.

So there you have it.  Anyone else out there who wants to talk? I’m here.

Side note: I was recently informed about a study being conducted at Columbia University Medical Center exploring some of the issues around antidepressant use during pregnancy. If you are interested, and live in the NYC area, you can contact the study coordinator, Michelle Gilchrist at (212) 851-5175 OR mag2241@columbia.edu.

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