Pregnant; send help.

May 15, 2012 9:59 AM

I am pregnant and on meds and terrified to not be on meds. Can you help me sort this through? I'm five weeks pregnant and on 300 mg/day of Wellbutrin XL. I promise I don't think you are my doctor or my pharmacist. I'm looking for advice from women who have Been There or those with concrete science-y knowledge.

Over the past several years, I've conducted several experiments with different drugs, different dosages, and being not on meds. Being not on meds is horrible -- I tried very hard, but it's damaging to my relationship, to my parenting abilities, to my professional life. Wellbutrin was my final answer due to its relative efficacy and lack of side effects. While it's not as effective as Zoloft, I value my sex life.

With Wellbutrin, I function reasonably well.

I'd gone off meds to try to get pregnant for a little less than a year, and last month it became apparent that I was no longer functioning well, and it was starting to seem like maybe I was too old to get pregnant. I decided to go back on Wellbutrin. Of course I promptly got pregnant.

Dr. Google has turned up some reasonably reliable looking information about autism and Wellbutrin, as well as some information about ADHD and Wellbutrin, and some scary looking information about other anti-depressant options. It's very difficult to look at these and think that I would be comfortable taking this or anything else for the duration of a pregnancy.

I cannot imagine how I could survive the hormonal shitstorm of a pregnancy without taking meds. I'd like to know, if you managed to do this, specifically how you managed to make this survivable, or if you had to do something similar--get through a period without medication--how you managed to do it without damaging your relationships or professional life. Yoga? Meditation? What helped? What can I do to make this not a nightmare for myself, my partner, my existing child, my potential child, my dog, and innocent passers-by? (I already do daily cardio and eat reasonably well; that won't be stopping.)

Again, I don't remotely think you're my doctor, I just want advice and to know how others managed this situation. I'm seeing my doctor on Thursday, and his feelings are in line with mine: it would be preferable to go off these meds. I am waiting until we get a heartbeat to make a final decision.



I would appreciate this parenting/pregnancy thread being a finger-waggling free zone.

posted by anonymous to health & fitness (20 answers total)

I am not on Wellbutrin; I am on a low dose of Effexor. This is my own personal experience and obviously IANAD.

At my last med check with my very nice psychiatrist, I discussed the possibility of a soonish pregnancy and what I should do medication-wise. After some discussion, she recommended staying on the Effexor at the current dose, which has been working for me for quite a while.

Her rationale was that, at this dosage level, the therapeutic benefit outweighed the risk of taking me off the drug just for the sake of being drug-free. As babies develop, they benefit greatly from a low-stress environment, and ramping up the anxiety, etc. (which would be an issue even if I weren't in the biggest stress time of my life with a baby inside!) would probably be more of an issue than anything that might happen if I stayed on the drug.

As to the risks, she said that it's possible that the baby could be a few weeks preterm, with the minor issues that that might cause (e.g. mostly developed but more fussy, etc.) but we're talking maybe two or so. She also said the baby could be at risk for withdrawal symptoms from the drug once it's out of my body, but that would last for maybe a day or two and run along similar lines (fussy, etc.).

My good friend KathrynT will be in shortly to share her info as well, which will doubtless be much more applicable than mine :)

P.S. ABSOLUTELY NO FINGER WAGGLING from me. Your baby needs a healthy and sane mom most of all. You will do the best you can, and that's all you can ask for. Many women have done it in your situation, and you know there are resources out there. You're a good proto-mom for being concerned, but you will be fine one way or another because you clearly care.

*hug*
posted by Madamina at 10:20 AM on May 15, 2012 [5 favorites]

Oh, PS -- she said that this advice also applied to higher doses of Effexor, so I would imagine there's a spectrum of Wellbutrin advice as well.
posted by Madamina at 10:24 AM on May 15, 2012

I went on Zoloft following the birth of my first child (when post-partum whim-whams amped up my usual anxiety/depression issues) and stayed on it during my second pregnancy per my doctor's orders. This was back in 2006 -- not sure what the current research is on this drug -- but my son and I are both healthy and pregnancy was just fine.

No finger waggling from me either -- absolutely seconding Madamina's P.S.

Take care!
posted by pantarei70 at 10:30 AM on May 15, 2012

You need to talk to your doctor and OBGYN, get the information and then make an informed decision. Please know that not all meds are going to be problematic. The key is understanding how much crosses the placenta and what the risks are to the fetus. A lot of medication is rated (safefetus.com) and much of it determines the benefit to the mother vs the risk to the fetus. You definitely want to ask a lot of questions about your medicinal options, and know that there are options.

I took 20 mg daily of Celexa before, during and after pregnancy. Very low dose, but my doctors gave me information and let me make a decision.
posted by jerseygirl at 10:31 AM on May 15, 2012 [1 favorite]

I stopped taking my meds at week 20 of one pregnancy and week 5 of another. (I didn't even realize that I'd stopped taking them at first in the second case, but they were making me throw up, so they were never going into my system.) I am not going to lie, it was tough, but it was definitely doable -- in fact, I have elected to remain off my meds after giving birth to my second kid.

The first thing I'll tell you is that the research you're citing is credible, but the correlation is not particularly strong. So while I absolutely understand your hesitation, you should ABSOLUTELY not destroy yourself to keep yourself crazy-med free during your pregnancy. By all means, give it a go, but give yourself permission to go back on them if you need to, or even if you want to.

The second thing is that, as you say, pregnancy is a crazy hormonal time, and sometimes, that can work FOR you. Sometimes whatever weird neurotransmitter situation is requiring you to be on meds can change for the better, and you simply don't need meds as much while you're pregnant. For some women, they are saner while they are pregnant than they are at any other time. It could be that way for you.

I managed it with a lot of complementary techniques. I saw a therapist once a month, I used a lot of CBT stuff to help keep me from at least not compounding my misery, I cut nearly all refined sugar out of my diet (which helped much, MUCH more than I thought it would) and exercised as much as my pregnancy would allow. I did the GAD-7 and the PHQ-9 every week or so, which are questionnaires relating to how much anxiety and depression are affecting your life. I enlisted the help of my husband, my friends, and my family to help provide objective analyses as well. I found it very helpful to remember that this was all short-term, that I didn't need to thrive emotionally during this time, just to survive.

There was also the tremendous excitement and distraction of this new person coming into my life, which helped a lot as well. You can kind of make that irritating pregnant-woman cognitive myopia work for you -- "Gah, I hate everything in the world. I'm going to spend the next four hours browsing decorative vinyl wall clings on Etsy! For the BABY!" And much like your partner is going to have to do a lot of the physical heavy lifting as you get more pregnant, it's also reasonable to expect them to do some of the cognitive/emotional adjustment as well; no, that doesn't mean you get to be a total bitch all the time, but it does mean that they can choose to roll with levels of moodiness that would absolutely not be acceptable on a permanent or long-term basis.

Good luck, and congratulations! Feel free to memail me, either just once or lots of times. Pregnancy is a TRIP, but you have a lot of options. One way or another, you will get through this.
posted by KathrynT at 10:34 AM on May 15, 2012 [2 favorites]

I don't know about Wellbutrin, but I stayed on a relatively new antidepressant (Cymbalta) through my entire pregnancy, with the support of my doctors. I did an outside consult with an expert on antidepressants in pregnancy at Mass General Hospital who recommended I stay on the med, which made me feel a lot better. If you are in New England and would like to see the same people, I can give you the contact info via memail or whatever method works best for you. My understanding is that there is a lot of unofficial data saying that antidepressants are basically fine for pregnant women, but because you can't do real studies on pregnant women for ethical reasons, it helps to have a doctor who knows what's going on in the latest research to tell you the nuances.

Some OB gyns and their nurses scare pregnant women about staying on antidepressants, but it really is not their specialty. It's not like we take this medication for the fun of it.

One of the things that I did not realize before pregnancy and parenthood is that you will be frequently presented with hypothetical choices A versus B. Choice A has xyz risks and could turn out just horribly, you know, and choice B has abc risks and could also turn out horribly. It usually turns out that Choice A and Choice B are both freakin' fine and both people choose either one all the time. But at the time, they present stuff like formula versus breastfeeding as if choosing the wrong one will have dire consequences, and it just isn't so.

I am not a doctor; this is just my experience.
posted by gentian at 10:42 AM on May 15, 2012 [3 favorites]

I took Zoloft during one of my pregnancies, as I was already on it and my doctor pointed out that being horribly depressed carried its own risks. If an anecdote would make you feel better: that kid is my one who doesn't have autism.
posted by The corpse in the library at 10:47 AM on May 15, 2012 [1 favorite]

First of all, congratulations on your pregnancy! And what a great Mom you are for being proactive, thoughtful, resourceful, and for taking the best care of yourself and your baby that you can. Remember that nobody is perfect, and there are no perfect pregnancies or motherhoods.

When I got pregnant, I went off of my meds (Zoloft). I upped my therapy sessions at that point to once a week to specifically support myself not being on meds. For me, that helped hugely...having that weekly, planned time to let it all out. I also was very up front with my midwife and nurse about my fears and wishes. Of course, as you know, the experience is different for everyone, and we all react to medication so uniquely.

I did experience post partum depression, and knew to watch for signs and symptoms of it. I ended up going back on a low dose of zoloft once I was done nursing, though I was told I could still nurse while taking it. That was my personal choice.

Echoing KathrynT: "The first thing I'll tell you is that the research you're citing is credible, but the correlation is not particularly strong. So while I absolutely understand your hesitation, you should ABSOLUTELY not destroy yourself to keep yourself crazy-med free during your pregnancy. By all means, give it a go, but give yourself permission to go back on them if you need to, or even if you want to."

Yes. You know the medication you have been taking works for you. Think about all of the positives that come from that, which will lead to a less stressful, happy Momma pregnancy...those things can and will go miles for your sweet baby. It is all a balancing act, but I generally believe that a happy Mom leads to a happy kid and healthy decisions based on that will usually be the best for everyone.
posted by retrofitted at 10:48 AM on May 15, 2012

My wife stayed on Prozac during pregnancy and I'm certainly glad she did. Even so the postpartum period was difficult. If you look at the general trend of medical advice on this issue it is that treating your medical health is important enough to accept the small and debatable risks of maintaining many medications during pregnancy, including Wellbutrin (per Mayo for example).

You do NOT have to consider interrupting your medication to be the only responsible choice. There are real risks inherent in pregnancy no matter what. Googling only shows you the bad stuff and includes the views of a lot of people who are incredibly biased against medication.
posted by Luke Skywalker at 10:55 AM on May 15, 2012 [2 favorites]

Here is a search on pubmed for adverse effects of wellbutrin +pregnancy. (I also did a search for the mesh heading prenatal exposure delayed effects that didn't throw up anything different.)

there appears to be some small link between congenital heart defects and buproprion use, but not all studies have shown that.
posted by gaspode at 10:56 AM on May 15, 2012 [1 favorite]

I took Effexor during my pregnancy, delivered on my due date and had a healthy baby. She is 3 now and just fine. Before I even thought about getting pregnant I tried to quit and the panic attacks came back so my doctor put me on a lower dose. At the time my life wad relatively stress free and the lower dose was fine. 3 years out I just recently bumped back up to the higher dose. If I were to get pregnant again I would def. try to taper down to the minimal effective dose. Its hard to not worry especially as pregnancy is all about the worrying but as long as your doctors are onboard with your plan I wouldn't fret too much. And ask your doctors about it. They see tons of babies born every year to mothers with all sorts of underlying conditions.
posted by MadMadam at 11:00 AM on May 15, 2012

I stayed on Wellbutrin (300mg/day) throughout my pregnancy. I was also on Lamictal and a relatively low dose of Prozac. I'm in the same boat you were - function fine on them, craptastic without them. We likely would not have had children if it meant coming off my meds.

It wasn't a decision we made lightly. I was part of a study on pregnancy in bipolar women at a program that specializes in prenatal, pregnant, and postpartum women with mood disorders. I also consulted with my OB/GYN as well as the head of the Maternal Fetal Medicine department at my well-respected hospital. Every last one of them had no concerns about the Wellbutrin. The Lamictal was the only one that gave them pause, but (for multiple reasons) even that one was pretty low risk. Taking extra folic acid was the only thing I did differently.

My little guy came a few weeks early as I developed cholestasis, but he was healthy. One of the benefits of the program I mentioned was that a nurse practitioner came to our house when Caleb was about a week old to do a series of tests of his reflexes, etc. He passed with flying colors.

I've seen various studies, and I agree with the poster above that the correlation is not particularly strong, nor is it consistent between studies.

I also, after much consultation with the Maternal/Fetal medicine doc and Caleb's pediatrician (can you tell I like to do research?) have breastfed him for the past nine months. He's a very happy, very healthy little guy who's crawling all over the place and is the light of my life, cheesy as that sounds. I also haven't had problems with postpartum depression, possibly because I'm already on meds. :-)

Obviously, we don't know yet if there will be any long term effects, but in the short term, all is well. I would not hesitate to go through another pregnancy while on these medications. Of course it's better not to take anything while pregnant, but the world just doesn't always work that way. A baby needs a healthy, functioning mom.

I wish you all the best! I'd love to talk to you more if you want to email. :-)
posted by CrazyGabby at 11:00 AM on May 15, 2012 [3 favorites]

I took 50mg/day Zoloft throughout pregnancy and breastfeeding (18 months) with my first, and am now pregnant with no. 2 while on the same dose.

I have no science-y knowledge in this area. I live in the Netherlands where the general medical opinion is that untreated depression in the mother during pregnancy can have various negative effects on the child, starting with low birth weight and ending in the obviously highly undesirable effect of maternal suicide. Pregnant women with mental health problems are seen as people in need of extra care and assistance, not people who need to suck it up and make sacrifices.

There used to be an idea that mothers should just white-knuckle it without meds during pregnancy and that that was best for the baby. Now we know a lot more about the effects of maternal stress and depression on the unborn child, and those aren't good either.

In addition to taking medication, I was referred to a psychiatrist for semi-regular appointments during my pregnancy (as those of us with a history of depression have a higher risk of depression during and after pregnancy). Fortunately I had no problems at all. My partner also came to an appointment with me and the doctor told him some of the signs of postnatal depression which he should look out for.

Without being flippant, I also want to point out what others have mentioned: whatever you do when you're pregnant, you'll find a study saying that it may be bad for your unborn child. I was eating licorice the other day and Googled it out of curiosity ... when eaten in large quantities during pregnancy it has apparently been linked to behavioural problems in children. Yep.

Make the best decision for you, together with your doctor, and keep in mind: this is just the first of many decisions you'll be making on behalf of your kid. Whatever the decision, there will be a chorus of people ready to tell you that you're doing it wrong. You learn to cope with it. I wish you a very healthy and happy pregnancy.
posted by rubbish bin night at 11:15 AM on May 15, 2012 [3 favorites]

This is the summary from Lexi-Drugs:

Pregnancy Considerations - Summary

Due to adverse events observed in some animal studies, bupropion is classified as pregnancy category C. A significant increase in major teratogenic effects has not been observed following exposure to bupropion during pregnancy; however, the risk of spontaneous abortions may be increased (additional studies are needed to confirm). The long-term effects on development and behavior have not been studied.

Pregnancy itself does not provide protection against depression. The ACOG recommends that therapy with antidepressants during pregnancy be individualized and should incorporate the clinical expertise of the mental health clinician, obstetrician, primary care provider, and pediatrician. If treatment is needed, consider gradually stopping antidepressants 10-14 days before the expected date of delivery to prevent potential withdrawal symptoms in the infant. If this is done and the woman is considered to be at risk of relapse from her major depressive disorder, the medication can be restarted following delivery, although the dose should be readjusted to that required before pregnancy. Bupropion has also been evaluated for smoking cessation during pregnancy; current recommendations suggest that pharmacologic treatments be considered only after other therapies have failed. Treatment algorithms have been developed by the ACOG and the APA for the management of depression in women prior to conception and during pregnancy

posted by Halloween Jack at 12:02 PM on May 15, 2012

On the off-chance you are anywhere near Boston, you might consider scheduling an appointment or consultation with the MGH Center for Women's Mental Health. Even if you can't go to see them, they might be willing to talk with you on the phone. They do have a resource page about psychiatric disorders during pregnancy that you may find reassuring.

I will say that I attended a talk by the director of that Center a few years ago, and he stated very clearly that in the vast majority of cases they recommend that women remain on their psychiatric medications throughout pregnancy. Frankly, we don't know as much as we might like about the safety of those meds for pregnant women (though we do know some), but we know A LOT about how harmful it can be to have a depressed/manic/severely anxious mom during pregnancy or early childhood. Of course, talking about your specific situation with a doctor is always appropriate.

Best of luck and congratulations on the pregnancy.
posted by Bebo at 12:28 PM on May 15, 2012 [2 favorites]

I was on Effexor XR during my last pregnancy. Apparently it's the last trimester where any adverse side effects would manifest. I tried to go off and things got really bad. I didn't make it a week without my meds.

My baby was born perfectly fine and with no side effects. He's now a very tall, very talkative, very smart four year old.

My doctor told me that it's most important for the baby to have a healthy mom. It's not going to do anybody any good if I was self-harming while I was pregnant. Take care of yourself first and your baby will be healthy.

I did not breastfeed though. My meds were secreted in breast milk, so I just went straight to formula. It was a compromise that I didn't like, but again, I had to consider my own mental health.
posted by TooFewShoes at 12:41 PM on May 15, 2012

It's going to be such a personal decision. You're going to do the best you can for you and the baby. The science is still forming on this, so it's hard to get the kind of information where you can be firm enough on the facts to just *know*.

Because of that, I cold-turkeyed all of the big meds I was on when I found out I was pregnant. I had to find new ways of defining/achieving functional throughout the pregnancy. There were hard times and harder times. But I couldn't bear the creeping-horror anxiety that persisted when I first decided to stay medicated, so that was the choice I made. I also decided to breastfeed, which meant making the same decision again and again, and ultimately I've just stayed honest with myself about how well I was coping and if I could go just another week/month/whatever without the meds. I've now been off all medication for 2.5yrs.

My coping skills and methods are not perfect, but none are harmful to my little one and all are modifiable once I get to the point where meds are possible again (ah - forgot that part - lost medical coverage when she was just a few months old and ended up not fighting for med assistance due to previously mentioned decisions). You might find that the same is not true for you, though, so know that I'm not saying "if I can do it, you can, too!" - maybe you can, maybe you can't. Only you can know.

I do look forward to a few months from now when medication can once again help with a couple of things I'm tired of constantly holding myself together on, as the edges are fraying quite a bit.
posted by batmonkey at 12:44 PM on May 15, 2012

Took Wellbutrin while pregnant with both of my boys. Both of them are perfect.

I talked with my ob/gyn, my primary care doc, my shrink, and my sons' pediatrician, and they all supported staying on the meds for me. (I also did seek out an ob/gyn with some expertise in depression during pregnancy, which made me feel a little more comfortable about the recommendation.)
posted by Eyebrows McGee at 1:57 PM on May 15, 2012

I've Been There and absolutely feel free to MeMail me if you need to talk about this more. (Standing offer for both the OP and anyone reading this in the future.)

Zoloft is the current standard for pregnancy-safe anti depressant. You might want to consider giving it a second chance in pregnancy as the hormonal shift may make the sex life issues different - sometimes pregnancy is an aphrodisiac. Of course, sometimes pregnancy is its own libido killer in which case Zoloft is not hurting you any.

I chose to stay on Zoloft as my experience being unmedicated was a disaster. I went off my meds shortly before TTC to try and have a medication reduced pregnancy (I have epilepsy in addition to depression, so I was always going to have to take anti-convulsants - which is one of the reasons I didn't want to take an anti-depressant unless I had to.) It was a complete mess. So, with my doctor's go-ahead I switched to Zoloft in anticipation of pregnancy.

Given that a history of depression in the past makes ante-natal depression as well as postpartum depression much more likely, I felt it was best for me and the proto-baby that I stay medicated. I took the lowest dose possible of Zoloft and it worked fine. My 20wk ultrasound showed zero abnormalities. In the immediate postpartum period, my baby had no signs of withdrawal from any of my medications. It worked for us. And I never had a depressive episode during pregnancy nor did I develop PPD - which is very lucky as my medical history placed me at such a high risk for it that my OB and doula considered it all but inevitable.

If you try going medication free and it doesn't work out for you and you need to take something, remember that your body and brain are functioning very differently during pregnancy. Zoloft *might* work for you while pregnant when it didn't before. The other thing to remember is that pregnancy is temporary and you can go back on Wellbutrin as soon as it's safe for you to do so. You don't need to stay married to Zoloft or any other baby-safer drug.

FWIW, I'm not Zoloft's biggest fan. At all. Effexor XR has been the anti-depressant that's worked the best for me in the past and I very much look forward to taking it again. Due to the withdrawal issues from Effexor and the time frame I'm looking at w/r/t future second pregnancy, my doctor and I decided that it would be best for me to stay on Zoloft until I've finished breastfeeding my second child. It's a pain, for sure, but it's not permanent and I can manage the Zoloft side effects better with the perspective that it was safest for my baby and will be my best choice when I eventually get pregnant again. YM, of course, MV.

Best of luck to you and I hope whatever you choose that you have a wonderful and healthy pregnancy!
posted by sonika at 2:30 PM on May 15, 2012

Definitely talk with your doctor, but until you can get in to see him or her, you can always give the Organization of Teratology Information Specialists (OTIS) a call at 1-866-626-6847. They are a non-profit and have a contract with CDC to provide accurate, current, scientific advice to clinicians and patients about exposures during pregnancy. You can call and talk to them for free about your concerns. They also have a fact sheet on Effexor. Congratulations and best of luck to you!
posted by k96sc01 at 4:23 PM on May 15, 2012