Should you stay on or get off Zoloft while pregnant?

August 26, 2005 5:18 AM

I'm looking for advice and anecdotes about Zoloft and pregnancy.

My wife has been taking Zoloft to treat what was a suicidal depression for the past four or five years. Combined with some initial counselling to learn how to think happy thoughts all over again, the meds were quickly and completely successful, and she's never been happier.

As prosperous, well-adjusted early-30-somethings, we'd like to start a family soon. However, there doesn't seem to be a lot of information out there about the risks associated with taking Zoloft during a pregnancy. Our doctor has indicated that there's a risk that the baby might be stillborn, but that there hasn't been a lot of research done.

My wife faces a dilemma - come off the Zoloft, and risk falling back into depression under the pressures of being pregnant, or stay on the meds, and risk a complicated or failed pregnancy.

I'd like to hear from women who've done either. What was it like being pregnant with or without Zoloft? Did you come off / go back to the meds while breastfeeding? What have your doctors told you about the risks?

posted by anonymous to health (9 comments total)

I can only suggest consulting her doctor's about an alternative medication for/during pregnancy and breast-feeding. It may well be a challenge to both of you but one that I'm sure can be well managed and planned for - and with beautiful results.
posted by LadyBonita at 6:58 AM on August 26, 2005

go back to the meds while breastfeeding? What have your doctors told you about the risks?

I can only answer these two questions-- my doctor specifically gave me Zoloft for my PPD because I was breastfeeding. Of all the anti-depressants, it's the only one not regularly found in breastmilk, and when it is found, it's in an impossibly tiny trace amount.

I can't help you with the pregnancy questions, though, and I wish you good luck on finding the answers.
posted by headspace at 7:18 AM on August 26, 2005

I started a low dose of Zoloft during my second trimester and am still on it while nursing. I initially wanted to try and go through my pregnancy drug free, but I found myself unable to function as a rational human being. I felt that since I already had I child, I had a responsibility not to be a complete nutcase to him, and taking a small amount of medicine seemed a decent compromise. Also, according to both my OB and my midwife, the stress levels I was experiencing while depressed weren't exactly benefiting my baby.

This baby is fine - incredible actually. I've continued to take Zoloft while breastfeeding, in part to stave off post-partum depression, which hit me hard after the last pregnancy, and in part to help me adjust to the "new normal" of motherhood. If your wife has had trouble with depression before, you should be concerned about pp depression - it made my earlier episodes seem like innocuous bad moods. I took Paxil, btw, when I was nursing my first child, with no ill effects.

My OB says that Zoloft only shows up in small amounts in the milk and, so far, has not shown to have harmful effects on the baby. Along with Paxil, it's commonly prescribed to pregnant and nursing mothers. There's a good discussion on the The Berkeley Parent's Network, complete with personal anecdotes.

It's never easy to decide to expose your baby to drugs, even a minute amount. But there are several components to being a "good" parent, and keeping your baby chemically pure (perhaps a quixotic goal in this environment) might come at too high an emotional expense. If you are worried, by all means, try exercise and therapy - they work for many people. But if your wife chooses to take Zoloft, remember that A) She's at the mercy of some powerful hormonal changes and B) She has the OK from the majority of the medical community. Don't let the inevitable "drugs are for the weak" chorus guilt either one of you.

Feel free to email me if you have any further questions.
posted by bibliowench at 7:24 AM on August 26, 2005

I have no idea why your doctor would say such a thing to you. With no conclusive evidence of any negative side effects at all the baby, I had no conflict at all about whether to stay on Zoloft during my pregnancy. Unfortunately, I was not able to breastfeed for reasons that were unrelated to the Zoloft, but my child was born completely healthy and continues to be an amazingly bright, energetic and wonderful wild 2.5 year old. Had I not continued the Zoloft, who knows how I would have coped with post-partum, the shocking sudden death of my brother 3 months after my daughter's birth, single motherhood and a host of life's other little surprises.

At the time, my doctor said that in situations where there is not conclusive evidence one way or another, the best thing to do is to see if the benefits outweigh the risks. For me, the benefits (huge) certainly outweighed the risks (if any).

I hope this helps. Good luck.
posted by robink at 8:39 AM on August 26, 2005

Wow. This is a subject I researched up and down and sideways before becoming pregnant. Like your wife, I've struggled with chronic and severe depression and have a pretty normal life when on the right meds.

I sought out a specialist from the Perinatal Depression Project at the University of Illinois at Chicago. It was the single best thing I could have done while looking for this type of information. Their patients are ONLY pregnant women or women seeking to get pregnant who struggle with depression. After a discussion with Dr. Laura Miller, I was very confident in my decision to switch to Zoloft for a pregnancy and breastfeeding. She carefully outlined the pro's and con's of many meds, and had the most complete and up-to-date research about the effects of meds on a developing fetus/baby.

The important thing to keep remembering is, "Healthy/happy mother is the best chance for a healthy/happy baby." Also, there is a bit of a risk for perinatal depression as well as postpartum depression (perinatal occurs during the pregnancy). I experienced a pretty nasty bout of perinatal depression during my first trimester but have had a very calm and emotionally positive second trimester. "Forwarned is forearmed" is my motto. We rallied our families and friends, shared what we had learned about the possibilities that we would need some special support throughout this time, and everyone has been wonderful.

Many women who need to take Zoloft during their first two trimesters will reduce the dose during the third in order to reduce the effect of withdrawal on the newborn, but if they cannot, the withdrawal effect was described to me as being relatively short because of the half-life of the meds (48 hours I think). So, not all women can reduce their dosage. They also have longitudinal studies on older children whose mothers took Zoloft during pregnancy and can find no ill effects on these children related to the Zoloft. (I am not a doctor nor do I play one on TV!)

I would consult a specialist. My OB/GYN, meds doc and even my general practitioner were very pleased with the quality of information that I received from Dr. Miller and they all wrote down the contact information for the PDP. I consider them to be top-notch doctors, but they didn't have the detailed information that a specialist would.
posted by jeanmari at 9:18 AM on August 26, 2005

I was prescribed zoloft for PPD and OCD after my first child was born. I made the decision to stop taking it before trying to get pregnant again, as pregnancy hormones tend to make me emotional, but happy for the most part. And the OCD is pretty manageable as long as I'm not going through a depression at the same time. Obviously, ymmv.

I started taking it again a few months after he was born.
posted by whatnot at 9:28 AM on August 26, 2005

Have you seen Dooce? Reading her archives could be helpful.
posted by Lotto at 10:08 AM on August 26, 2005

Jeanmari, thank you for posting the link to the UIC program. It's exactly what I've been looking for when thinking about trying to get pregnant within the next year or so.
posted by sugarfish at 4:30 PM on August 26, 2005

A dead mother isn't any good for the baby, so I have to side with staying on medication.

Get a second opinion. Look into changing the dose or switching to a different medicine. You're playing with fire though, so be vigilant with any change. Trust a doctor over what us yahoos say here.
posted by fleener at 10:25 PM on August 26, 2005