Did you take anti-depressants while pregnant?
February 21, 2014 7:06 AM   Subscribe

I went off of anti-depressants when I found out I was pregnant and it has been really really difficult. Debating whether to go back on prozac now that I'm almost in the second trimester and weighing the benefits and risks. No you are not my doctor. Yes I've consulted both doctors (shrink and OB) who advise taking the prozac.

However I'm nervous about breastfeeding and the other risks. There was a question on here a while ago where folks shared what they took and the outcomes (I think all were positive). Please share yours. One question I have - do you know of a link between taking anti-depressants (particularly prozac) with the development of autism? Thanks in advance for sharing your experience. If you can find the previous mefi question that addresses this topic that would be a bonus.
posted by anonymous to Health & Fitness (19 answers total) 5 users marked this as a favorite
Oh, sweetie. There is SO much crappy alarmist info out there, and I'm sure you've already been exposed to lots of it. Many medical professionals are terrified of pregnant/nursing moms (viewing them as big ol' walking liabilities) and are thus hesitant to prescribe any treatments at all.

While the antidepressants-during-pregnancy issue does contain a lot of gray area, it IS often a good course of action - especially if you've had two docs give their a-okay.

The antidepressants-during-nursing issue is a bit more clear-cut: for a lot (but not ALL) drugs, the benefits HUGELY outweigh the potential risks (cite, cite, cite, cite, cite). The stuff about "infant plasma concentration" is the heart of the matter (is this stuff making into the kiddo's blood?), and those results seem largely very, very positive (a lot of SSRIs are undetectable in infants' plasma, and many others are so low as to be negligible).

Personal anecdote: I took Paxil and Lexapro while nursing. I'd do it again in a heartbeat. You only get one go-round with your infant, and taking those meds allowed me to be present, engaged, and affectionate with my baby rather than a weeping, shuddering wreck.
posted by julthumbscrew at 7:22 AM on February 21, 2014 [16 favorites]

I've been on Wellbutrin for some time now, and I'm currently in my second trimester. I've asked two OBs and a nurse practitioner if I should stay on it, and the answer has been a unanimous and resounding yes. Like, "there's no point to going off it" yes. Depression during pregnancy has its own risks, so in many cases taking the medication is the safer route. I obviously can't yet tell you how the kid turned out, but so far so good.

Additionally, the first trimester is super hard, and pregnancy in general can make your emotions all wonky. I was often tired in that same cloudy way that depression made me tired, and I've had a couple days where I just had to curl up and cry. I have a feeling that the combination of heading into your second trimester and going back on the Prozac will make you feel a ton better.

Congratulations, and I hope you're feeling more like yourself soon!
posted by Metroid Baby at 7:35 AM on February 21, 2014 [2 favorites]

Also, as to breastfeeding, if you are not okay with the risks of taking your meds while breastfeeding, you can always choose not to breastfeed, or do a combination. Yes, I'm sure you want to breastfeed and it would be ideal, but it's also very important for you to be able to function and be able to parent your child. I'm facing a similar situation (arthritis medcation, not psychiatric) and I am not letting myself feel guilty if I have to go back on meds in the first few weeks post-partum and can't be (or decide not to risk) breastfeeding.
posted by Pax at 8:08 AM on February 21, 2014 [3 favorites]

FWIW, this is not something I've had to face yet personally but I take antidepressants (bupropion) and am considering getting pregnant within the next year or so. At this point, I think the positives of staying on an antidepressant while pregnant outweigh the negatives. My antidepressants help me stay active, live my life, and relate to my husband and other people. Becoming a mother is stressful. It's more important, in my opinion, that a kiddo has a mother who is happy and medicated than to have a mother who is miserable and not medicated.

I understand your concerns regarding autism and again, I'm no expert but I don't think people know what causes it so I wouldn't worry about antidepressants. Plus if you're an engaged mother while medicated, you'll be able to notice any possible signs of autism early so you can get your kiddo any help it may need. And you don't have to breastfeed. Best wishes and congratulations - I'm sure you're going to be a truly wonderful mother.
posted by kat518 at 8:16 AM on February 21, 2014

Hell yeah. Zoloft, started while breastfeeding my first child, because I had PPD. I took it again, prophylactically, while pregnant and then breastfeeding my second kid. If I were to have a third (no no no no) I would do it again.

This was a few years ago, so there might be new research about what drugs are best to take.

do you know of a link between taking anti-depressants (particularly prozac) with the development of autism

Nope. Don't worry about it. From that article: ...Based on the human studies so far, "if there is any increased risk of autism, it appears small."
And for any one woman, Chambers said, that possible risk would have to be balanced against the risks of leaving major depression untreated.

posted by The corpse in the library at 8:33 AM on February 21, 2014 [1 favorite]

Take the meds! I am a woman who, during two pregnancies, took "scary" meds for various conditions, and I am also a person who functions best when I have help from psych meds. Get started on your meds so that your mood can improve and things can be a little easier, and you can enjoy your baby when it's born. I had PPD after my first, and fortunately responded well to meds, but I tell you it was night and day how much fun being a mom got when I wasn't struggling with my mood.

My psychiatrist and OB both were very supportive of the idea of taking meds. My shrink told me, "we can't do trials on this stuff because you can't do experiments on unborn children, so we can't do a trail where we give some women an antidepressant and some we don't and see how the babies come out. But what we do have is lots and lots of evidence from practice that women and babies do well on these meds."

Congratulations and good luck.

But here's a tip from someone who took steroids long-term during both of my pregnancies and got a lot of pushback about it: if anyone sees your prescription bottle in your purse or on your dining room table and asks you what you're taking, the answer is always "prenatal vitamins." Say it with me now: "Prenatal vitamins." This will save you a tremendous amount of grief from the ignorant and uninformed.
posted by not that girl at 8:52 AM on February 21, 2014 [5 favorites]

For me, the positives of staying on my anti-depressant (Fluvoxamine) greatly, greatly outweighed the risks of trying to get through pregnancy and breastfeeding without them. Both me & the boy were fine in the end too.
posted by machine at 8:52 AM on February 21, 2014 [1 favorite]

Anecdata: I've gestated and nursed two healthy children on my hefty prescription of sertraline. Without the sertraline, I am a mess; with it, I am a normal person and a good mom.

There is no evidence linking SSRIs to autism. Here's a recent cite from the New England Journal of Medicine.

It sounds like your psychiatrist and OB are giving you good advice, in line with the clinical evidence. julthumbscrew's links are great. Incidentally, the most studies have been done on Prozac and Zoloft (sertraline) because they've been around longest, so if it makes you feel any better, you take one of the two drugs that's been studied most in this area, and medical professionals who are up on this stuff think that it's not only "not bad," it's good for women to stay on their SSRIs while pregnant and while breastfeeding.

There's a lot of scaremongering around about pregnancy and breastfeeding. It can be paralyzing: what if I make the ONE WRONG DECISION THAT SCREWS UP MY BABY FOREVER AND IT'LL BE ALL MY FAULT. But, truly, it's going to be ok! It's good to take care of yourself. And you'll take much better care of your baby if you're healthy and happy.

FWIW -- and I know this is not everyone's experience -- I've found that I actually feel at my best emotionally while nursing. That constant hit of oxytocin is awesome.

posted by a fair but frozen maid at 8:54 AM on February 21, 2014 [4 favorites]

I can't speak specifically to prozac, but I have known a couple breastfeeding/pregnant mothers who have taken it with good results. I have taken both zoloft and wellbutrin while breastfeeding. I started zoloft just before baby turned 1 and added wellbutrin around 15 months because it had worked well for me in the past.

The doc who prescribed zoloft did so because it's considered the most ideal first try for breastfeeding mothers. I'm pretty sure prozac runs a close second.. There is a very low concentration found in breast-milk and studies have shown that none shows up in babies' blood. I can't say I noticed any change in my child when I started taking it. That doctor nearly prescribed me wellbutrin, but withdrew the idea when I expressed some concern about its categorization and relative lack of research.

By the time I was ready to change my meds, breastfeeding had decreased to about twice a day. I took Wellbutrin 300mg XL and Baby Violet remains healthy and developmentally on track to this day.

For me, zoloft worked well to curb anxiety problems but amplified my depression taken alone. I'm happy I made the decision to introduce the wellbutrin. The benefit seems have outweighed the risk. I'm not sure I would have wanted to take wellbutrin while exclusively breastfeeding, or if I'd have previously been comfortable taking them in pregnancy (with all the reassurances in the world), but my experience has otherwise been good. If I have any future pregnancies with mental health troubles, I will definitely be more open to pharmaceuticals.

Listen to your doctors/midwives carefully, but most importantly listen to what your body is telling you. I hope you find peace in whatever choice you make.

posted by Violet Femme at 8:58 AM on February 21, 2014 [1 favorite]

Took antidepressants during both pregnancies and while breastfeeding both for a full year each; no problems at all. Happy, functional mom clearly outweighs the tiny risk for the vast majority of women.
posted by Eyebrows McGee at 8:59 AM on February 21, 2014 [1 favorite]

I'm in my second tri and am sitting in the waiting room for my pdoc checkup :) Obviously every experience will be different, but the way I (and my doctor) see it is this: a calmer, more settled mom is way more important to the baby's health than anything else you might gain by going off antidepressants. The baby will feel your emotions, your hormones, etc. and pick up on those things.

I am on 150mg of Effexor. The risks around birth are basically the same on or off it: slightly irritable baby, slight prematurity (like a week) due to stress, etc. I haven't heard of breast feeding risks, but I KNOW we would have talked about it. We discussed this before I got pregnant, and we discuss it every time I come in (2 months). I always have the option of changing my mind, even though Effexor has crappy withdrawal.

My doctor just chimed in to say that if you're taking meds during pregnancy, the dropoff for the baby during breastfeeding is pretty low-key.

Basically, this is a decision to make, and KEEP making, with your OB and your psychiatrist. There are ways to safely stay off of psych meds (for some people), including strict exercise and self-CBT plans. But that's something to plan with your doctor, too, NOT to do on your own.

Consider how much stress you are likely to be under during various points of pregnancy, and postpartum. You need to do what will keep you safe and healthy. Your brain and emotions are simply another bodily system to consider in the equation.
posted by Madamina at 9:10 AM on February 21, 2014

This was a concern for me when I was planning to get pregnant, so my psychiatrist referred me to the Mass General Hospital Women's Mental Health Center. Obviously that's not useful if you're not in the Boston area, but the website itself has lots and lot of good info.

FWIW, the pyschiatrist at MGH that I talked to felt that the risk from me going off my meds (wellburtrin) and having an episode would be far more harmful to the baby than the risk of staying stable on the meds. My regular psychiatrist and my OB were also 100% supportive of this. I will continue to take it while breastfeeding.

The hormonal rollercoaster was hard enough to deal with on my meds - I would not have wanted to try it unmedicated.
posted by data hound at 9:53 AM on February 21, 2014 [2 favorites]

I did not take anti-depressants with my first pregnancy. My first child has autism.
I did not take anti-depressants with my second pregnancy, even though I was dealing with situational depression brought about by the death of my dad. I did not want another autistic child so I swore off any medications. My second child has developmental delays.
I took Zoloft with my third pregnancy because I had severe post partum depression from my second pregnancy (got pregnant again when the second was 9months - failed birth control). I was so depressed I was suicidal and had to be hospitalized twice. I was on the maximum dosage allowed for pregnant women. My third child is totally normal.
Your mileage may vary.
posted by ramix at 11:52 AM on February 21, 2014 [5 favorites]

My doctor took me off Wellbutrin which I take for seasonal affect disorder when I started seriously trying. I got pregnant in June and stayed off medication until October when it became clear to me that I would not be able to function without something. Then she put me Prozac for the duration of my pregnancy. My doctor is very up on recent research and felt Prozac was the best choice. I couldn't breastfeed (low supply in part due to undiagnosed tongue tie) so we went almost immediately to formula (though my doctor ok'd breastfeeding with Prozac). It really cannot be said enough: happy mama = happy baby. You have to take care of yourself if you're going to take care of your baby. My guy is closing in on a year and he is happy and amazing.
posted by betsybetsy at 5:11 PM on February 21, 2014

Sorry, forgot to address your specific question about autism. Here's my understanding. No one knows what causes autism. There are a couple of things that absolutely lead to developmental problems similar to autism (mostly genetic disorders) but for the vast majority of people diagnosed with autism there is no clear cause. Studies have been done but most have problems such as small sample size, differences in how autism is diagnosed etc so it's difficult to draw definite conclusions. Regarding use of psychiatric drugs during pregnancy there are a few studies but most don't differentiate between different types of psychiatric drugs (Wellbutrin is in a different class than Lexapro, etc). My doctor approved Prozac for me because it is very widely proscribed so there's more opportunity to study. The study she told me about looked at women who were taking Prozac when they were pregnant and noting whether their child had autism rather than looking at children with autism and seeing if their mother took Prozac which is an important difference I think. I believe there was a slight increase in correlation but that could be attributed to other factors (the depression itself, lack of adequate early prenatal care, who knows what else). Sorry I don't have citations for specific studies but you can check out PubMed. Basically, when it comes to any advice concerning your baby you want to look very closely at the source, especially if it's a very charged topic.
posted by betsybetsy at 5:38 PM on February 21, 2014

There is a ton of stuff stored in your body that is already being passed on to baby, from heavy metals to flame retardants, all with known and proven dangers. And, in most cases, these contaminants are utterly benign.

I do not think that the very hypothetical risks of the drugs that maintain your mental health are really much of a big deal compared to, say, cadmium.

Note: I have man parts, but I do take an antidepressant. My good friend did grow herself a baby, and stayed on her Celexa the whole time. Her kid just tuned one, and she is doing great.
posted by ivan ivanych samovar at 7:17 PM on February 21, 2014

There have been studies showing that unmedicated women with depression have babies who are underweight or have behavioral problems, probably because someone who has depression but isn't taking medication is likely to take worse care of herself than usual.

So it's important to think of it not just as "medication = interfering with fetal development, no medication = neutral," but to realize that there are risks to not taking your medication, too. Obviously those risks, in both cases, are going to vary depending on the severity of your depression -- if the depression is super mild, the risks of going off the medication will be less -- but the fact that both your doctors are encouraging you to stay on the meds leads me to believe that your depression is not super-mild.

Another thing to keep in mind is that going off your meds during pregnancy can increase your risk of post-partum depression.

And a third thing: The nice thing about being on Prozac is that it's one of the oldest commonly-used antidepressants, so there are lots and lots of studies about it, because there's been time to conduct them. Doctors really aren't just guessing with Prozac anymore.
posted by jaguar at 7:25 PM on February 21, 2014 [1 favorite]

Are there other reasons that you're proxying the very unlikely autism etc risks for? I was on prozac for several years, and in hindsight, I wish I had been put on it post-partum for a year or so again because it was a very very tough time. But it was a struggle for me to go on prozac because I felt like a failure as a parent, like I wasn't worthy or capable of parenting because I needed meds, that they were a sign of my failure to be enough. That was the depression talking (and my parents who were anti-meds) because duh, being a good parent is not being superhuman perfect, but being someone who can ask for and use help, including meds, to give them the sanity and energy and ability to parent well.

The hilarious thing is that I have used all these arguments to help people very dear to me get on and stay with medications, and yet for myself, I'm a failure because I can't magically fix myself into the perfect parent all by myself.

You love your baby lots. Give your baby a healthy mum with medication.
posted by viggorlijah at 8:19 PM on February 21, 2014 [3 favorites]

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