Antidepressants, Breastfeeding and Pregnancy Information

[Crystal]

Antidepressants, breastfeeding and pregnancy information resources

http://www.kellymom.com/health/meds/antidepressant-ref.html

note that the kellymom references are a bit dated, the latest in 2004 or so.

Breastfeeding expert Dr.Hale provides a heirarchy of antidepressant choice and summary discussion of pros and cons. See summary of Hale's seminar here: http://www.kellymom.com/health/meds/antidepressants-hale10-02.html

Zoloft is the number one choice, Lexapro is further on down the line.

The main reasons are that Zoloft is not excreted in the breastmilk, Lexapro is in very small quantities. There are reports of this causing sonomulance (sleepiness) in newborns. However there are very few reported cases (only two as of this report) and the risk seems to be minimal for older infants.

Weight gain and sexual side effects as described by (poster) are possible with all the SSRIs and it seems that some people are more sensitive to these than others. My doc says that Lexapro has the lowest level of reported side effects of any of the SSRIs.

One important possible side effect to watch out for is increase or intro of suidical or other thoughts of harming self or others. Doctors recently realized this is a risk with all SSRIs. With Lexapro, it can happen about 2-3 weeks after starting the meds and 2-3 weeks after med increases. It's important to be monitored closely by a doc during these times.

ETA: Celexa is the earlier version of Lexapro.

ETAA: Read below for important new info on Paxil, no longer recommended for pg women, associated heart defects.

[Crystal]

On Lexapro:

I took this from the 2nd trimester until Julian was almost 4 months old Lexapro for depression related to fibromyalgia. My FMS specialist highly recommends Lexapro. It worked very well for me and I had no real issues weaning off.

Lexapro is considered the "cleanest" of the SSRIs, meaning it has the lowest incidence rate of reported side effects. Weight gain is not as common with this as it is with other SSRIs.

Many people experience some unsettling side effects in the first few days of taking the meds including eye twitching, eye watering, dry mouth and feeling a bit wiggy in the body. This usually passes.

There's an elevated riosk of suicidal thoughts during the adjust periods at 2 weeks after starting new/higher doses, so patients should be closely monitored and have follow up appointments during those times.

Hales does not not recommend Lexapro, but it is not his first choice for SSRI as it does pass into bm in significant measures, has a long half life and of course long term effects on exposed infants are unknown. Other SSRIs (Zooft) are higher on the recommendation heirarchy, but also have more side effects for moms. Risk should be weighed against benefit.

I switched to a low dose of Zoloft and it's working quite well.

[Crystal]

On weaning off antidepressants:
Those of you who are weaning,

Be sure to make a quiet space for yourself today to relax and meditate for at least 10 minutes. Do nothing but sit, relax, clear your mind and, if needed, listen to meditative music. Breathe deeply and slowly.

Be sure to go for a brisk walk for at least 20 minutes.

Eat healthy, light, balanced whole food meals that are low in refined / simple carbs, high in fiber and protein.

Ask for help with your kids if you need it.

If you start to feel anxious, drink some chamomile tea, mint tea and/or -if it is close to nap- or bedtime, some BedTime Tea by Yogi teas.

If you start to feel freaky, withdrawal like feelings or overly anxious, do some breathing and stretching.

Brush aside the old tapes and excuses in your head telling you you can't do this, you don't have time, you don't feel good enough, you don't have enough energy, etc. Each of these little exercises will help get you through the next 10 minutes. Continued into a daily routine, they will help you feel and be more healthy in the long term.

[Crystal]

SSRIs and weight gain


you won't be able to make a decision about weight gain based on others' experiences with the meds. SSRI side effects are different for different people, some get fat on one and some get skinny on the same thing.

I had a very good experience with Lexapro in general, but all the SSRIs I've taken have affected my appetite in that they all make me want to eat a lot more.

The only way you are going to know is to try it.

Lexapro has a reputation of being the "cleanest" of the current SSRIs with the lowest level of reported side effects.
***


It helps to understand the how SSRIs make you gain weight. They don't know the exact mechanism / why yet - but they do know that serontonin seems integral to the way the hypothalamus functions. This is the part of the brain that controls appetite in that it signals the brain that you are full.

SSRIs impact the amount of serontonin flowing through the whole system. For some people, tinkering with the hormone probably sets the hypothalamus out of whack in such a way that it can no longer communicate this message of fullness, so we don't know when to stop eating.

Craving food all the time wouldn't be a problem if I was eating lettuce, carrots and apples all day. Unfortnately, junk food makes us feel good for a variety of reasons, so if you keep it handy that's what you will be reaching for.

I know I've mentioned to you in the past that there is solid research out there that shows that regular cardio exercize (at least 30 minutes 5 times a week) and a healthy diet are as effective as medication in controlling depression, and are more effective in the long run for people who keep it up.

I know how hard it is to get started and keep up with it, which is why I'm still on meds and getting fatter by the minute. (She types as she stuffs another trisket topped with hummus and dark chocolate in her mouth).

Changing your dosage won't matter with the food craving issues.

[Crystal]

Paxil is being moved to Category D for pregnancy and is no longer recommended.

originally posted by ILM:
The early results of two studies showed that women who took Paxil during the first three months of pregnancy were about one and a half to two times as likely to have a baby with a heart defect as women who received other antidepressants or women in the general population. Most of the heart defects reported in these studies were atrial and ventricular septal defects (holes in the walls of the chambers of the heart). In general, these types of defects range in severity from those that are minor and may resolve without treatment to those that cause serious symptoms and may need to be repaired surgically.

In one of the studies, the risk of heart defects in babies whose mothers had taken Paxil early in pregnancy was about 2 percent, compared to a 1 percent risk in the whole population. In the other study, the risk of heart defects in babies whose mothers had taken Paxil in the first three months of pregnancy was 1.5 percent, compared to 1 percent in babies whose mothers had taken other antidepressants in the first three months of pregnancy.

http://www.fda.gov/bbs/topics/NEWS/2005/NEW01270.html


ASDs and VSDs are the most common CHD, very low risk as far as CHDs go. They are very easily repaired and very often undiagnosed or ignored b/c they often repair themselves with no treatment.
As a CHD parent I am not convinced that these kids would not have had a CHD without the Paxil.
I am thinking it was only caught and noticed b/c the moms were on Paxil.

I know plenty of people IRL that were told they had a VSD or ASD and left alone, never treated or diagnosed, so I think it is waaaay underdiagnosed to begin with.