Hi guys. Some of you have may seen my previous threads about trying to get off my meds so I can get pregnant; I've also talked a bit about it in chat. An issue has come up in this process for me and I was hoping to get some thoughts about it.

When my husband and I first seriously started talking about getting pregnant a few years back, I was on Lamictal, Effexor, Wellbutrin, Abilify, and Klonopin (as needed). This was the cocktail I had left the hospital on in 2010 and as I was relatively stable on it my pdoc (actually a nurse practitioner) was loathe to touch it. She did not think I would handle being off all of my meds well and repeatedly suggested that my husband and I look into adoption.

From my own research I knew that plenty of women take antidepressants while they are pregnant; it is just a matter of knowing the risks as well as knowing which meds to take and in what trimesters. My NP, however, was very cautious and strongly favored the no-meds-at-all approach to pregnancy. I don't think this was based on any of her previous patients' experiences; in fact, I get the impression she doesn't have much experience with pregnant patients, period. She would often crack open her Physician's Desk Reference when I had a question about a med's classification.

She didn't think I would do well on no meds, however. But I was insistent that I wanted to at least try and have a baby. We started slowly weaning me off my meds and it did not go well.

As a result I ended up in a partial hospitalization program. I could not stand the group therapist I was assigned to there but when I discussed my meds with the NP there she said that 1. I was on way too many and should get off some (I was so happy about that) and that 2. Some meds are ok with pregnancy and she had treated plenty of pregnant women on meds.

After the PHP I went back to my regular NP, now just on the Lamictal and Effexor. My regular NP was skeptical of the changes the PHP NP had made. Also, when I told her about the PHP NP's view of being on meds while pregnant, she said something to the effect of, "Well, I don't know why she thinks that's ok, but I am basing my opinion on the most recent literature."

It was getting clearer to me that my NP and I just had different philosophies on psych meds and pregnancies. I tried to get an appointment with a pdoc who specializes with pregnant women but he wasn't taking new patients. So instead I talked to my OB/GYN for a sort of second opinion.

He said 1. Lamictal is only dangerous during the first trimester because of increased cleft lip/palate risk and 2. Effexor is only dangerous during the last trimester because of pulmonary hypertension risk. I took this info back to my NP and said I wanted off the Lamictal; we did a slow two-month taper off. I figured at that point I might as well try to get off the Effexor as well.

Last week was my last dose of Effexor. The next day all hell broke loose and I felt more anxious and depressed than I had in years. The range and types of emotions I was feeling were those that I had not felt since my last hospitalization.

So my husband suggested I go back on the Effexor until I get pregnant and am in my last trimester as according to my OB/GYN that is when it is dangerous. I thought this was a good idea until---and here is my main issue---I found a study online that links Effexor to increased risk of miscarriage.

Here's the link if anyone is actually interested:

Use of antidepressants during pregnancy and the risk of spontaneous abortion

Basically the article says that being on Effexor doubles the risk of miscarriage and the higher dose you are on, the higher the risk is. I have a background in statistics/econometrics and as far as I can tell the study/methods are sound.

So now I just don't know what to do. I'm not sure I can realistically go on feeling like this for nine months or longer. At the same time, I don't want to double my risk of miscarriage by going back on the Effexor. Complicating the issue is the fact that I feel constantly at odds with my NP because she believes no drugs are safe during pregnancy and I feel like it is a balancing of risks. I also do not feel like she has confidence in my ability to get through a pregnancy on no/limited drugs and she also keeps "reminding" me how hard it is to raise a child.

Wow, this is really long; I apologize. Thanks for reading.