Zolodex - For obvious ethical reasons, there are not any studies done for humans trying to conceive while taking Dexedrine™ (dextroamphetamine). Most case studies I have read on this subject involved accidental pregnancies while abusing &/or dependent on methamphetamine (speed). These mothers are taking a more potent form of amphetamine, and are taking much higher doses relative to what you are taking. Babies born to these mothers usually arrive prematurely, and subsequently have a lower birth weight. These babies may experience withdrawl symptoms (agitation, dysphoria [depression & anguish], and lassitude [uninterested in surroundings]).

Extremely high doses of amphetamines, given to mice and rats, who then conceive, may cause embryotoxic (eg. miscarriages) and teratogenic (malformation) effects; but I have not read a study where a direct causal link involving the amphetamines has been proven. It doesn't happen all of the time, to all of the litters.

I have not had direct clinical experience with anyone taking amphetamines and either trying to or becoming pregnant. This means that I can only report what I have seen in the literature; and even then I have not read any articles involving Dexedrine and women trying to conceive or becoming pregnant. My reading on the subject has only involved those who are addicted to speed. The problem with these case reports is that speed is usually not the only drug that these ladies abuse, and they generally do not have the best prenatal care. It is difficult to determine what, if anything, causes an abnormality in their baby. Low birth weight and premature birth is a risk factor of cigarette smoking. Adulterants and impurities in the drugs could cause worse problems than the drugs themselves. Generally, those addicted to speed do not take care of themselves (ie. poor nutrition, poor sleep habits, poor hygiene, etc.).

One would assume that a healthy woman taking moderate to low doses of Dexedrine for a medical purpose, and who is receiving proper prenatal care, would be at less risk of delivering a baby with any kind of problem. I must stress that I have no scientific proof of the last statement, though.

The CPS (Compendium of Pharmaceutical and Specialties), the Canadian equivalent of the Physician's Desk Reference (PDR) does not say that conceiving a child or pregnancy is an outright contraindication, but states that Dexedrine should only be used in a pregnant women when the benefits of treating the depression with Dexedrine outweigh the risks of not successfully treating the depression.

As for not successfully treating depression both during pregnancy and post-partum has been shown to be harmful to the fetus. Several studies have shown this. Depressed pregnant women do not have the energy to take care of themselves during pregnancy, to the level that the non-depressed woman would. This could result in a nutritional imbalance in the fetus. Studies have shown that a woman who is still depressed post-partum does not have the energy to interact with their baby to the extent that they should. There have been long term studies showing that this lack of stimulation in the child has been associated with learning difficulties and social adjustment problems which are still evident when the child is 7 years of age.

As for the Zoloft™ (sertraline), there have been recent studies showing that it seems safe in pregnancy. Zoloft may also be the drug of choice in mothers with depression who want to breastfeed. While the drug is excreted in the breast milk, it is reduced to very low nanogram per millilitre (ng/l) concentrations in the babies blood, due to a reasonably well developed enteric first pass metabolism effect as the Zoloft is absorbed.

Okay, so now what's the safest course of action for you? You state that without the Dexedrine you tend to relapse; and since depression adversely affects pregnancy, this may may mean that you may have to continue taking the Dexedrine. One thing that you must discuss with your doctor is how to handle conception and early pregnancy. The first trimester (ie. the first 3 months) are the most critical in fetal development. Perhaps if you could stop the Dexedrine for the first trimester (but continue with the Zoloft at the same dose, maybe even increasing the dose a little bit); then restarting the Dexedrine in the second trimester, you may avoid taking this drug (thereby reducing fetal exposure to the Dexedrine) during the fetus's most vulnerable period. OTOH, this may not be an option for you, but it is something to talk to the doctor about.

I would advise you to book an appointment late in the day (ie. last appointment); and explain at the time of booking that you need to have an hour (or at least a half-hour) for a consult about your planned pregnancy. The two of you, actually the three of you (your husband needs to have informed input into this decision, as he is going to have input somewhere along the line....I'm sorry, I can't believe I said that =^) This does involve you and your husband, so he should be there, as well. Take in a list of questions (written out) to ask (eg. should you try to find a minimum effective dose of both meds before trying to conceive?; should you try to stop the Dexedrine for the first trimester?; what should be done as a rescue plan if you relapse; how often should you have ultrasounds?; starting when?; is amniocentesis an option?; is it necessary?; what short of prenatal vitamins should you take?; etc.). This is just a sampling of questions. Others on this board may be able to come up with a few more questions, or may have some insight into this.

Basically, you want to arrive at a game plan that covers all eventualities. Perhaps send your list of questions in to the doctor a week or two ahead of time. This will give him/her time to ponder the questions, and you will be able to use the appointment to find a game plan that is satisfactory to all three of you. You may want to include an ob/gyn doc in this, as well, or at least have your doc contact the ob/gyn that you will be using, as a consult. Get as much professional information as you can.

Remember, this is not a field that I am comfortable giving advise in. There are too many unknowns with the drugs; and I also do not know your medical history, nor do I know you. Be sure to get a second opinion about anything I have said. Use my words only as a guideline. I do not have any concrete answers, here.

I hope that this gives you some direction. - Cam