Cam - how dangerous are my meds if trying to concieve?

Years ago, I was diagnosed with chronic depression; and, more recently, with A-ADD (Adult ADD). I take 100 MG of Zoloft daily and 15 MG of Dexedrine. The combination works wonders. But now that I'm trying to get pregnant (I'm 35), I fear the Dexedrine could affect the fetus. My doctors say different things. Most say they just don't know -- but the safe bet is to get off the Dexedrine BEFORE conceiving. They seem to agree that Zoloft is safe enough. Whenever I ease off my Dexedrine, I immediately spiral downward into a depression. I'm fog-headed and exhausted, cranky and unclear. Since my husband and I have tried to get pregnant for more than a year now unsuccessfully, this off-and-on approach to my medication is not ideal. What, realistically, are the risks associated with staying on my medication until I know for sure that I am, indeed, pregnant? I'm getting to the point where I'd rather take that chance than go through the monthly roller-coaster ride. Any advice is sincerely appreciated.

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

Cam,
My mom had me 10 yrs. after my brothers (says I was an accident) for the first trimester she had been on diet pills because she did not realize her weight gain was because she was pregnant she just thought her periods were out of wack due to her age and menstrual problems. What I am getting at is that her use of diet pills in the first trimester may have attributed to some of my attention problems I have had through out my life, some doctors said it is very possible. So I would suggest to anyone to not use amphetamines during pregnancy or even while trying to conceive, in fact I cannot picture any doctor saying it is okay. You give the right information and it is good that you stress to people that you are just giving information but that the person in question take issues up with their physician. You are a big help to us with the info. you are able to pass on. Thanks!
Stay well,
"darkeyes"
PS How are you coming along with your "pains?? See a doctor yet?

Darkeyes - No, I haven't seen a doctor, yet. I am feeling better, and do see my massage therapist tomorrow. I am loosening up a bit, and the muscles in my thighs, hips, and pelvis are not as tight. I think that I just really jammed my braking leg into my pelvis and hur thte muscles really good.

If the massage therapist has trouble with knots again tomorrow, I may have to go. Last week she damn near killed me, while working out the kinks in my back. She says that she cannot believe that my neck doesn't hurt, with how knotted it was. Let's see what tomorrow brings.

Thanks for your insight into the amphetamines. Like I say, I haven't seen that situation clinically, so I have to rely on what the books say. Often there is big differences in certain aspects of knowledge in something you read and see clinically. Overall, the articles and books tell generalities, but it is the details that differ, sometimes vastly. That is why I am hesitant to give only book knowledge; it probably doesn't tell the whole story.

Thanks again, and keep healthy for the holidays. - Cam

Cam, Thank you very, very much for the information. I completely understand that this is unchartered territory - so I appreciate you taking the time to help me come up with an action plan before my husband and I conceive. I know there are no guarantees with medications like these - but I wholeheartedly appreciate the detailed information you've shared. I promise, if we ever are able to have a healthy, happy baby, I will let you (and everyone else here) know the result..
In the meantime, I plan to take your advice and map out a series of questions, and contingency plans should I decide to continue on the 15 mg of Dexedrine while attempting conception. In the past, when I've spoken to my OB GYN about that possibility, he simply dismissed the idea as a "no no," so I felt like I had no option. But I need to make it clear that I am seriously considering staying on it (at least until we know for sure that we're pregnant) despite the potential risks. I want to safeguard my own health and stability before I become responsible for another life. He may balk due to liabilities, but I'm willing to take full responsibility, even sign a waiver, if necessary.
I've already decided to stick with the 100 mg of Zoloft, because, as you noted, a depressed mother-to-be may (inadvertantly) do more harm to a developing fetus than one who continues on the moderate dosage. The OB GYN and my psychiatrist both strongly agree on that point. (As does my regular family doctor).
I am in good health otherwise, although I am getting older (now 35); and have been treated with surgery twice for minor endometriosis. So far, no luck with getting pregnant, but I believe if I can keep my energy level and moods stable (with medication) our odds of conception will improve.
Thanks again, Cam. I'm so grateful to have found this board, and you, online. I'll keep you posted. Have a wonderful weekend. -- Laura