[LostandLonleySoul]

The last time I went to the Dr he said that it was ok for me to start taking all my meds again (900 lithium, 800 seroquel, and 300 effexor). I quit taking the meds when until I was two months pregnant(that is when I found out). Now that I am around 22 weeks he said that the risk of something happening to the baby now is really slim and that there haven't been any studies that show that after the first trimester the baby will not have birth defects. I am just really unsure. I know that the Dr. wouldn't lie about something like that, but is he really informed about this? What if there is just insufficiant data on this matter? Please help me.

[Larry_Hoover]

There are two issues. One is your health, and the other is that of your baby. If you're not well, your baby cannot be well.

I have studied this issue at great length, and the decisions must be made on a case by case basis.

Your doctor is correct that the fetus is past the point where adverse development effects from the meds would be likely. You've got a little less than half the pregnancy yet to go. If your mental health is such that it makes sense to stabilize you with medication, that is also the best decision for the baby. That is what the experts have said.

Your doctor is properly informed, and he has told you what he thinks is best for you and the baby.

If being off your meds is a concern to you and your doctor, then it is better that you go back on them.

Your doctor will give you instructions on how best to take the meds (probably starting at a lower dose, and building over time).

I'm happy to help in any way I can. PM, or on the boards.

Lar

[jennie]

Using Psych Drugs During Pregnancy . . .
* The goal of treatment is to minimize risk of fetal exposure to psychotropic drugs while limiting risks of untreated psychiatric disorder. Ideally the woman should be on the lowest possible doses of medication to treat her symptoms.
* When testing a psychiatric medication's effects on pregnancy, doctors look for three things: the occurrence of birth defects (structural teratogenesis), the occurrence of behavioral problems (behavioral teratogenesis), and the occurrence of unusual symptoms directly after birth (perinatal syndromes).
* If psychiatric meds are prescribed, it is better to use one that has been marketed for 20 years or more.

Lithium -
* is in the FDA pregnancy category D (Positive evidence of human fetal risk exists, but benefits in certain situations (eg, life-threatening situations or diseases for which safer drugs cannot be used or are ineffective) may make use of the drug acceptable despite its risks.)
* Ideally, women should attempt to discontinue lithium prior to pregnancy. If the woman’s symptoms recur she can be restarted on lithium in the second trimester. If she requires lithium maintenance she should be on the lowest possible dose that will stabilize her mood. It is important to remember to reduce the dose of lithium by 50% prior to deliver to avoid toxicity. This is necessary because of changing fluid volumes at the time of delivery.

Seroquel -
* is in the FDA pregnancy category C (Studies have shown the drug to have animal teratogenic or embryocidal effects, but there are no controlled studies in women OR no studies are available in either animals or women)
* There are no adequate and well-controlled studies in pregnant women and Seroquel should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
* A switch to a high-potency antipsychotic (in small doses) is usually recommended, since they are associated with no increased risk to fetus or baby, and is recommended for use during pregnancy in high-risk patients.
* FDA approved in 1996 (under the 20-year criteria)

Effexor -
* is in the FDA pregnancy category C (Studies have shown the drug to have animal teratogenic or embryocidal effects, but there are no controlled studies in women OR no studies are available in either animals or women)
* after delivery, the baby will experience neonatal discontinuation syndrome symptoms (such as irritability, respiratory difficulty and poor feeding). Tapering or discontinuing antidepressants prior to delivery may therefore be beneficial for the newborn, but also introduces the risk of depressive relapse in the mother. Babies born to mothers on antidepressant therapy should be monitored for discontinuation symptoms over the first week of life.

Note: psychiatric meds appear in breastmilk, breastfeeding not recommended while taking these meds

*******

The ultimate decision rests on you. No one can make you take these drugs while you are pregnant. What level of risk of potential harm to your baby are you willing to accept?

******

My advice . . . you've been off psych meds for 14 weeks now. If you can continue to manage your psychiatric symptoms with psychotherapy and support from friends/family, then stay off the meds. Increase your counseling appointments, if possible. Be honest about your symptoms. If you need help, ask for help. Last resort get back on psych meds and cross your fingers your baby is born okay.

(note: I'm not an expert . . . just a concerned pregnant woman)

[LostandLonleySoul]

Larry,
well there are things that show physical things that can happen, but what about mental. I know that there are risks with the child at birth with oxygen and other things. I think that it would be better for me to remain off them until after the baby is born.

Jennie,
Thank you for the information that you provided.

[Larry_Hoover]

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LostandLonleySoul said:
Larry,
well there are things that show physical things that can happen, but what about mental. I know that there are risks with the child at birth with oxygen and other things. I think that it would be better for me to remain off them until after the baby is born.

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Oh, absolutely true. If you can be off your meds through the rest of your pregnancy, that's excellent. I got the distinct impression (my gut reaction to your post) that there was some real concern about whether you really could manage that.

I didn't even want to talk, yet, about managing the birth period, because it's still far off. If you were on meds at the time of birth, your pregnancy is high risk, and extensive supports would need to be in place to manage your child, in case. The baby instantly begins withdrawal from the drugs, once the umbilical cord is cut. Plus, there may be effects of the drugs themselves. Your doctors would plan around all that. Some doctors have the mother withdraw from drugs just before birth, so that the baby doesn't experience the withdrawal syndrome after being born.

There isn't a whole lot of literature available to inform us about the development of children exposed to e.g. antidepressants during pregnancy. The information I've seen (and I search regularly) does not indicate any long-term adverse effects. The Motherisk program, supported by the Hospital for Sick Children in Toronto, has an excellent website. http://www.motherisk.org/

What seems to be of great importance, for the optimal development of the child, is the mother's mental health. And I think that applies during pregnancy as well as after birth. You go from being pregnant to being a full-time mother. Your baby needs your wellness after birth, too.

If it's worth anything, I'll send good vibes your way. And I wish for you and your child, all the best.

Lar