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Antidepressants In Pregnancy

Discussion in 'Psychiatry' started by firedoor, Aug 12, 2011.

  1. firedoor

    firedoor let it bleed
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    Apparently all of the SSRI's except for Paxil are "Category C" with an unclear caveat regarding the 3rd trimester related to the risk of persistent pulmonary hypertension to the fetus/newborn.

    Please tell me how you approach this.

    When an antidepressant is indicated what is your first choice (and presuming that the mother will be breastfeeding) ?

    Once you decide upon an antidepressant, are you concerned with specific trimesters or dosage-dependent risks?

    I had once thought that if an antidpressant was indicated, that Prozac was the way to go given it's extensive track record and long half life (hence minimizing newborn withdrawal effects). However, it seems that nowadays Ob-Gyn's rx/suggest Zoloft without significant concern.
     
    #1 firedoor, Aug 12, 2011
    Last edited: Aug 12, 2011
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  3. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    When I was a resident, a patient who was stable on prozac--through 2 full term pregnancies, with 2 years of nursing each child, and with no adverse outcomes for her or either baby--came to me post-partum having been changed to zoloft at the INSISTENCE of her OB, and not doing as well as she had up to that point. So I researched the issue. My suspicions of Pfizer shenanigans notwithstanding, there IS evidence that sertraline is LESS concentrated in breast milk than in plasma, whereas the other SSRIs are equivalent or increased in milk. That was it. But that 2-3 articles was enough, I believe, to make sertraline the SSRI of choice for OB/GYNs everywhere.

    I think you can make a reasonable risk-benefit case for any SSRI except Paxil. Ditto for venlafaxine and mirtazipine.
     
  4. billypilgrim37

    billypilgrim37 Unstuck in Time
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    Our cadre of women's health researchers generally recommend light box first, sertraline second, nortriptyline third in pregnancy.
     
  5. Manicsleep

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    Psychotherapy should probably be first line but otherwise I agree with BP. Its amazing how often "the baby" takes importance in pregnancy and beyond and the mother gets left behind and starts to feel like a second class human being.

    A good MFT can be invaluable in these situations.
     
  6. firedoor

    firedoor let it bleed
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    So it seems that Prozac is at least as appropriate in pregnancy as Zoloft, if not perhaps more so since excretion in breast milk may actually be desired with respect to discontinuation concerns?
     
    #5 firedoor, Aug 12, 2011
    Last edited: Aug 12, 2011
  7. sunlioness

    sunlioness Fierce. Proud. Strong
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    Is anyone else seeing a plethora of television commercials asking women who were on Zoloft during pregnancy and whose babies had problems to call a certain phone number? They also mention Paxil, which I get, but I'm not sure where the Zoloft ads are coming from. I even did some digging around and asked some people at work and couldn't figure it out.

    Also, BP's cadre of women's health researchers is an excellent cadre.

    ECT is also worth considering in some cases.

    Heh. And now as I am sitting here reading the forums with the TV on, I see a commercial asking if you were on "Paxil, Prozac, Lexapro, Zoloft or Effexor and had a baby born with birth defects or breathing problems." If so, you need to call a number or visit the website "yourbirthdefectlawyers dot com".
     
    #6 sunlioness, Aug 12, 2011
    Last edited: Aug 12, 2011
  8. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    Where are the lawyers advertising: "If you drank alcohol, used crack or meth, and smoked cigarettes through pregnancy, visit youmightbeaprenatalchildabuser.com"? :rolleyes:
     
  9. WannaSwitchBack

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    I was taught that sertraline> prozac should be prescribed and that the mom should pump and dump the first few tablespoons, in order to significantly decrease the concentration (with first breast- feed after dosing the sertraline). So I would have to say that if you are initiating the SSRI in the peri-partum time frame, that sertraline would still be a better choice then prozac (due to far less SSRI in the breast milk). Having the mom switch seems to miss the point of maintaining euthymia. Euthymia of the mom should be a major part of the algorithm; also advised light box/ therapy,next sertraline, next prozac or nortriptyiline.
     
  10. digitlnoize

    digitlnoize Rock God
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    Ya know...if patients can sue doctors for crap like this, then it only stands to reason that doctors (or a "class-action" suit of concerned citizens) should be able to sue parents for "Mal-parenting," since this prenatal child abuse comes at the detriment of society, we should all be able to sue for the costs incurred by these peoples' poor judgement and child/fetal abuse.

    I, for one, would like my money back that goes to paying for other peoples' screw ups.

    Make it profitable, and the lawyers will follow. Reverse Malpractice is the future. Make it happen. :ninja:
     
  11. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    Yeah, but I get paid quite a bit for dealing with other people's screwups, so that might cut into my income a bit.
     
  12. sunlioness

    sunlioness Fierce. Proud. Strong
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    I see the next insurance pre-existing condition on the horizon. If your parents screwed up, you're uninsurable.
     

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