Paxil while pregnant?

[pschmom1]

I was just curious as to others opinions about taking paxil while pregnant. A good friend of mine has been taking Paxil for 7yrs due to frequent panic attacks and more than likely generalized anxiety disorder although never actually formally diagnosed. She was 18yrs when she started the paxil and has recieved little to no therapy while taking it. She has tried to get off of it in the past but only lasted a day or two before the withdrawels were too intense. She is currently trying to get pregnant and knows there may be risks associated with taking paxil while pregnant but seems to overlook them. Her ob/gyn (who is rather new and doesn't hold the best reputation in town) told her that it is fine to take paxil in your first trimester. But I have read an extensive amount on this and everything I find is so contradictory. I'm rather uncomfortable about her decision and I was wondering what anyone else has to say about this topic concidering it is an SSRI. Also, is it recomended that someone be on paxil for so long with no therapy and only under a FPs care? Just curious.

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[OldPsychDoc]

I was just curious as to others opinions about taking paxil while pregnant. A good friend of mine has been taking Paxil for 7yrs due to frequent panic attacks and more than likely generalized anxiety disorder although never actually formally diagnosed. She was 18yrs when she started the paxil and has recieved little to no therapy while taking it. She has tried to get off of it in the past but only lasted a day or two before the withdrawels were too intense. She is currently trying to get pregnant and knows there may be risks associated with taking paxil while pregnant but seems to overlook them. Her ob/gyn (who is rather new and doesn't hold the best reputation in town) told her that it is fine to take paxil in your first trimester. But I have read an extensive amount on this and everything I find is so contradictory. I'm rather uncomfortable about her decision and I was wondering what anyone else has to say about this topic concidering it is an SSRI. Also, is it recomended that someone be on paxil for so long with no therapy and only under a FPs care? Just curious.

1) Paxil is probably the least safe SSRI duing pregnancy.
2) Paxil should always be tapered off slowly, if possible, to avoid the discontinuation symptoms she seems to be getting.
3) She would possibly be better off on fluoxetine or sertraline (both reasonably safe during pregnancy). Discontinuing the Paxil would probably be easier if she were cross-tapered with another SSRI.
4) It's not uncommon for an FP to treat a "simple" panic disorder with meds and no therapy--especially if one gets lucky and it works well for 7 years!

 

[pschmom1]

I agree, but I'm not sure why she won't even try. Ok I can't say that, she switched to celexa but when she ran out she immediatley began taking the paxil she still had. She didn't have much to say about the celexa, it's almost like she is mentally addicted to the paxil. She knows that there are meds out there to help her taper off of the paxil b/c we have talked about it several times, but she just keeps taking it and won't commit to any type of transformation. Im not even sure if she still needs the paxil. As far as I know, she doesn't have a chemical imbalance and she got on it when she was 18. Life is very different for her now for the better and I truly believe that she would be fine without it. I know that prozac is a nice transformation drug (her doc recomended this years ago) and relatively easy to get off of, but then it is said to cause anxiety in some people. Also she is always sick which I really believe is psychosomatic as do other friends that know her. Could the paxil maybe be a crutch for her to believe she has a disorder? I know I'm all over the place with this, but I'm just confused and concerned.

 

[OldPsychDoc]

....Also she is always sick which I really believe is psychosomatic as do other friends that know her. Could the paxil maybe be a crutch for her to believe she has a disorder? I know I'm all over the place with this, but I'm just confused and concerned.

This is why psychiatry residency is four years long. Each patient has a unique story with reasons within reasons for their behavior. Your job when you're their doc is to work with them to find some way to improve their function--and there will be times when the patient just doesn't want to change, or when some factor in their psychosocial life makes things unexpectedly worse, etc...

 

[Hurricane]

Don't the babies get the discontinuation syndrome? From what I remember in my OB rotation, it's not life threatening or anything, but they're very irritable as the SSRI clears from their system...

 

[OldPsychDoc]

Don't the babies get the discontinuation syndrome? From what I remember in my OB rotation, it's not life threatening or anything, but they're very irritable as the SSRI clears from their system...

Yes, that's why it's not recommended in trimester 3.
There's also evidence for increased risk of birth defects in trimester 1 now.

http://us.gsk.com/news/paroxetine/paroxetine_pregnancy.pdf