safest ssri in pregnancy

[cherryalmond]

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Yes I know this topic has been visited already and I have done some pubmed searches on this. I guess just to update what is everyone's experience with this. I have a patient who presented having been on zoloft for several yrs and was on it with her first preg, now is pregnant again in first trimester and says it's not working for her anymore. I am concerned about cross titrating her in first trimester. She's also having panic and i am unsure what is the 'go to' med for anxiety in pregnancy..vistaril? but vistaril and benzos are both category c.

 

[BobA]

Have you heard of the website:
womens mental health .org

It's a fabulous resource from MGH

 

[zenman]

You can increase their therapy visits also.

 

[billypilgrim37]

Nortrip has good data in pregnancy. For our group, sertraline then nortrip is the standard clinical pathway.

Sent from my DROID RAZR using SDN Mobile

 

[vistaril]

Yes I know this topic has been visited already and I have done some pubmed searches on this. I guess just to update what is everyone's experience with this. I have a patient who presented having been on zoloft for several yrs and was on it with her first preg, now is pregnant again in first trimester and says it's not working for her anymore. I am concerned about cross titrating her in first trimester. She's also having panic and i am unsure what is the 'go to' med for anxiety in pregnancy..vistaril? but vistaril and benzos are both category c.

well Zoloft is a category C as well.....also, benzos are not category C. The most common benzos used in pregnancy are category D, which is probably something psychiatrists should know. In talking to obs, they don't get super freaked out about Valium(preferred benzo in preg) even though it is category D. The thing is when you look at the data on Valium and cleft palates for example, it is super unconvincing. So most obs are going to feel ok about using valium at least some on preg pts....first trimester a little different I probably wouldn't. Vistaril is category C yes....but what isn't? Vistaril is safe in pregnancy, but how much it is going to help is another matter.

Basically, don't overthink this. Here is how I would manage this pt from a pharm standpoint: I would run through my usual dep/anxiety algorithm for this pt, throwing paxil(catD) out and throwing benzos(D) out in first trimester. The only difference is I would probably have a higher threshhold to treat during pregnancy with anything.

 

[cherryalmond]

O Idid know that the benzos were category d since I had just looked it up. Not sure why I posted they were c like vistaril. I did think valium was cat c till ilooked it up. It's true everything is cat c. What about wellbutrin during preg? I'd rather add in some wellbutrin to her zoloft then cross titrate her onto say prozac and have to deal w possible withdrawal effects on her while in first trimester.

 

[docme]

Vistaril is category X in the first trimester and C after that. Wellbutrin used to be B but its C now. For GAD-Buspar is category B and its safe. For sleep, I would try Benadryl first, its B as well. Most SSRIs are C including Zoloft so its always risks vs benefits.

 

[billypilgrim37]

The letter categories are not very useful. There is much better data that distinguishes these drugs besides the FDA categories.

There is good evidence for light box therapy in pregnancy.

 

[vistaril]

The letter categories are not very useful. .

this is true.

 

[OldPsychDoc]

Well vistaril and billy agreed on something...guess we can close the thread.

 

[billypilgrim37]

Well vistaril and billy agreed on something...guess we can close the thread.

Get a needle and some thread! We need to sew up the tear in the fabric of the universe!

 

[FLpk1girl86]

The letter categories are not very useful. There is much better data that distinguishes these drugs besides the FDA categories.

There is good evidence for light box therapy in pregnancy.

What is light box therapy? Has it been studied in non pregnant patients?

Get a needle and some thread! We need to sew up the tear in the fabric of the universe!

You're awesome.

 

[billypilgrim37]

What is light box therapy? Has it been studied in non pregnant patients?

http://www.ncbi.nlm.nih.gov/pubmed/15096083

Plenty of evidence in many populations, even for more severe depression, and for bipolar depression.

 

[FLpk1girl86]

http://www.ncbi.nlm.nih.gov/pubmed/15096083

Plenty of evidence in many populations, even for more severe depression, and for bipolar depression.

Wowww that's awesome.. and artificial light apparently is more theraputic than natural sunlight... maybe because it's stronger?