I have a 28 yr old female patient with MDD, recurrent, moderate and GAD who responded well to sertraline and we increased dose to 150 mg daily to target residual symptoms. She has had some nipple discharge but prolactin levels were normal. She was told by PCP that sertraline may be causing the nipple discharge. She also had a pregnancy test which came back positive. She reports numbness and tingling in her hands and fingers and reports that became more of an issue when sertraline dose was increased from 100 to 150. She is asking me to decrease the dose now that she is pregnant. I look at sertraline and pregnancy and there is conflicting info. What would be a good solution to this scenario ?
Sertraline and pregnancy
- Thread starter chillax9
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Reduce to 100, schedule CBT or IPT, and start thinking about painting the nursery.
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More importantly I'd ask if she experienced any benefit from increasing to 150 mg. Regardless of whether or not these symptoms are coming from Zoloft, it appears that by wanting to go back to 100 mg that she's saying the risks outweigh the benefits. Hypothetically, if you could say for certain that this wasn't a result of increased Zoloft, you could reassure her until the cows came home but her anxiety about it would persist. I would ask what the harm in decreasing would be. Maybe, knowing the patient, you have a better answer for that question.
Bottom line is you can look at what's known in the literature and what's expected, but what's more important is what the patient is now telling you.
Bottom line is you can look at what's known in the literature and what's expected, but what's more important is what the patient is now telling you.
H
HarryMTieboutMD
You need to have an informed discussion with her- generally most SSRIs (except Paxil) are ok in pregnancy- though Kathy Wisner from Nortwestern who is THE authority on this gave a grand rounds last year said even Paxil is okay to use. Keep in mind depression itself is very teratogenic. Since she might have had side effects from increased dose you could explore decreasing the dose and as OPD said augmenting with therapy, behavioral activation, etc. Unless depression becomes severe I would hold off on adding another medicine
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Yes, I think it is under-appreciated that active psychiatric illness in itself appears to be associated with negative pregnancy outcomes, and so taking someone off of their psych meds during pregnancy must involve weighing risks and benefits rather than reflexively thinking less medication exposure is better.
Incidentally, as someone who personally experienced some pretty gnarly carpal tunnel syndrome when I was pregnant (and only when I was pregnant), I would try to investigate when the finger numbness began. I feel like a lot of times pregnant/postpartum patients attribute things to med side effects that are really just some of the weird and lovely things that pregnancy causes.
