Monday, January 13, 2014

Pregnancy and Antidepressants

"I'm pregnant and I'm taking antidepressants. Is it safe to take it?" In my line of work I hear this question quite often: The answer is "No."

Before you decide to throw away your medication away, I want you to consider this: Is it safe to stop my antidepressants now that I'm pregnant? Also, "No."


Antidepressants are a special kind of medication. You can take anti-cholesterol medication for years and years, and not feel any difference. When you stop taking you anti-cholesterol medication, you most probably still feel the same. Taking antidepressants are different. When you start taking your anti-depressant, you feel different; hopefully better. Most antidepressants work by affecting the levels of transmitters such as serotonin and noradrenaline in the brain. By taking anti-depressants, you may find you function better, have less mood swings, feel better.

And then you decide to stop.

Dizziness, uncomfortable tingly sensations, anxiousness, aggression, confusion, 'electric-shock' sensations... These are some of the withdrawal effects you can experience if you stop taking your antidepressants abruptly. By suddenly stopping your antidepressant you cause your brain transmitter levels to go out of whack, and you may find that you start feeling these withdrawal effects even after missing just one or two doses. People taking antidepressants with short half lives (i.e. they are removed from the body faster) such as venlafaxine (Efexor簧) or paroxetine (Aropax簧) are more likely to experience withdrawal effects when they stop suddenly. If you stop your antidepressant abruptly without consulting a doctor, you may even become suicidal.

When you become pregnant, the last thing you want to do is stop your antidepressant abruptly. The first thing you should do when you find out you're pregnant is to book an appointment with your GP to discuss your options. Taking antidepressants during pregnancy may not be ideal, but neither is stopping abruptly. You doctor will consider YOU as an individual, look at your history of depression (and your family history), and the type of antidepressant you are taking, and together you and your doctor will decide the SAFEST course of action. For example, you may be taking a low strength of an antidepressant and be functioning well, but if you stop your antidepressant abruptly, you may be likely to fall back into a depressive state during your pregnancy, and may be at risk of endangering yourself and your baby. In this case it may be a safer option to continue your antidepressant during the pregnancy, and your doctor may decide to gradually withdraw your antidepressant closer to your delivery date. Gradual tapering of antidepressants reduces the risk of prominent withdrawal effects, and you may find during gradual withdrawal that you feel nothing more than a slight 'hangover'.

If you have been on antidepressants for a long time and your doctor feels that if you are to gradually stop your antidepressant during pregnancy, you are unlikely to fall back into a depressive state (perhaps you have strong family support now, or a less stressful job and therefore are less likely to become depressed again), you may have the option of ceasing your antidepressant. You may need to undergo a specific reducing regime of your antidepressant that may include halving your dose every one to two weeks until you can stop, but remember that the longer the reducing regime, the less likely you will experience withdrawal effects. After ceasing your medication, you may like to trial cognitive behavioural therapy to control your depression.

Another option may be to switch to a safer alternative. Paroxetine, classed as a selective serotonin re-uptake inhibitor (SSRI), should NOT be used during pregnancy as studies have shown that babies are more likely to be born with a birth defect or heart defect. Other SSRIs are considered safer and may be an alternative during pregnancy, if your doctor decides that continuing your medication is the safer option for you.
If you have just become pregnant and are taking antidepressants, your course of action would not be the same as the next pregnant woman on antidepressants. There are many options out there, I have named a few. To find the best option for you, book an appointment with your GP this week and get the ball rolling.

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