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Research Roundup: Should Pregnant Moms Go Off Their Meds?

antidepressants safe in pregnancy

Weighing the benefits and risks for baby

It’s an important question for a lot of moms: should you stay on psychiatric medications while pregnant?

This week the FDA issued a warning to doctors about pregnant women on antipsychotics (a class of medications used primarily for bipolar disorder and schizophrenia), saying that newborns whose mothers were taking these drugs were at risk for having abnormal muscle movements and withdrawal symptoms, including agitation, sleepiness, tremors, trouble breathing and eating after birth.

But it’s a complicated question — what should a mom do if meds are helping her but she’s worried about the baby? Here’s what the research says:

These are some highlights about the risks of psychotropic drugs in pregnancy:

  • Last year, a study in the journal Pediatrics of 82,000 babies whose moms were taking antidepressants found a slight delay in motor development: the infants sat and walked almost a month later on average.
  • Paxil (a form of antidepressant called an SSRI) has been found to increase the risk of fetal heart defects when it’s taken in the first trimester.
  • Other antidepressants, like Prosac, Celexa, and Zoloft, increases the risk of lung problems when taken in the last half of pregnancy.
  • Lithium is considered a possible teratogen (something that disrupts fetal development). Doctors will help moms make informed decisions about this drug and closely monitor a woman considering getting pregnant while taking it.

Those are some of the risks of taking the drugs, but it’s not that simple. For many women, the risk of not taking their medication outweighs this. Most research finds that antidepressants (except Paxil) are overall safe and the risks are relatively small. Meanwhile, a mom with a history of major depressive or bipolar disorder is more likely to develop postpartum depression (a risk to both mom and baby), so being on medication could be the safer route.

In my practice I’ve seen the range of cases: from moms with mild symptoms of depression or anxiety who wean gently (under their doctor’s guidance) before trying to get pregnant, to women with severe psychiatric symptoms that would put the baby at greater risk than the meds themselves — with those moms I encourage staying healthy, even if that means continued medication. In other words, there is no simple answer about psychiatric drugs in pregnancy — it’s a cost-benefit analysis.

But one thing that many women don’t know is that analysis should be done by a psychiatrist who specializes in pregnancy and postpartum issues. Not a general doctor or even a general psychiatrist. So the doctor that prescribed your medication before pregnancy might not be completely capable of treating you while you are pregnant.

Do you have any experience with this dilemma of drugs in pregnancy? Please share your thoughts.

Image: flickr

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