Depression during pregnancy | March of Dimes
Jul 27, Why this mom of twins chose to stay on her SSRI during pregnancy, and I should taper off of my medication prior to becoming pregnant again. by the time the baby blues would subside and real PPD may kick in. I Five and a half months later, my girls are healthy, happy, and meeting their milestones. I. Jan 1, I am taking fluoxetine, but I would like to stop taking it before becoming Can taking fluoxetine during my pregnancy cause birth defects?. Aug 7, Now fast forward 3 years and I am again stressing about everything and She worked with me during my first pregnancy to keep me drug free, This is just my experience, and hopefully some others can share . I wish I could go back to therapy but unfortunately my insurance will not cover it until we meet.
Selective serotonin reuptake inhibitors SSRIs are the most frequently prescribed class; clinicians infrequently use tricyclic antidepressants TCAs and monoamine oxidase inhibitors in contemporary practice. Current antidepressant treatment usage among pregnant patients follows this prescription pattern [ 2 ].
Miscarriage Increased risk for spontaneous abortion is associated with the use of various antidepressants in early pregnancy [ 19 — 24 ]. No differences were observed among the various classes of antidepressants. This investigation predominantly included late miscarriage since rates in both groups were low compared to population-based rates [ 26 ].
None of the studies that contributed data controlled for psychiatric illness state. Moreover, confounding health habits, including smoking and drug use, and age were variably controlled among studies that contributed to the meta-analysis. Studies with adequate control for potential confounding variables, especially age, which is a strong predictor of spontaneous abortion, are needed before an association can be established.
Not all studies show this association [ 20 — 22242930 ], although only a few had adequate power to find a difference [ 319 ].
The effect of SSRIs on birth weight persists in these studies after statistical control of possible confounders, which supports a true association between maternal SSRI use and reduced infant birth weight.
After application of propensity score matching, which attempts to equalize variables among the treated and untreated depressed women, rates of SGA infants in the SSRI exposed group were significantly higher than in women who were depressed and not treated with antidepressants, but the absolute difference in incidence risk for this outcome was small and is estimated to be only 0.
The time and duration of exposure to an antidepressant are additional factors that are difficult to disentangle. In many instances, third trimester exposure will occur among women who took medication throughout pregnancy rather than third trimester only.
This contrasts with first trimester exposure, which, by definition, only occurred in the first trimester and hence is briefer. A third consideration is the likelihood that women who require medication during the third trimester may have more severe underlying illnesses. It is not possible to say whether the time point at which an exposure occurred, a longer duration of exposure or more severe illness confers the greater impact on growth [ 33 ].
Other studies do not support an association [ 243031 ]. Studies that find an effect for antidepressants on gestational age typically find modest differences in mean gestational duration of one week or less for those exposed compared to those not exposed. Application of propensity scores to control for confounders eliminated differences in the rates of PTD among women who did or did not take an antidepressant agent [ 9 ]. Further studies showed that the effects of SSRIs on gestational age are dependent on the duration of in utero antidepressant exposure and that longer exposures are more likely to decrease gestational age [ 33 ].
Tricyclic antidepressants The majority of studies have not shown an association between TCA use in pregnancy and structural malformations [ 2736 ]. Serotonin reuptake inhibitors The majority of linked database [ 1831 ] and two recent case cohort studies [ 3738 ] found no increased rate of major or specific cardiac malformations when in utero SSRI exposure was considered in aggregate.
While some linked database reports find that compared to unexposed offspring, those exposed to paroxetine during the first trimester are at higher risk of cardiac malformations [ 183940 ], these results are disputed by other reports including several large case cohort studies [ 3738 ].
- Warnings Against Celexa During Pregnancy
- Reward and Risk: Choosing to Stay on an SSRI During Pregnancy
- Depression during pregnancy
Another group failed to find an association between maternal paroxetine use and cardiac defects in a study that included women who took paroxetine early in pregnancy [ 41 ]. However, they did find a difference between their risk estimates derived from teratogen information services and those derived from database studies. The tendency of linked database studies to report all malformations and include those that are clinically insignificant may account for differences.
Specific defects found by some groups include ventricular outflow defects, craniosynotosis and omphalocele [ 3738 ]. Again, these risks are extremely small and not replicated by other studies [ 18 ]. Infants exposed in utero to an SSRI in combination with a benzodiazepine but not an SSRI alone, may have a higher a incidence of congenital heart defects compared to no exposure, even after controlling for maternal illness characteristics [ 42 ]. Such results raise the possibility that presumed associations between antidepressants and malformations may be complicated by poly-drug interactions.
To summarize, the current data on SSRI exposure show no consistent information to support specific morphological teratogenic risks. Concurrent medication use or health habits confound possible associations and create methodological challenges in this area of investigation.
Other antidepressants Other antidepressants include bupropion Wellbutrin and Zybanvenlafaxine Effexorduloxetine Cymbaltanefazodone, and mirtazepine Remeron. These agents vary in chemical structure and putative mechanism of action. None of the studies found a statistically significant difference or higher than expected rate of congenital anomalies when compared to controls who were either taking other antidepressants [ 40 ] or taking agents known not to be teratogenic; however, data are more sparse than for the SSRIs or TCAs [ 20212939 ].
No increased risk for stillbirths or congenital malformations was observed [ 43 ]. Neonatal neurobehavioral outcomes 3. Tricyclic antidepressants In utero exposure to TCAs are associated with increased perinatal complications including jitteriness, irritability and, rarely, convulsions in neonates [ 3236 ].
Symptoms include tachypnea, hypoglycemia, temperature instability, irritability, a weak or absent cry, and seizures [ 1935 ]. Symptoms in neonates were transient and typically resolved by 2 weeks or sooner after delivery.
Other perinatal complications Other perinatal complications have been reported among women who used antidepressants in late pregnancy. An increased risk of persistent pulmonary hypertension PPHN was found among newborns whose mothers were treated SSRIs with a greater risk for infants who were exposed later in pregnancy [ 4449 ]. PPHN is characterized by right to left shunting of blood through the ductus arteriosus and foramen ovale and results in neonatal hypoxia. If this is chronic and severe, babies can develop right heart failure.
Warnings Against Celexa During Pregnancy | Consumer misjon.info
The base rate of this condition is between 0. Recent studies suggest that the absolute risk may be elevated to 3—6 per among infants exposed to SSRIs in pregnancy [ 1949 ]. Exposure to non-SSRI antidepressants in these studies were not associated with PPHN [ 19 ], but tests of such associations are limited by the less frequent use of other classes of medication in pregnancy.
Respiratory distress in the newborn may occur along a spectrum of seriousness in association with maternal SSRI use with PPHN among the most serious consequences [ 19 ].
Women who have longer rather than shorter periods of SSRI treatment may be at higher risk of delivery of an infant with respiratory complications [ 33 ]. Long-term effects on offspring Limited information is available about possible long-term effects of SSRI exposure in utero. Adverse neurocognitive effects at 6—9 months after delivery were not associated with maternal SSRI use in one small study [ 51 ].
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In another report from the same study, the use of TCAs in pregnancy was not linked with differences in general behavior, cognitive function, and temperament in young children [ 52 ]. More work is needed to distinguish the specific effects of prenatal psychotropic medication exposure from the effects of antenatal and postnatal depression.
It should be stressed that there may be developmental risks for children with depressed and anxious parents independent of psychotropic drug exposure. Particular attention should be paid to regulatory problems e. Electroconvulsive therapy during pregnancy Electroconvulsive therapy has long been regarded as a safe and effective treatment for severe depression in pregnancy, especially when the depressive disorder is life-threatening or fails to respond to antidepressant drugs.
There is little evidence that it is harmful to the woman or fetus when both are carefully monitored [ 53 ]. Diagnosing a depressive disorder in perinatal women Routine use of a self-report screening instrument does not supplant clinical diagnosis but can determine which women require further assessment. Many questionnaires include questions about fatigue, changes in sleep, or alterations in appetite that may be indicative of a depressive disorder but are also common in unaffected pregnant women.
The most commonly used screening questionnaire for depression in pregnancy is EPDS and includes 10 items [ 54 ].
Choosing to Stay on an SSRI During Pregnancy
A cutoff of at least 12 is often recommended in pregnancy [ 55 ]. The nine-item Patient Health Questionnaire is also useful and has been evaluated in an obstetrical—gynecological setting [ 56 ]. They believe that not prescribing the medication could have more serious negative effects. Heart Defects Inthe American Psychiatric Association and the American College of Obstetricians and Gynecologist joined up and stated that using SSRIs during the first trimester could lead to an increased chance of babies being born with a heart defect.
The study found that this was particularly prevalent in women who took more than one SSRI. The New England Journal of Medicine published a study in that showed that Celexa in the third trimester could increase the chance of babies developing PPHN, a potentially deadly condition.Bellamy and Clarke -- May we meet again (5X13 SPOILER) HD
The defect can cause long term health problems and is often fatal, as it stops the lungs from properly moving oxygen through the body. Anencephaly, Craniosynostosis and Omphalocele Inthe New England Journal of Medicine published a report in which it showed that SSRIs like Celexa were linked to a marginally higher risk of three specific birth defects. Here, much of the brain and skull is missing, and most children die within a few minutes or hours.
This can be repaired with surgery. Treatment may be available in certain cases, such as where a small part of the intestine protrudes. If more or larger parts of organs protrude, surgery will have to be offered in stages. Long term prognosis varies depending on the extent of the damage.
Celexa Side Effects There are a number of serious side effects associated with the drug, which all require immediate medical intervention. One of the most serious is a heightened risk of suicide. However, changes in heart activity, allergic reactions and serotonin syndrome are also possible.
Many also suffer from panic attacks and anxiety. Young adults and teens are at particular risk. If these symptoms appear, patients should immediately seek medical attention. However, they should not stop taking their medication, as this could also lead to extreme reactions. Changes in Heart Activity People who take Celexa often experience shortness of breath, chest pain, fainting, dizziness, charges in heart rate and more.