Antidepressants in pregnancy and breastfeeding ?
Q.Can anyone point me to any good web resources on antidepressant use in pregnancy (and, while I'm at it, while breastfeeding)? (Just in case anyone was wondering, I'm asking professionally and not personally...)
A.Neither of those directly cover pregnancy, Hales would have slightly more detail for pregnancy, but still only very minimal, certainly nothing like the choice hierachy of breastfeeding. As I'm sure you know, it's not something you want to be switching around without clear need, either not working or side effects too great, so when selecting a drug for pregnancy, there needs to be a long term plan for breastfeeding as well, which then leave sertraline as the drug of choice for pregnancy as well as breastfeeding, and it's risks in pregnancy seem to be very very slight increase in neural tube defects, so taking the higher, precription only dose of folic acid upto 12 weeks may be adviseable, but I don't think there is any research that confirms that in this particular instance it reduces the risk (note, it's not adviseable to take it beyond 12 weeks, there is no benefit and an increased risk of breastcancer), the other was a slight increased risk of IUGR, but even with a history of IUGR, that slight risk was not enough for me to not take sertraline, the risks of not taking it were probably much greater, as it turned out that baby didn't have IUGR. Prozac would appear to be the drug of choice for pregnancy, simply because it's been around longer, so there is more data, but everything points to other ssris actually being better. I don't think "milder" and "stronger" are particularly helpful descriptive words when it comes to antidepressants in the same way that they would be with, say, opiate based painkillers. In this case it's not even a direct comparison as Effexor is an SNRI, whereas Prozac is an SSRI, and start doses will be different to account for the difference in effect from the same dose, so for Effexor, the initial dose is 75mg, whereas for Prozac it's 20mg. Effexor is still low down the preferred list for breastfeeding, but generally tends to be viewed as ok if necessary whereas Prozac would be avoid if possible for breastfeeding. So if someone is already on Effexor, there is probably no indicator to change, but it would probably fall in the category of one you wouldn't commence use in pregnancy or breastfeeding unless other drugs had proved unhelpful. One problem with prozac is that the generic has been available for a longer time than other SSRIs and there are very many producers of the generic, so even going to the same pharmacy, you may not get the same formulation each time and some formulations are more prone to the common side effect, nausea, than others. Of course it has the well publicised increase in suicide with Prozac, but it is not something that affects solely Prozac, Effexor apparently doubles the suicide risk and similar is true for most many antidepressants, which just emphasises the importance of closely watching any person who is prescribed antidepressants.
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