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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Kevines on July 11, 2008, at 9:27:07
My wife and I are trying to get pregnant, and this has caused us to review the medications that we are putting into our system. For about 6 months my wife has been on a mix of Lexaprol and Welbutrin, both are small doses, but we have been unable to find any data regarding this mix on pregnant women and breastfeeding. What should we do, and how do we know if the benifites out way the risks? My wife thinks she should get off Welbutrin and stay on lexaprol, but I feel that if we are worried about risk to just cancel them both and try and deal with her depression through out the pregnancy. You can see why this worries us. Anyone have any sites they can refer or information we can use to help make a decision?
Posted by linkadge on July 11, 2008, at 10:28:32
In reply to Lexaprol and welbutrin mix during pregnancy, posted by Kevines on July 11, 2008, at 9:27:07
There are risks of course but I don't know if I can properly put them into perspective for you.
Antidepressants cross through to the baby during pregnancy. It is known that babies brains can become accustomed to the medication too. The baby can go through withdrawl after they are born. This can result in things like excessive crying, increased pain sensitivity etc. Basically, everything that your wife goes through in withdrawl the baby will experience. Some people discribe antidepressant withdrawl as "hell". I can't imagine putting a baby through hell as its first experiences in the world.
The SSRI's also increase the risk of certain malformations
Less well known is exactly how the drug will affect the development of the child. Antidepressants simply havn't been studied the way that other substances have. In my personal view, the baby is going to be exposed to elevated levels of monoamines during pregnancy and then all of a sudden wham their synapses which have been exposed to elevated levels of the neurotransmitters all of a sudden are in a state of deficiancy.
I'd personally get off both if possable. You may look into alternatives. The Omega-3 fatty acids have documented antidepressant effects. They are an option that would only serve to benifit the development of baby. SAMe is another option which would probably be safer during pregnancy.
I've heard that many of the hormones that are present during pregnancy can provide a mood elevating effect. The depression may not return like you'd expect.
Linkadge
Posted by gardenergirl on July 11, 2008, at 11:31:06
In reply to Re: Lexaprol and welbutrin mix during pregnancy, posted by linkadge on July 11, 2008, at 10:28:32
Larry Hoover wrote a great piece about antidepressant use during pregnancy. You can find his post about it here on Babble at http://www.dr-bob.org/babble/20040904/msgs/387622.html
That post contains links to the article in two parts on Usenet. http://tinyurl.com/6qpya
http://tinyurl.com/52ac7Lots of useful info there, as usual from Lar.
good luck,
gg
Posted by Phillipa on July 11, 2008, at 13:04:08
In reply to Re: Lexaprol and welbutrin mix during pregnancy, posted by gardenergirl on July 11, 2008, at 11:31:06
And years ago when they didn't seem to have a clue that meds would affect a preganacy the baby I was on benzos, prescribed wine, and seconal given to me by my ob-gyn. My Daughter is fine today and very smart but at birth did have failure to thrive and cried 24 hours a day and projective vomited each meal. It took about l8 months for things to staighten out. Now this was not antidepressants but another example of meds. I know my neice took zoloft during her pregnacies and everything was fine. And by the way welcome to babble. Love Phillipa sure time for a discussion with your ob-gyn. Phillipa
Posted by Kevines on July 11, 2008, at 13:12:47
In reply to Re: Lexaprol and welbutrin mix during pregnancy, posted by Phillipa on July 11, 2008, at 13:04:08
> And years ago when they didn't seem to have a clue that meds would affect a preganacy the baby I was on benzos, prescribed wine, and seconal given to me by my ob-gyn. My Daughter is fine today and very smart but at birth did have failure to thrive and cried 24 hours a day and projective vomited each meal. It took about l8 months for things to staighten out. Now this was not antidepressants but another example of meds. I know my neice took zoloft during her pregnacies and everything was fine. And by the way welcome to babble. Love Phillipa sure time for a discussion with your ob-gyn. Phillipa
Phillipa,
Thank you for your input... However we haved talked with our Ob-gyn and our family MD, and none of them could give us a thumbs up or down with regards to using these meds. Scary from our stand point and we are seeking other sources hence why we posted on here. We just want to make smart and healthy choices.
Posted by Phillipa on July 11, 2008, at 13:47:44
In reply to Re: Lexaprol and welbutrin mix during pregnancy, posted by Kevines on July 11, 2008, at 13:12:47
What advise did he give you to take them or not. Zoloft allowed my neice also to breatfeed her three babies. Love Phillipa understand. Have you also googled a forum for this topic? Must be some. Lar is very smart and what he writes is accurate to the best of my knowledge.
Posted by raisinb on July 11, 2008, at 15:45:15
In reply to Lexaprol and welbutrin mix during pregnancy, posted by Kevines on July 11, 2008, at 9:27:07
I know from friends' experiences that there's very little research about how newer psych meds might affect pregnancy or breastfeeding. All drs seem to give the same answer--they don't really know.
There seems to be a consensus that Zoloft is not (or not much) excreted in breast milk (I think because of its half-life maybe?) but that's all.
My friend's pdoc told her it was okay to take xanax a certain # of hours before she pumps, but then she also knows a woman whose baby went through xanax withdrawal because she was taking it during breastfeeding.
They don't seem to study this stuff. I guess it's hard to find test subjects, of course.
Posted by Kevines on July 11, 2008, at 18:51:41
In reply to Re: Lexaprol and welbutrin mix during pregnancy » Kevines, posted by Phillipa on July 11, 2008, at 13:47:44
This is true, there is very little research on any of these medications with regards to Pregnancy and Breastfeeding... Want to know why, look no further then those that profit the most from these meds... However I'm not one of those people that complain about big company profits, it just seems unbelieveable that there isn't much on these drugs, and the companies website says talk to your doctore, so they pass it off to the docs. Our doctor said they feel that the Lexaprol would be safe but were uncertain about the welbutrin, I think if we stay on the meds it'll be the lexaprol, but the idea that our child would have any kind of withdraw just because we didn't want to work through nine months of possible issues, seems wrong. So Thank you for the follow up and keep any good info coming...
Posted by SLS on July 12, 2008, at 4:41:27
In reply to Re: Lexaprol and welbutrin mix during pregnancy » Kevines, posted by raisinb on July 11, 2008, at 15:45:15
Linkadge is absolutely right when he says that the infant must suffer a withdrawal syndrome once delivered. Some of the observable symptoms include irritability and persistent crying. This is often explained away as being colic. It may be that the withdrawal effects are more broad and severe
If I remember correctly, there is some comprimise in lung function. Persistent pulmonary hypertension (PPHN) is a dangerous complication that can arise late in a pregnancy. So, there are two untoward events that occur to the infant. SRI withdrawal and PPHN. (SRI includes any antidepressant that potently inhibits the reuptake of serotonin, and includes Effexor, Cymbalta, and Anafranil). PPHN seems to occur more often when an SRI is taken after the 20th week of pregnancy.
The one thing I can't provide you with is statistics. Some researchers cite the resolution of PPHN and withdrawal syndrome to occur within a few days. Many insist that the benefits of continued SRI treatment are indicated as to prevent postpartum depression in the mother.
I really can't take a position of recommending a course of action with certainty. I simply don't know how common these effects are. Much depends on your case history. If you had difficulty finding a drug that works and tried a great many of them, I would probably stay on the medication. However, it might be fair to say that reducing the dosage gradually during the last month and immediately raising it upon birth might be a way to go. Then, the degree of withdrawal effects that the infant experiences can be reduced.
http://www.womensmentalhealth.org/posts/ssris-and-persistent-pulmonary-hypertension-of-the-newborn/
Now that you have been appropriately scared by this post, I recommend a trip to Google; to be followed up with conferences with your psychiatrist and obstetrician.
- Scott
Posted by gardenergirl on July 12, 2008, at 19:54:53
In reply to Re: Lexaprol and welbutrin mix during pregnancy, posted by Kevines on July 11, 2008, at 18:51:41
> This is true, there is very little research on any of these medications with regards to Pregnancy and Breastfeeding... Want to know why, look no further then those that profit the most from these meds... However I'm not one of those people that complain about big company profits, it just seems unbelieveable that there isn't much on these drugs, and the companies website says talk to your doctore, so they pass it off to the docs. Our doctor said they feel that the Lexaprol would be safe but were uncertain about the welbutrin, I think if we stay on the meds it'll be the lexaprol, but the idea that our child would have any kind of withdraw just because we didn't want to work through nine months of possible issues, seems wrong. So Thank you for the follow up and keep any good info coming...
Did you look at Lar's work? Also, part of the problem with doing research on this is that you cannot ethically put a pregnant female into a research study giving her psychotropic drugs as the experimental group. So you cannot have randomized assignment to groups. You can only utilize practical assignment, and that adds junk to the conclusions. So the research is not done as much as needed to really get some answers.
gg
Posted by B2chica on July 16, 2008, at 12:18:25
In reply to Re: Lexaprol and welbutrin mix during pregnancy, posted by Kevines on July 11, 2008, at 18:51:41
i have bipolar and pretty severe depression part (as do we all), i was lucky enough to get off my meds just before i got pregnant a couple years ago, i've never felt more stable than during my pregnancy, even through breast feeding, HOWEVER as soon as my milk was lessening and i was stopping nursing my depression came back harder and QUICKER than before.
my OB always told me that babies are resiliant and she would rather see me on meds if needed than have me harm myself during pregnancy because of my depression.
but my pdoc and OB looked at the meds i was on and each told me the preference and order of drugs that they would like to see me off of or stay on till last minute.my advice would be to talk this over with your doc. i don't know how severe your wife's depression is, if she could try to manage with fish oil, vitamins, exercise and sunlight. or if staying on medications until you are pregnant than try to wean off and see how it goes is always an option. if it doesn't work, get back on what you/she needs.
remember you child will need YOU. and 9 months is a LONG time to be miserable.
Best wishes
b2c.
Posted by Phillipa on July 16, 2008, at 20:30:54
In reply to Re: Lexaprol and welbutrin mix during pregnancy » Kevines, posted by B2chica on July 16, 2008, at 12:18:25
That would suggest to me a link between hormones and depression Thanks B2chica. Love Phillipa
This is the end of the thread.
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