Pregnancy and Pre-Existing Depression
In The Real World
So in a typical Ob/Gyn practice, what’s typical?
The SSRIs are so safe, it seems, that I’ll use them (especially Wellbutrin and Prozac) during the 2nd and 3rd trimesters even for mild depression if it is interfering with a patient’s happiness. I won’t prescribe casually in the 1st trimester unless the depression is severe. If severe depression involves any type of thought disorder, I’ll insist that a psychiatrist be involved.
Breastfeeding risks of using depression drugs should be left to the pediatrician. If the benefit of the drug during breastfeeding outweighs the risk, a new mother may still want to switch to formula so that she can treat herself without worry.
Outside of pregnancy and breastfeeding, I feel that the SSRIs are a very safe drug class and I have used them for anything from PMS (now melodramatized as “premenstrual mood dysphoria”) to depression. Interestingly, Prozac is now available as Sarafem for PMS.
For just anxiety in the non-pregnant woman (without depression), I prefer Buspar or the newer Celexa, and I don’t usually use Xanax, Valium, or the diazepam class. This is because anxiety tends to be a long-term problem, and the diazepam class is not a safe long-term drug because of its addictive potential.
The neurotransmitter aspect of treating disorders is all the rage in pharmaceutical research. Just take serotonin, for instance. There are some serotonin receptors that affect mood, some that affect appetite (the SSRI Meridea is used in dieting), and other receptors, which do other things. The SSRIs hint at an exciting growth direction for drugs for many diseases. True, we’ve had our disasters (the Redux fiasco years ago which resulted in heart damage), but for the most part this direction has yielded many safe drugs that seem to have minimum risk in pregnancy.
That’s good news, because pregnant people get sick, too.
YOU MIGHT BE INTERESTED IN