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Mental Health  (Expert Forum)
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Effexor XR and pregnancy
Answered by
Roger Gould, M.D. - Mental Health, Wellness
Questions posted in the Mental Health forum are being answered by Dr. Roger L. Gould, author of the Mastering Stress and Depression program and affiliated with the UCLA. Department of Psychiatry. Topics covered include anger, attention deficit disorder (ADD), bipolar disorder, dementia, electroconvulsive therapy (ECT), learning disabilities, memory, obsessive compulsive disorder (OCD), panic, personality disorders, phobias, post-traumatic stress disorder (PTSD), schizophrenia, stress, transitions, and work problems.
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MedHelp Member's Question

Effexor XR and pregnancy

by jennjenn, Dec 27, 2002 12:00AM
I have been on Effexor XR 225 mg daily for about 2 weeks, and been on Effexor a total of about a month and a half. I just found out that I'm pregnant. I know this is a category C drug, but I'm afraid to go off of it, due to the fact that after skipping one dose, I was ready to commit suicide. My doctor is looking into the situation. Until then, can you tell me what might possibly happen to my baby?
Doctor's Answer

by Roger Gould, M.D., Dec 27, 2002 12:00AM
The official position about this is that there is not enough clincial experience with pregnant women and it should not be administered when pregnant.  Sorry, I don't think anybody knows right now, except that it is risky.  Your doctor may try the manufacturer through the drug representative to find out if there is any latest unpublished reports.
Member Comments (13)

by janeleopard, Dec 28, 2002 12:00AM
I don't know anything about Effexor specifically, but there are a couple of antidepressants, such as Celexa and Zoloft, that have pretty good track records with pregnancy. While they're still category C (mostly due to the impossibility, ethically, to perform double-blind studies on pregnant women), significant data on women who have decided to take these medications during pregnancy have shown no problems with birth defects, or with children's further growth and development up to the teenage years.

While I wouldn't push anyone to take this issue lightly, I do think there's a lot of hysteria and guilt around it, and that women need to be reassured that there is a very good chance that these drugs are safe. It's also important to note that depression itself can have negative effects on a pregnancy; not only because the mother may not care for herself as well as she would otherwise, but also because of the increased stress hormones that are produced during a depressive episode. In fact, studies have shown that an untreated depressive episode can be detrimental to a fetus. This puts the mother-to-be in quite a bind. It's a tricky situation, and no woman should try to deal with it without professional help.

Since many obstetricians, even the very best ones, don't have a lot of experience with psychiatric drugs, I would advise finding a psychiatrist who has an established record of treating women during the childbearing years. Under a psychiatrist's supervision you could try weaning off the Effexor, or, if that is clearly not safe, switching to a safer drug.

I wish you the very best of luck.

by peas, Dec 29, 2002 12:00AM
The forum MD is correct, take his advice.  There are not enough adequate studies on humans during pregnancy to quantify advocation of Effexor during pregnancy. Neither are there enough studies on Zoloft and Celexa (both being SSRIs, both carrying the SAME risks re adverse effects regardless of "ONE" study mentioned below - was the study independent?  Are there other studies you can find?  These are questions you need to research).  



Here is a government site where you can search each drug:

http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203653.html



It has an alphabetical index from which you then scroll down to find the drug you require information on.  



FROM that site

Choosing alphabetical letter and then



1)  Celexa:



"Pregnancy—Studies have not been done in pregnant women. However, studies in animals have shown that citalopram may cause decreased survival rates and slowed growth in offspring when given to the mother in doses many times higher than the usual human dose. Before taking this medicine, make sure your doctor knows if you are pregnant or if you may become pregnant.



Breast-feeding—Citalopram passes into breast milk and may cause unwanted effects, such as drowsiness, decreased feeding, and weight loss in the breast-fed baby. It may be necessary for you to take another medicine or to stop breast-feeding during treatment. Be sure you have discussed the risks and benefits of the medicine with your doctor.



Children—Studies on this medicine have been done only in adult patients, and there is no specific information comparing use of citalopram in children with use in other age groups."





2)  ZOLOFT



"Pregnancy—  One study looked at the babies of 147 women who took sertraline either at the beginning of pregnancy or through the entire pregnancy. This study found no harmful effects of sertraline on the babies. However, more study is needed to be sure that sertraline is safe to use during pregnancy. Before taking this medicine, make sure your doctor knows if you are pregnant or if you may become pregnant.



Breast-feeding—Sertraline passes into breast milk. No problems have been reported in nursing babies, but the long-term effects are not known.



Children—Sertraline has been tested in children 6 to 17 years of age with obsessive-compulsive disorder. In effective doses, *******this medicine has not been shown to cause different side effects or problems than it does in adults.****** However, sertraline can cause a decrease in appetite and children who take this medicine for a long time should have their growth and body weight measured by the doctor at regular visits.



SOUNDS OK?  BUT THEN LETS LOOK AT WHAT THOSE SIDE EFFECTS ARE ON THE SAME WEBSITE:



"Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. One rare, but very serious, effect that may occur is the serotonin syndrome. This syndrome (group of symptoms) is more likely to occur shortly after an increase in sertraline dose.



Check with your doctor as soon as possible if any of the following side effects occur:



More common

Decreased sexual desire or ability  



Less common or rare

Breast tenderness or enlargement;  fast or irregular heartbeat;  fast talking and excited feelings or actions that are out of control;  fever ;  inability to sit still;  low blood sodium (confusion, convulsions [seizures], drowsiness, dryness of mouth, increased thirst, lack of energy);  nose bleeds ;  red or purple spots on skin;  restlessness;  serotonin syndrome (diarrhea, fever, increased sweating, mood or behavior changes, overactive reflexes, racing heartbeat, restlessness, shivering or shaking);  skin rash, hives, or itching;  unusual or sudden body or facial movements or postures;  unusual secretion of milk (in females) .....



Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:



More common

Decreased appetite or weight loss;  diarrhea or loose stools;  dizziness;  drowsiness;  dryness of mouth;  headache;  increased sweating;  nausea;  stomach or abdominal cramps, gas, or pain;  tiredness or weakness;  trembling or shaking;  trouble in sleeping  





Less common

Agitation, anxiety, or nervousness;  changes in vision, including blurred vision;  constipation ;  flushing or redness of skin, with feeling of warmth or heat;  increased appetite;  vomiting  





After you stop taking sertraline, your body may need time to adjust. The length of time this takes depends on the amount of medicine you were using and how long you used it. During this period of time, check with your doctor if you notice any of the following side effects:



Agitation;  anxiety;  dizziness;  feeling of constant movement of self or surroundings;  headache ;  increased sweating;  nausea ;  trembling or shaking;  trouble in