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Effexor XR and pregnancy

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?
15 Responses
242532 tn?1269553979
MEDICAL PROFESSIONAL
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  Your doctor may try the manufacturer through the drug representative to find out if there is any latest unpublished reports.
Avatar universal
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.
Avatar universal
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
Avatar universal
CATEGORY C DRUGS:

Pregnancy Category Ratings for Medications

Drugs have been categorized by the Food and Drug Administration (FDA) according to the level of rishk to the fetus. Many of the medications included in this site refer to the Pregnancy Category. The following are descriptions of each category.

Category A: Controlled studies in women fail to demonstrate a risk to the fetus in the first trimester, and there is no evidence of risk in later trimesters; the possibility of fetal harm appears to be remote.

Category B: Either (1) animal reproductive studies have not demonstrated a fetal risk but there are no controlled studies in
pregnant women or (2) animal reproductive studies have shown an adverse effect (other than decreased fertility) that was not confirmed in controlled studies on women in the first trimester and there is no evidence of risk in later trimesters.

Category C: Either: (1) studies in animals have revealed adverse effects on the fetus and there are no controlled studies in women or, (2) studies in women and animals are not available. Drugs in this category should be given only if the potential benefit justifies the risk to the fetus.

Category D: There is positive evidence of human fetal risk, but the benefits for pregnant women may be acceptable despite the risk, as in life-threatening diseases for which safer drugs cannot be used or are ineffective. An appropriate statement must appear in the "Warnings" section of the label of drugs in this category.

Category X: Studies in animals or humans have demonstrated fetal abnormalities, there is evidence of fetal risk based on human experience or both; the risk of using the drug in pregnant women clearly outweighs any possible benefit. The drug is contraindicated in women who are or may become pregnant. An appropriate statement must appear in the "Contraindications" section of the labeling of drugs in this category.
Avatar universal
CATEGORY C DRUGS:
http://www.templejc.edu/ems/drugs/Pregnancy.htm

"Pregnancy Category Ratings for Medications

Drugs have been categorized by the Food and Drug Administration (FDA) according to the level of rishk to the fetus. Many of the medications included in this site refer to the Pregnancy Category. The following are descriptions of each category.

Category A: Controlled studies in women fail to demonstrate a risk to the fetus in the first trimester, and there is no evidence of risk in later trimesters; the possibility of fetal harm appears to be remote.

Category B: Either (1) animal reproductive studies have not demonstrated a fetal risk but there are no controlled studies in
pregnant women or (2) animal reproductive studies have shown an adverse effect (other than decreased fertility) that was not confirmed in controlled studies on women in the first trimester and there is no evidence of risk in later trimesters.

Category C: Either: (1) studies in animals have revealed adverse effects on the fetus and there are no controlled studies in women or, (2) studies in women and animals are not available. Drugs in this category should be given only if the potential benefit justifies the risk to the fetus.

Category D: There is positive evidence of human fetal risk, but the benefits for pregnant women may be acceptable despite the risk, as in life-threatening diseases for which safer drugs cannot be used or are ineffective. An appropriate statement must appear in the "Warnings" section of the label of drugs in this category.

Category X: Studies in animals or humans have demonstrated fetal abnormalities, there is evidence of fetal risk based on human experience or both; the risk of using the drug in pregnant women clearly outweighs any possible benefit. The drug is contraindicated in women who are or may become pregnant. An appropriate statement must appear in the "Contraindications" section of the labeling of drugs in this category."
Avatar universal
If it sounded like I was enthusiastically pushing the use of drugs during pregnancy (???), I apologize. Nor did it seem to me that I had contradicted the forum doctor. I don't know if Effexor has been studied. However, there HAVE been numerous studies of women taking SSRIs (including one that appeared in the venerable New England Journal of Medicine) that showed at least some SSRIs to be generally safe when taken during pregnancy.

A suicidal mother is NOT safe for her baby.

It's tempting to get into an argument here, but that' totally missing the point of this forum. I was taken aback by the tenor of peas' comment. The tone is angry and conveys some kind of twisted mission. It seems he/she wants to throw the baby out with the bathwater, as it were. The only thing all that "drug information" quoted above does is scare the pants off people. Most of this information was in fact written explicitly to avoid lawsuits, not to enlighten patients. If you don't believe me, look up Tylenol--just plain acetaminophen--on medline or in the Physicians Desk Reference. My doctor (an esteemed specialist in maternal-fetal medicine) once told me that if water were listed in the PDR, no one would drink it anymore. My job is to edit medical texts for physicians, and my own familiarity with drug literature bears up this observation.

Here's what I think. Jenn Jenn must be worried sick about her baby. She needs information, and boy is there a lot of information available out there--but it's almost impossible to sort it out by oneself. Most of it (especially on the Internet)is "worst case scenario." The last thing a fetus needs is to have a mother who is in a perpetual state of anxiety. Jenn Jenn also needs support. This is why I think she needs a qualified doctor--one who has dealt with these issues and knows the terrain--to help sort through the information and make an informed decision. She needs an expert, someone with a balanced, non-hysterical perspective on the issues of depression medications and pregnancy/breastfeeding, not someone raving at her on the Internet.

Besides a psychiatrist and obstetrician, it would make sense to look into a pediatrician for the baby. The American Academy of Pediatrics is a wonderful source of information, and publishes a list of drugs that are compatible with pregnancy and breastfeeding. Thomas Hale's book "Medications and Mother's Milk" is a terrific resource for breastfeeding. In addition, many hospitals have lactation consultants, who have a wealth of information at their fingertips.

But back to the immediate problem. My heartfelt hope is that Jenn Jenn finds the right support. Her baby in all likelihood will be healthy whether she takes an SSRI or not, if she takes care of herself. Positive behaviors such as diet, exercise, and abstaining from alchohol or smoking have a tremendous impact on making a healthy baby.
Avatar universal
Other than expert articles the only comments I made within this thread are as follows, and I fail to see how you define these as "raving" or with a "twisted mission" or is it the articles written by experts that you are referring to?? :

"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"...article....

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

"SOUNDS OK ON CHILDREN AND ADULTS?? Then look on their own site for Side Effects and you'll see that it isn't so OK after all?" .......article......


"END OF EXTRACTS

From the above you can probably see that on sites where it is legally required to give a certain level of information then you still need to check further into the wording of that information to ascertain exactly what it really covers.

Do searches. For and against. Read articles. Look at the studies that have been done. Look for evidence from those on support boards suffering from the adverse effects. Balance the evidence, bearing in mind the advantages for a "pro-med" stance from the pharmaceutical companies and funded or 'interest in' organisations. Then make an informed choice rather than go on a 'chance' option. You and your baby deserve information and support, not "luck"."


Avatar universal
CELEXA (also known as Lexapro, escitalopram oxalate etc) AND PREGNANCY.  This is from the RXLIST (simply the documented list of required information) and was last updated on 31st December 2002.  

http://www.rxlist.com/cgi/generic/lexapro_ad.htm#AR


".....Pregnancy

Pregnancy Category C

In a rat embyro/fetal development study, oral administration of escitalopram (56, 112 or 150 mg/kg/day) to pregnant animals during the period of organogenesis resulted in decreased fetal body weight and associated delays in ossification at the two higher doses (approximately
Avatar universal
Likewise, the RXLIST pregnancy extract regarding
ZOLOFT (aka Wellbutrin, sertraline) which was also revised less than 2 weeks ago on 31st December 2002. It seems patently clear that the RXLIST is not set up to avoid lawsuits, it is merely an Internet Drug Index:

http://www.rxlist.com/cgi/generic/sertral_wcp.htm

"....Pregnancy, Teratogenic Effects, Pregnancy Category C

Reproduction studies have been performed in rats and rabbits at doses up to 80 mg/kg/day and 40 mg/kg/day, respectively. These doses correspond to approximately 4 times the maximum recommended human dose (MRHD) on a mg/m2 basis. There was no evidence of teratogenicity at any dose level. When pregnant rats and rabbits were given sertraline during the period of organogenesis, delayed ossification was observed in fetuses at doses of 10 mg/kg (0.5 times the MRHD on a mg/m2 basis) in rats and 40 mg/kg (4 times the MRHD on a mg/m2 basis) in rabbits. When female rats received sertraline HCl during the last third of gestation and throughout lactation, there was an increase in the number of stillborn pups and in the number of pups dying during the first four days after birth. Pup body weights were also decreased during the first four days after birth. These effects occurred at a dose of 20 mg/kg (1 times the MRHD on a mg/m2 basis). The no effect dose for rat pup mortality was 10 mg/kg (0.5 times the MRHD on a mg/m2 basis). The decrease in pup survival was shown to be due to in utero exposure to sertraline HCl. The clinical significance of these effects is unknown. There are no adequate and well controlled studies in pregnant women. Sertraline HCl should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Labor and Delivery

The effect of sertraline HCl on labor and delivery in humans is unknown.

Nursing Mothers

It is not known whether, and if so in what amount, sertraline or its metabolites are excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when sertraline HCl is administered to a nursing woman...."

Avatar universal
Jennjenn, you say you felt suicidal with one missed dose of Effexor.  Effexor is similar to the SSRIs and cold turkey/missed dose has been known to cause suicidal feelings on Paxil.  COLD TURKEY IS DANGEROUS.

If you want to come off, then it is most important that you taper off gradually and in your own time - depending on the level of withdrawal symptoms you experience.

So, here are a couple of 'taper off' sites with advice as to how to wean off the drug in the most successful way:

The WEANING OFF method for SSRIs is appropriate for weaning off EFFEXOR (VENLAFAXINE):

http://www.antidepressantsfacts.com/taper.htm

http://www.prozactruth.com/taper.htm

Take information to your doctor.
Your paedriatician might also be able to suggest a solution.
It might also be worth you discussing the situation with your local pharmacist, they sometimes have a far more objective view than a busy doctor, and can often be very helpful in suggesting diets etc to help you recover as quickly as possible.

It may be that you are advised to stay on Effexor but to minimise the risks by reducing to a low level by tapering down a little. If you do decide to (or are advised) to wean off completely, then visit a support board where you can talk to others who are going through the same thing, or who have been through it and have experience of the more likely things to help.  There's a list of support and information sites here too:

http://www.antidepressantsfacts.com/info-support.htm

You came online to get information and that in itself shows that you care about the situation and so you are likely to succeed :)  You are not alone, there are many people in a similar situation.  

Thoughts are with you.






Avatar universal
Well, being a male, I don't know anything about being pregnant, but as a father, I know plenty about worries of med reactions during pregnancy -- especially considering my wife is bipolar NOS and had to come off her meds during her second (and last) pregnancy.

While that was difficult for her, I personally know it would have been truly impossible had one of her meds been Effexor XR.  I am a diagnosed depressive who has been on Effexor since mid-June 2001.  When I lost my prescription coverage due to my loss of job in August of this year, I stupidly tried to take myself off of it -- by tapering from 5 75mg capsules to zero in the period of one week.

I have never, ever experienced a scarier episode in my life.

I had the classically described "brain shivers" -- where it is as if there are tiny electrical shocks being delivered constantly to one's entire nervous system, particularly when turning one's head suddenly.  I was so emotionally volatile I was probably clinically psychotic.  I was ready to leave my wife and family several times, after loud arguments with my wife (who didn't know what was going on until I started the meds again), and I don't have a clue as to what they were about or why, since my marriage and my home life are reasonably happy and secure.  At one point I held a box cutter to my throat and threatened to kill myself in front of my wife and 7 year old daughter -- again, I don't know why (except that I was tired of feeling insane and could almost not remember why -- the Effexor withdrawal -- I felt this way in the first place).  What was most frightening of all was the day I looked into my own living room, saw my two children playing and watching TV. . .and wondered -- for a moment -- just who they were.

That was enough for me.

We made arrangements to pay for the Effexor (and when I told my doctor, he got as emotional as he ever does -- which is not very -- and asked why I didn't call him for samples, which he gave me plenty of that day).  My only answer was "Guess I wasn't connecting too clearly" -- which could qualify as one of the understatements of the century.

After I was back on my usual dose, I began having sexual problems, a quite common side effect in men as I understand it.  I spoke with my doctor about tapering and he suggested a VERY gradual taper -- by 37.5mg a month.  The first month was basically all right.  This week, however, I tried the second part of the taper.  Could not do it.  Began feeling the onset of very SLIGHT symptoms of the earlier withdrawal I described here.  That was enough for me.  I plan on telling him at my appointment today that I have changed my mind.  He sympathized with my problem when I first spoke to him last month and prescribed Viagra.  A true wonder drug.  No kidding.  So that angle is now covered, too.  :)

I don't mean to frighten, but I have a knee-jerk reaction when ANYBODY suggests to ANYONE else to even slow down with this drug.  Do a Google search for "effexor side effects" or "effexor withdrawal symptoms" and you will encounter a GREAT many stories as bad as mine. . .and many even scarier.  This drug is very strange and definitely does NOT act like any of the other SSRIs when stopped or even tapered.  I joined this board for the Addiction forum, but lurk here from time to time, and when I saw this thread, I felt I had to put my two cents in.  Let me just say that I have withdrawn from the "hardest" narcotics there are out there -- many times, unfortunately -- but have NEVER, EVER experienced anything even remotely like what I went through coming off Effexor.  I can honestly say that, as much as I loved my dope, I would never think of committing a crime to avoid withdrawal from any of it.  If I were faced with a denial of my Efexor. . .I don't know if there is anything I would not do or anyone I would not hurt to get my supply.  Either that, or I would just kill myself right away to avoid the syndrome.  Yes, it is THAT scary.

So much for not trying to frighten anyone, I guess. . .just, please, to anyone who may be thinking of cutting down or stopping Effexor. . .go VERY slowly and VERY carefully, and make sure your doctor (AND family) is completely informed and involved in your process and knows what to look for behavior-wise about you that may be important.  

Lastly. . .and I really hesitate to say this, but knowing what I know now -- if my wife were on Effexor and became pregnant again, I would not want her to even taper off.  Pregnancy is a volatile time on the body under the best of circumstances. . .and I can't imagine what might happen were you to add a hellish episode of Effexor withdrawal to that mix.  Birth defects are among the most frightening things for a parent to consider -- but considering the possibility that there may not even BE a baby coming because the mother took herself and her child away forever. . .it just comes down to a risk versus benefit situation, I guess. . .and each individual has to decide for herself what that ratio may be (of course in close conjunction with her physicians).

Grace and peace to all, thanks for hanging with me -- I get very wordy when I am as concerned as I am now -- and my thoughts and prayers are with you.

peace,

Kurt
Avatar universal
Just a personal opinion on AD's and pregnancy.  I work in the medical field and what I saw written I honestly believe. Most drug companies catagorize these drugs as unsafe for legal reasons. I have had 2 successful pregnancies on anti-depressant and anti-anxiety meds. Both were catagorized as class C's.
  A few months ago, on my to be third baby, I decided that my luck may be running out and decided to go it without the drugs. Well, that was the worst mistake of my life to date.  I was so enraged, depressed and sick that I could take no more, and after numerous hospitalizations (where the medical professionals were trying thier hardest to get me back on the meds) for hyperemesis and severe depression & anxiety, another person inside of me took over and without my husbands consent or even the chance of a discussion, I ran and got an abortion.  I live and suffer and torment myself everyday for that. Without my meds, I was far past the point of rationalization, and did something that I would never even consider for a moment in my right state of mind. Not only did I devestate myself, but my poor husband was wrecked, totally destroyed by what I did and did alone without even trying to talk to him about it.  For the past 3 months, I swore I would be punished and never be able again to get pregnant with the child we so desperatly wanted, because of what I did. It made my depression worse 10 fold, and forget the anxiety levels, that is beyond discussion.  Well, after all the pain and torture, and going back on my LIFESAVING meds, I am pregnant again - just 6 weeks. Never, for any reason will I even entertain the thought of going off my meds. I currently take lexapro and klonopin, and from what very good doctors and friends in my position, and my own experience with my 2 prior pregnancies tell me, the meds are Well Worth the risk.  There is not a lot to prove differently as far as I'm concerned, and I've extensively researched real women on AD's and AA's during pregnancy.  A suicidal, depressed, anxious, and irrational woman is more dangerous to a growing fetus than the anti-meds that she is taking to keep her in her right frame of mind to take care of that pregnancy. Like I said, it's a personal opinion, but it's a well thought out and well researched one.  My advice, take the meds, you and your unborn baby will be better with them than without them.
P.S. - from a friendly basis of doctors advice - most aren't sure and most can't tell you it's ok even if they believe it is because of possible lawsuits, there is a risk with almost everything that you do while pregnant, but I think the med risk outweighs the other case senario by a lot.
Avatar universal
I have been considering having another child, but since having my last child years ago have been suffering from depression.
  EffexorXR has been the only  medication that has helped my depression and I feel wonderful again. I have tried the gammant of SSRI's and none of them have allowed me to "feel" all things emotions, tears , laughter etc.  Looking back I wonder if I was suffering from depression longer than I actually realized. I have been taking effexor for 2 1/2 years now.
   I am concerned because like Kurt mentioned in an earlier post, though I have never "tried" to come off of it intentionally.  There was a time or two when I needed to get a refill and delayed a day or two--boy if you miss one dose or two--you can't even turn your head. My head will be literally humming or spinning, you want to actually pull your head off your shoulders and that is before the migraine kicks in. I have never been so scared about losing my mind before--even at my worse depressive episodes when I thought I couldn't go on before going on medication in the first place. I have mentioned to my husband I am scared of going crazy if I try to go off of this medication.  It is not like the other anti-depressants, where you may get a headache and then go into a state of euphoria for a while-this drug is different.
   Is there anyone out there who has taken effexorXR throughout their pregnancy and had a successful outcome ?? I know what the recommendations are--but I want to hear real life stories and experiences ??
   Spring
Avatar universal
I have been considering having another child, but since having my last child years ago have been suffering from depression.
  EffexorXR has been the only  medication that has helped my depression and I feel wonderful again. I have tried the gammant of SSRI's and none of them have allowed me to "feel" all things emotions, tears , laughter etc.  Looking back I wonder if I was suffering from depression longer than I actually realized. I have been taking effexor for 2 1/2 years now.
   I am concerned because like Kurt mentioned in an earlier post, though I have never "tried" to come off of it intentionally.  There was a time or two when I needed to get a refill and delayed a day or two--boy if you miss one dose or two--you can't even turn your head. My head will be literally humming or spinning, you want to actually pull your head off your shoulders and that is before the migraine kicks in. I have never been so scared about losing my mind before--even at my worse depressive episodes when I thought I couldn't go on before going on medication in the first place. I have mentioned to my husband I am scared of going crazy if I try to go off of this medication.  It is not like the other anti-depressants, where you may get a headache and then go into a state of euphoria for a while-this drug is different.
   Is there anyone out there who has taken effexorXR throughout their pregnancy and had a successful outcome ?? I know what the recommendations are--but I want to hear real life stories and experiences ??
   Spring
Avatar universal
I would like to hear from someone who took Effexor xr before and during pregnancy.  I have suffered from GAD and severe Depression for several years, But have had success with the Effexor xr.  I tried to decrease my dose from 3 75mgs. to 1 75mgs. I am feeling depressed and find myself not being able to handle situations that didn't seem to bother me when I was on my full dose.  My husband and I are wanting to try to have a baby, but are afraid that the Effexor will harm the baby.  I have read the comments about the class c drugs.  I have also spoke to my OBGYN that told me to go on the lowest possible dose.  I just feel that I would not be able to function without my Effexor.  If anyone has an opinion or could help me please let me know. Thanks
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