April 19th, 2011
05:13 PM ET

Is my antidepressant use risky to my future kids?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Tuesdays, it's Dr. Charles Raison, an associate professor of psychiatry and behavioral sciences at Emory University, and an expert in the mind-body connection for health.

I am a 21-year-old female set to graduate from college in May. I have been taking antidepressants since roughly my senior year of high school, so approximately four or five years. I have been on Xanax, Cymbalta, Effexor, Paxil and Wellbutrin. I am currently taking only the Paxil and Wellbutrin together (in conjunction with birth control pills, which I have been on since my freshman year of college). I just read your answer about the effectiveness and safety of taking antidepressants long term, and my question is this: Since I am fairly young, and may be taking antidepressants for several years, how do I transition when I marry and decide to have children? I know that Paxil can result in serious birth defects, but it is working very well for me. What would I do instead?

Asked by a college student, New York

Your question is a great one, and like all great questions it has no simple answer. The fact that you are already planning ahead like this is itself probably the best answer to your question. We'll go through several options, but the most important point is that great care be taken along whatever path you choose.

I'm a fan of antidepressants as anyone who reads this column regularly knows. And I think it is probably true that the majority of women who take antidepressants through pregnancy are better for the experience if medication keeps them from having a relapse of their disease, because the data are strong that depression is associated with physical changes that are bad for fetal development.

The data that depression in mothers negatively affects their children is even stronger.

But it is also increasingly clear that antidepressants do pose some risk in pregnancy in terms of adverse fetal outcomes. Because of this, the best of all worlds would be to get off your antidepressant before you conceive without having a relapse of your depression.

Unfortunately, we know from many studies that even after years of stability, stopping an antidepressant greatly increases the likelihood that the depression will return.

Add the stresses of pregnancy, childbirth and little babies (I have two, so I know this well), and the odds for a relapse go up even further.

Fortunately, antidepressants are not the only "antidepressants." Psychotherapy works as well as medications and is - as far as we know - completely safe in pregnancy.

Recent studies suggest that a particular kind of meditation called Mindfulness-Based Cognitive Therapy is also as effective as medications in preventing depressive relapse in people who have had a number of previous episodes. While not as good as learning it from a teacher in a group, an excellent introduction can be found in the book "The Mindful Way Through Depression: Freeing Yourself from Chronic Unhappiness."

If you decide to stop your antidepressant before pregnancy, it is of great importance that you do so slowly and carefully under the care of a clinician. If you elect to switch out the medication with a behavioral antidepressant strategy such as therapy, it is also important that you start before weaning off the medications for maximal protection.

soundoff (30 Responses)
  1. Dr Stephanie Smith

    Dr Raison
    Thanks for your thoughtful post. This is such an important issue for women and families. It's great to see it addressed BEFORE pregnancy occurs.
    And as a psychologist, I am thrilled at your point that psychotherapy is an excellent alternative to medication therapy. It's important that patients know all options available to them, including the benefits of psychotherapy, medication, and both combined. Nice piece!

    April 19, 2011 at 18:20 | Report abuse | Reply
    • Diane

      I just want to point out that all antidepressants are not equally risky during pregnancy. http://www.womensmentalhealth.org/ is a great resource (run by Massachusetts General Hospital) and contains a very reasonable discussion of the various risks during pregnancy and breast-feeding associated with different psychiatric drugs, including antidepressants, mood stabilizers, and anti-psychotics. Untreated mental health issues are not benign, and stopping medication is not the only option.

      April 19, 2011 at 23:41 | Report abuse |
  2. Dr. Nicole

    Dr. Raison-
    I second Dr. Smith....thank you for your great and thorough post. As a psychologist as well, I think you were spot on.
    My primary area of research was mindfulness meditation with a cognitive behavioral component and I continue to recommend this treatment to clients and fellow clinicians. Thanks for the nod to this rather new (yet old!) approach to well being!

    April 19, 2011 at 19:35 | Report abuse | Reply
  3. Andrew McFadden

    I'll bet the Paxil-pal who wrote this article got a luxury cruise payed for by Glaxo SmithKline in exchange for these kind words and a few prescriptions. Anti-depressants will be the death of us. How can we be motivated to make a change in the world when half of us are medicated to numb us from feeling unhappiness and frustration? The rest of the world will pass us by while we chug these pills down, eyes glued to a TV screen: fat, happy, and content.

    April 19, 2011 at 19:56 | Report abuse | Reply
    • Rich Uncle Pennybags

      I told my friend the other day how effective anti-depressants can be and when i came home I found a new lexus and cheque for $50,000 !
      These drug company people are so generous !
      Please, get a reality check man.
      Maybe if you educated yourself about these issues from a real school and not from politicos with axes to grind you'd make some sense.
      Anti-depressants work and help many people.
      How are people going to go out and help change the world when they're so severely afflicted with a serious mental illness they cant even get out of bed ?
      Your generalizations about people who use anti-depressant medications as being fat lazy tv junkies is so offensive and idiotic I dont even think it deserves a proper rebuttal but instead should be pointed out and highlighted as a shining example of the crippling ignorance you seem to suffer from.
      I'm currently running trials for a medication which cures stupid, I'll send you the paperwork to participate in the trials if you're interested.

      April 19, 2011 at 20:17 | Report abuse |
    • Andrew McFadden

      I'm going to assume you weren't only educated in sarcasm, and that you are aware that these drug companies are out to make a profit. In doing so, they have been known as most modern big businesses have, to manipulate facts and people. My comment about the author of this article was offhanded and (probably) exaggerated, but you can't deny that pharmaceuticals DO grant big bonuses to doctors who will speak for them at conferences, and prescribe and support their meds. At that point, there is a conflict on interest, and I'll trust that you can figure out what I mean by that.

      People are manipulated into taking pills they don't need every day. Countries who graduate many more successful people than us get by on FAR fewer meds than we do. One half of all Americans are medicated. Those are just facts, my friend. Here's some more: As of Feb. 2010, 61% of Americans were either overweight or obese. And the average American watches TV for 4 hours a day. That's two months per year. Yeah, we literally are fat, medicated, and glued to the tube.

      April 19, 2011 at 20:44 | Report abuse |
    • El

      It's illegal to accept a bonus for prescribing a certain medication. Do you ever think that people need medications because they're fat and unhealthy to begin with? Other countries use psychiatric medication too, in fact psychiatry was developed in Europe (ever heard of Freud?). Can you name a country that "graduates many more successful people than us?" Perhaps they "get by on FAR fewer meds than we do" because they are poor.

      Sorry andrew, we don't have a pill to fix ignorance.

      April 20, 2011 at 05:04 | Report abuse |
    • Andrew McFadden

      If you're fat and unhealthy, you don't need medication, you need a treadmill and a friend! This is exactly what I'm talking about. We live in an age where we believe you can solve any problem with a pill. We expect results from a pill, and our expectations are capitalized on by the drug companies. These ineffectual drugs have been pushed through the FDA trials because the FDA is loaded with friends of people in the pharmaceutical industry. I'll bet all of you would tell me corruption runs rampant in government and big business. Here's evidence of it right in front of you, and you swat it away.

      As for knowing nothing about depression, I would say I know quite a lot since I have major clinical depression. The reason I became so opposed to these drug companies and bad psychiatric practices is because I did the research, I had to to know what I should do, how I should feel. And what did I find out? That these people don't care about you. American psychiatry has a very long history of hoodwinking and abusing the mentally ill. From torturing people into sanity, to lobotomies, to electro- and insulin shock, psychiatry has done a whole lot of harm and told a lot of lies. Don't take my word for it, research it.

      PS: I'm not a scientologist, I'm just disgusted by bad medicine.

      April 21, 2011 at 16:21 | Report abuse |
  4. Steve

    Antidepressants are an absolute crock. I would love for one of you geniuses who prescribe this poison to explain what a "chemical imbalance" is. How do you test for this imbalance?
    Exercise has been shown to work better then any antidepressant...but why mention that? Just give some pills.

    April 19, 2011 at 20:30 | Report abuse | Reply
    • Mark

      Nice try Steve but frankly untrue as proven by countless studies and years of psychiatric experience. Exercise definitely helps but does not adequately treat most forms of mental illness.

      April 19, 2011 at 21:01 | Report abuse |
    • Kate

      If that was truly the case (that exercise is better than the pills), then my daily Yoga and 3x weekly workouts would have prevented me from relapsing during my attempts at coming off the medication. Who are you, Tom Cruise?

      April 19, 2011 at 21:08 | Report abuse |
    • Steve

      Define chemical imbalance.......I am still waiting for that......idiots are treating a "chemical imbalance" that cannot be measured,
      with chemicals......

      It must suck to be in a profession based on theory.......pathetic

      April 19, 2011 at 21:42 | Report abuse |
    • Steve

      It is amazing how humans have been around tens of thousands of years without antidepressants and now shockingly over a third of American women "need" them. What a friggin joke! Pathetic

      April 19, 2011 at 21:54 | Report abuse |
    • Al

      There is a lot of theory but it is also backed by a lot of data. By understanding neuronal synapses we have learned that there is such a thing as a chemical imbalance. This happens when neurotransmitters are underproduced, and this reduction so happens to correlate with depressive symptoms. The reason why you probably didnt know this is because this proffession is way over your head. Next time read a friggin book or atleast wikipedia-it, its all over the place!

      April 19, 2011 at 22:38 | Report abuse |
    • Andrew McFadden

      Sorry Al, but there is no evidence yet that low seratonin (neurotransmitter) levels causes depression. It could very well be the other way around. In that case, SSRIs (antidepressants) only cure a symptom that has nothing to do with a person's mood at all. This would make sense, seeing as SSRIs rarely outperform placebos in most clinical trials.

      April 19, 2011 at 23:03 | Report abuse |
    • El

      actually, the evidence that low serotonin levels cause depression is from the fact that increasing synaptic serotonin levels improves depression. and yes, SSRIs seem to cure the symptom (depressed mood). isn't that what it's supposed to do? finally, SSRIs do outperform placebo in most clinical trials, this is how they were FDA approved for treatment on depression in the first place. obviously you have little familiarity with actual clinical treatment of major depressive disorder. Yes it's true that everyone has their own agenda, I'm just waiting for you to drop the URL to your 'natural herbs webstore' on us.

      April 20, 2011 at 05:00 | Report abuse |
    • Beth

      Steve–Humans have been around for tens of thousands of years without many things. Without cars, without vitamans, without cell phones, without television, without doctors, without jobs, without computers. Tell me, do you have any of these things? Could you live without all of them? Sure you could. The question is: are you willing to?

      April 20, 2011 at 08:31 | Report abuse |
  5. Kate

    What about those who can't afford Psychotherapy (it is relatively expensive) and our insurance will not cover it? My husband and I would like to have a second child, but I can't stop taking an antidepressant; I've tried several times and relapse within weeks. My clinical depression is not going to go away and I am not quite 30 yet. Some of us do not have a choice but to either not add to our families (which can be completely heart-wrenching) or to continue taking the medication through pregnancy. My husband and I have done a lot of research in the past year, have spoken it over with my doctor and she has talked to SEVERAL of her psychologist friends who have all agreed with us; that knowingly staying on Wellbutrin XR through the pregnancy is better than the alternative, other than not having another child.

    So what do you recommend then? Your article really doesn't show any other useful suggestions except for the Psychotherapy. IMO, it was a non-article because it really didn't answer any the question.

    April 19, 2011 at 21:05 | Report abuse | Reply
    • Kathleen

      Kate, you hit on something exquisite and it extends to pain management also. If there was adequate reimbursement and coverage for interventional therapies, and adequate funding for research, the entire approach for treating depression and pain would be different. We would not just see medications in the forefront of depression therapy. Right now, drug companies fund the majority of research. My heart goes out to you because meditation, exercise, even laughter Yoga are all approaches that can at least be used in conjunction with medication therapy, yet few patients are guided that way. If there are any free programs, grab them and keep researching those findings on your own.

      April 23, 2011 at 17:00 | Report abuse |
  6. Bobby

    What about the supplement SAME, of accupunture, biofeedback..

    April 19, 2011 at 21:11 | Report abuse | Reply
  7. yurekea1

    I spent three years of my life trying to overcome alcoholism. For the first two years I was on multiple antidepressants =the result was frequent relapse. Once I turned my life over to god and quit the B.S. drugs, I became sober and mentally sound. Check out the "Marketing of madness" It is available on DVD and it features what a money machine these hyped up next generation drugs are. The FDA should be ashamed for being the blatant puppets of big pharma that they truly are.

    April 19, 2011 at 22:53 | Report abuse | Reply
  8. Diane

    Not all antidepressants are equally risky during pregnancy. http://www.womensmentalhealth.org/ is a great resource (run by Massachusetts General Hospital) and contains a very reasonable discussion of the various risks during pregnancy and breast-feeding associated with different psychiatric drugs, including antidepressants, mood stabilizers, and anti-psychotics.

    April 19, 2011 at 23:11 | Report abuse | Reply
  9. Henry

    I was depressed lots of times throughtout my life...I didn't need a book or a pill. I turned my focus unward and thought of ways for me to better myself. I also turned most of energy towards the gym. I know I'm not better than most of the other commenters but if being pill-less works/worked for me, why can't it for most of America?

    April 19, 2011 at 23:31 | Report abuse | Reply
    • Support36

      You can't compare your depression to someone else's depression. They could have a more severe form or an imbalance of different neurotransmitters. For the people who notice a "night and day" difference between being on medication and not, there is no reason to try other methods. Everyone should find what works best for them and not judge those who need medication.

      April 20, 2011 at 05:28 | Report abuse |
    • Beth

      Henry, I'm glad that your lifestyle change worked for you, but asking why your specific treatment doesn't work for everybody is kind of silly, don't you think? That's like asking "I love anchovies on my pizza, why doesn't everyone love anchovies on their pizza?" To assume everyone's body works the same is ludicrous; if that were the case, we'd only have one drug for every disease, everyone's body would heal exactly the same after surgery, we'd all die at the exact same time, etc.

      April 20, 2011 at 08:25 | Report abuse |
  10. xinejaquette

    I was diagnosed with bipolar at 16. I am now 31 years old and also 38 weeks pregnant. I checked in with my psychiatrist but he was unfamiliar on how to proceed safely. He recommended I seek out a prescribing psychiatrist that specialized in monitoring pregnancy. She evaluated the situation and helped me debate risk factors and what we could do to eliminate risk or reduce it. The pregnancy has been very closely monitored with ultrasound and blood draws but everything looks healthy. I had my psychiatrists, a weekly therapist, OBGYN appts, lab draws & ultrasound appts so easily 75 medical appts in the last year. I would advice good insurance coverage and regular appts whether you continue medication or not. One option suggested was to cease medications and resume them after week 20 of pregnancy but I was worried that if it took us a long time to conceive I would be open to a relapse before conception.

    April 20, 2011 at 02:23 | Report abuse | Reply
    • D

      Congratulations. I was diagnosed with Bi-Polar II and became pregnant the first time at 31, although had not taken medications in at least a year. I have 2 healthy boys. You are going about it 100% the correct way. I wish I would have had a psychiatrist at the time because a lot of OBs really don't know much about psychiatric medications. My OB was aware of my diagnosis of the Bi-Polar and of general anxiety disorder. Due to anxiety attacks, she prescribed and I took Paxil for 6 weeks in my second trimester the first time. This was literally at the time it was becoming aware to the public and doctors that it was dangerous in the 1st trimester, they knew of dangers in the 3rd trimester, but could monitor for those and I let her know there was no way I was going to continue the medication during the 3rd trimester. I took nothing in the second pregnancy and suffered for it. Just make sure to continue following up with your psychiatrist after having the baby. During my second pregnancy my anxiety increased to continuous and no longer just attacks by the 3rd trimester. Honestly, seemed to be closer to psychosis with the thoughts going through my head. But again, I was not seeing a psychiatrist at the time, only a psychologist. I did have postpartum depression with both boys, but not so typical, it was about 3 months after birth in both cases. Make sure you continue seeing the psychiatrist after having your baby to make sure you do not have unaddressed problems. Best of luck to you.

      April 20, 2011 at 08:33 | Report abuse |
  11. Cristi

    I think the point here is that untreated mental illness is what's truly bad for mom & baby. Not all methods of treatment work the same for every person, so finding what's right for you, whether meds, therapy, exercise, acupuncture, massage, light therapy, etc or a combination. It's good to be thinking in these terms early bc finding a balance takes time. I personally needed meds during pregnancy for my major depression & anxiety but also did regular chiropractic, massage and therapy with my first pregnancy. I did try to slowly wean before getting pregnant and it just didn't work for me. Each mental illness & person is different so focus on what helps you, and with the help of your doctor, you'll do what's right for your future child. Good luck.

    April 20, 2011 at 12:49 | Report abuse | Reply
  12. Sadness Addicted

    There are significant long term health effects from taking antidepressants.

    I offer the following observatio­n. I have known identical twin sisters. Both shared a dysfunctio­nal childhood. One twin learne to cope with her sadness and loss. The other twin started medicating 15 years ago with zoloft, then prozac and has been on 150 mg to 300 mg of effexor for the last 3 years.

    Recently I observed these identical twins. The medicated twin In comparison to the non-medica­ted twin, “flickers” like someone with early Parkinson’­s disease, she unconsciou­sly rolls her tongue and forces it in and out of her rounded lips, unconsciou­sly circuitous­ly rubs the tip of her index fingers against the first joint of her thumbs and she has a comparativ­ely weakened memory.

    The science of serotonin reuptake inhibitors effect on depression hypothesiz­ed by Nemeroff 20 years ago has yet to be proven. But stories like this one have caused the general population to believe the theory is scientific fact.


    May 5, 2011 at 19:42 | Report abuse | Reply
  13. Benjamin Tamblyn

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