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Hey guys,

So, I've been off of all my meds since May (Effexor and Neurontin) and I am not doing well. I've been diagnosed BP II since 1999, though, of course, it's only the depression that causes me problems. Hubby of 6 years and I are trying to get pregnant (and being the impatient individual that I am, I think it is taking too long - it's only month two, and I know that odds are within 6 months, but damnit! I'm tired of "trying." I just want!).  Well, I am not doing well. Hubby and I have agreed that I am cycling, and I feel like it is really straining our marriage because I am putting hubby under so much stress. I started having sleep probs in May and take 1-2 AMbien a night so I can get some sleep (it helped my mood for a while, but not recently). I saw my ob/gyn last week and she said that I cannot stay on the Ambien while pregnant, but could not suggest anything instead (which let me tell you, pissed me off to no end. Ambien is Class B, so I don't understand why I can't take it - insomnia is not good). I hate my job (i'm a psychology associate in a juvenile prison - my boss sucks, I'm tired of dealing with the apathetic kids) and I have trouble getting out of bed most days out of the week. The only reason I am staying in my job is because I need six months more in order to get my psychologist license, and I really, really want my license. But my job is killing my soul (and at times, my humanity). My husband says I should quit, but I can't find another job, and I would feel worse if I just sat at home all day watching the dogs (we agreed previously that I would work until I delivered (but I have to get pregnant first!), because I would have my license by then).  So, instead, my husband has pretty much arranged that my father is going to stay with us for a month to help me out. I know this depression is a lot of stress for my husband, and I adore my father and he is great to have around. But I would just feel like such a failure to have my father have to stay with me when I am 27-years-old. I'm not sure that makes sense, but that's how I feel.

I guess I'm just looking for a little support. I've been going to therapy, but honestly, that has not helped. I'm doing everything I am supposed to: staying social, getting exercise, trying to get sleep. My appetite is so low I've lost about 8 pounds in the last month and a half - I forcefeed myself. I know I have to keep my weight up if I want to get and stay pregnant, but it is very hard. I feel like a burden . I've suggested going back on medications (at least ADs), but my husband is deadset against it - he would rather me quit my job and stay at home in a little lump (He's very afraid of negative sequelae to the fetus. I've tried to explain that my depression itself could hurt the fetus more, but he's somewhat inflexible on the point. ) I don't know what to do. My last depressive episode (6 years ago) landed me in the hospital. I don't want to go back there (literally and figuratively). Any wisdom or words of support would be appreciated.

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Psyche,

All the stress, hating the job, not being on any meds, and starting to loss weight, sounds like you are definitely getting depressed again, JMO. You are correct that a severe depresion could endanger a fetus as much as some medication.

Have you checked out the pinned topic on top of this board about medications during pregnancy and breatfeeding? There are some meds that are considered pretty safe during pregnancy especially considering what going left untreated would do. Try looking there and reading some info and try sharing it with your husband.

BTW, what meds were you taking before that worked for the depression? I will be happy to do some research on specific meds if you can't find out what you need to know from one of the pinned topics on the board. I'll look into safe sleep meds for you.

Erika

Edit add: Have you ever taken Lamictal? Good mood stabilizer and founf to be gnerally safe druing pregnancy.

Lamotrigine ( Lamictal ) is considered a newer-generation anticonvulsant, and the pharmaceutical company established an international lamotrigine pregnancy registry. It just released the findings, which involved over 400 first-trimester exposures to lamotrigine monotherapy.[7] The overall risk for major malformations is about 2.9%, which falls between 2% and 4%, the baseline risk for major malformations in the general population. I always educate my patients that we're all at risk for having a child with a birth defect. When you evaluate these medications, you have to ask the question, "Do they increase that baseline risk?"

So far, of the anticonvulsants, lamotrigine seems relatively safe with respect to risk for major malformations, compared with divalproex.

http://www.medscape.com/viewarticle/506804

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Oh boy.  A lot of emotions swirling around a decision like this, huh?  I remember when it seemed like two months was forever, and I remember thinking I should buy home pregnancy kits in bulk so I could check once a week, "just in case"!  LOL  Each of my girls took around 8 months to conceive, if I remember right.  But phooey on the averages; when you're eager, each day stretches out in front of you, and you just sit there listening to the pounding tick of your biological clock! ;)

But ... (this is just my opinion, but you did ask) I think .... you should put trying to conceive on hold until some other things start getting resolved.  It doesn't sound like your husband truly understands what a debilitating chronic illness you have.  Yeah, it would help to have your dad around (and please don't feel like a failure because of it!  I think it's really a precious thing to have extended family pitching in -- rare these days, but wives and mothers used to have a much better support system.  These days we're just expected to buck up and be independent and isolated.  Bah!)  But while depression is aggravated by stress and workload, that's not all there is to it.  I hope you can get hubby to understand that quitting your job would not magically make the depression go away either. 

The fact that both your OB and your husband seem so deadset against meds worries me.  At a minimum, I would nail down a contingency plan with your family and with your doctors about what to do if your bipolar/depression crashes your world while pregnant.  Cuz when it hits (like you probably know from six years ago), it's a crappy time to have to suddenly formulate a plan.  There's so much literature out there now about the effects of depression on pregnancy, and more and more data is being analyzed and published every year about specific medication effects.  Probably a lot of the stickies at the top of the board have this info; I confess to not having read them  :)   However I did recently see a Medscape review of women's issues in the treatment of bipolar, and I seem to recall that lithium was recommended for pregnant women who tended to cycle into mania, and Lamictal was recommended for us depressive types.  (My own BP wasn't diagnosed until after my last pregnancy and I don't plan on having any more kids, but it's a subject that continues to interest me.)  And of course there's lots of data about women taking antidepressants during pregnancy and breastfeeding.  I hope your OB does her homework and isn't just expecting you to tough it out.

{{hugs}}  Hopefully Susanb will see your post too; she probably has a lot more insight into your situation than I do, and her posts are always helpful!

(Oops - I see Erika posted while I was disconnected and dealing with kid stuff!  Good; sounds like we're on the same page!)

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I've been on Lamictal - I got a head-to-toe rash and had to discontinue. I was taking Effexor and Neurontin for approximately 5.5 years and it worked great. But Neurontin is a teratogen, so my shrink and I dc'ed it. Once we dc'ed that, I started having sleep problems, so we added Ambien while I tapered completely off the Effexor. Even at 37.5, the Effexor seemed to be having some good effects - but then I saw an article on the side effects of ADs in the third trimester on neonatal respiration. So I dc'ed it. I've been off of all meds since early June, and I have several good days followed by several gutter days. I usually feel better in the afternoons.

Hubby and I talked this evening about restarting the AD. He is still very worried about fetal effects (which I can understand), but we need to choose the least harmful route (AD or non). Any articles about Effexor in pregnancy would be very helpful and appreciated.

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Medication Exposure During Pregnancy: Antidepressants

Drug Use in Pregnancy

According to the United States Food and Drug Administration (FDA), the guidelines for assessing the category of risk for various medications are listed in Table 1 and Table 2 .[5,6]

Although the category B medication bupropion may seem a logical first choice, it's important to note that it is assigned category B only because there are no human studies; thus, its safety is untested.[7]

According to the Evidence-Based Medicine Working Group of the American Academy of Family Physicians (AAFP), the selective serotonin reuptake inhibitors (SSRIs) and the tricyclic antidepressants (TCAs) have been found in studies to be safe and effective in reducing the symptoms of depression.[8]

No studies have shown antidepressants to increase the risk of major malformations, although 1 study showed fluoxetine was associated with a greater risk for minor malformations.[9]

Tables for:

Medication Exposure During Pregnancy: Antidepressants

[Medscape Ob/Gyn & Women's Health.  2005; 10 (1): 

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As you've probably discovered, there seem to be two conflicting (although not contradictory) recommendations about Effexor in pregnancy.  Early studies have found there are (so far) no concerns about teratogenicity; then there's the more recent study you mention about third trimester difficulties.  The third trimester thing really makes sense to me, given its reputation for withdrawal effects (I've been through it myself and hate to think of a newborn going through it.  <shudder>)  There are similar reports about Paxil.

Have you ever tried any of the other SSRI's?  A bit risky for a bipolar without a mood stabilizer, but if Effexor was working for you with just Neurontin (not a heavy duty MS), maybe it's worth a try?  Personally I can handle SSRI/SNRI's without triggering mania or much cycling, but they always poop out on me.  Then again, it's hard to say how pregnancy hormones would effect you.  A lot of MI women feel better than they've ever felt during pregnancy.  I was on Prozac for the first five months with my second child, but DC'd it because I was feeling OK except very tired, and I always have trouble with somnolence with SSRI's.  I didn't have trouble with depression again until several months after giving birth.

I thought this was a good article about risks versus benefits in discontinuing antidepressants during pregnancy.  They seem to have a lot of other good articles on that website too.

And here's another recent one in the same vein:  Weaning women off antidepressants in late pregnancy unwarranted risk

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Well, I started having depressive pisodes when I was 10, but it was not until I was 19 that I was placed on my first AD - Zoloft. Zoloft worked (I was also in therapy at the time), but if I missed a dose, I would have terrible shakes and nausea. When I was 21, I became depressed again and was switched to Paxil. Within a month, I was rapid cycling and landed in the hospital. I was diagnosed BP II at that time (i was given Effexor and within 24 hours happily zooming around the halls on the unit - and I was suicidal when I checked in 3 days earlier).  We attempted Depakote, but I spent the night vomiting after the first dose. I have thyroid problems (how many of us don't?), so Lithium is really a last resort. My doc prescribed Neurontin, and that seemed to work great - no cycling, I was sleeping. I only gained about 5 pounds, which was not a big deal (since dc'ing in June, I've dropped to a weight I have not been at since I was in high school. My husband is worried because he says I feel bony). I was at 225mg of Effexor and 1600mg of Neurontin - really, it was the depression that was the bad part - I love the hypomania, though my hubby says I scare him when I'm hypomanic. (who doesn't love hypomania!) My moods generally cycle every couple of days now that I am not on meds: some days I get everything done, and other days I am a little lump.

I showed Hubby the thread last night, and he seemed to be considering restarting ADs. The effexor was very helpful when I was taking it, even with a dose at 37.5 (not great effects, but I was not in the gutter). Today, I am feeling ok. Not weepy, which is always a plus, but not normal. Just there.

BTW, thank you for your suggestions. It does make me feel better to have support and kindness.

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I thought this was a good article about risks versus benefits in discontinuing antidepressants during pregnancy.  They seem to have a lot of other good articles on that website too.

<{POST_SNAPBACK}>

Thanks or the link Gretl. If you don't mind I would like to pin the article/link on the board. Or feel free to do it yourself.

One thing that I can't stress enough is to get your OB/Gyn to work together with your pdoc before and after you become preganant to handle your meds. Many OB/GYNS will say absolutely no to ADs and other psychotropics during pregnancy but as you can read form Gretls's link the benefits of taking meds during preganacy very often outweigh any of the risks.

Erika

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I've never pinned anything beside a diaper, but what the heck, how hard can it be?  ::wink::

Lemme give it a try...

EDITED:  waaaaaah!  I can't figure it out!!  LOL  So tell me ... how do you "pin" a topic?!

By the way, did you know that if you're trying to pin a cloth diaper and the tip of the pin is dull, you can slide it across your hair or alongside your nose?  The oil from your hair or skin helps it slide right through however many layers of cloth you're using.  Little known fact.  Also known as TMI trivia  B)

(And Psyche, sorry for the hijack!!!!!!)

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  • 2 weeks later...

Hey guys,

So, I've been off of all my meds since May (Effexor and Neurontin) and I am not doing well. I've been diagnosed BP II since 1999, though, of course, it's only the depression that causes me problems. Hubby of 6 years and I are trying to get pregnant (and being the impatient individual that I am, I think it is taking too long - it's only month two, and I know that odds are within 6 months, but damnit! I'm tired of "trying." I just want!).  Well, I am not doing well. Hubby and I have agreed that I am cycling, and I feel like it is really straining our marriage because I am putting hubby under so much stress. I started having sleep probs in May and take 1-2 AMbien a night so I can get some sleep (it helped my mood for a while, but not recently). I saw my ob/gyn last week and she said that I cannot stay on the Ambien while pregnant, but could not suggest anything instead (which let me tell you, pissed me off to no end. Ambien is Class B, so I don't understand why I can't take it - insomnia is not good).

<{POST_SNAPBACK}>

Have you considered going to an ObGyn who specializes in these things? Also, Ambien is just an overpriced benzo, and my ObGyn sees no problem with my Clonazepam and pregnancy (it's the pest option for epileptics who are pregnant, I think), maybe another, cheaper, milder benzo might help all around.

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SUSAN! TIGGER POUNCE! MISSED YOU MISSED YOU MISSED YOU!

Hey, even Brooke Shields gets PPD, even if Tom Cruise says it doesn't exist (damn scientologists, run them over with a combine). You're in good company, anyway. I know that doesn't make it easier but I thought it might make you briefly amused.

Hey if you need a break, gimmie a call! I'm sure you're only, what, 10 hours away?  ;)

I know being a mom is hard. I'll have all the time in the world to do it, being disabled, but it will still be hard. You haven't discouraged me in the slightest.

Hang in there hon, we love ya, give that adorable baby a smooch for me!

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  • 1 year later...

Hey, there--the nuse in IN--

as Gretl said--

"The fact that both your OB and your husband seem so deadset against meds worries me. At a minimum, I would nail down a contingency plan with your family and with your doctors about what to do if your bipolar/depression crashes your world while pregnant. Cuz when it hits (like you probably know from six years ago), it's a crappy time to have to suddenly formulate a plan. There's so much literature out there now about the effects of depression on pregnancy, and more and more data is being analyzed and published every year about specific medication effects. "

This is good info, and the pinned articles at the top are also great. The problem you face is risks vs. benefits. I sam VERY concerned that you seem to have an OB/GYN who is not up to date on the reasearch being done, and published. Again, my usual song-and-dance--PLEASE find an OB/GYN who is willing wto work with your OB as a TEAM. NO ONE, least of all us BP folk, should go off our meds just cold-turkey.

Trust me. there are many excellt (uaully young, and often women) OB's who have delt extensively with women who have MI and wisht to get or are pregnant. Mainly because according to my informal research, as many as 30% of women who are pregnant have had or are having MI issues during their pregnancy.

As for your husband, you need to have ihim on your side, bbecause his role is to be your advocate, to speak for you when you can't (labor, for insance) He may just be scared--would he be willing to read some of the research we've posted above? And by allmeans, when you find that doc, encourage him to go.

Ideally, there shuld be one meeting with your pdoc, OB, you and your hubby. Again, my favorite anaolgy--

If you had a chronic medical disease--lupus, for instance, and got prognant, the rheumatologist who manages your lupus would work with your OB to assure that you have a safe pregnancy and healthy babyThey wuld work as a TEAM. Yes, some meds may have risks. And that is where your EDUCATED choices come in. You are an adult, and must be as knowledgeble as possible about all these meds--thats why we have all the stufies posted here, all n one convenient little place.You must speak for your baby and for yourself.

And there is vast reaseach that shows clearly that a depressed or MI mother, untreated, will pass those behaviors on to her infant as early as 3 weeks of age. In other words, the baby takes her behavior cues from you--and if you are depressed, the infant is going to show depressive symptoms. You are also at vastly increased risk for post partum depressen or even psychosis (think--Andrea Yates). You are much less likely to fall victim to this if you are carefully medicated and stable during your pregnancy.

Please feel free to PM me--and pardon the long rant--

I wish you much luck--by now you may be pregnant, and I would love to hear how you are and how your pregnancy is being managed.

Love, china, resident OB nursie

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  • 2 weeks later...

HIya-

I looked at the lit and can say it looks lke WB is a winner for you. I admit I didn't read through every post all the way.

at any rate, for myself, my pnurse wanted me to take zoloft and haldol for my bp1 w/psychotic symptoms when i was pregnant, to get rid of my other meds. i'm not sure why he wanted to disc. the lamictal and WB, but he did, and wanted to get it down to zoloft and haldol. so that was going to be the routine.

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Haldol is EVIL, and I would not recommend it for anyone, preg or not. The instances of it causeing irreversible side effects, such as tardive dyskenesia, are way too high for anyone to take a chance unless its the last resort--but certianinlyNOT if you are pregnant. Its a scary drug, folks--

At the risk of sounding repetitive--please re-read my earlier post!

china

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i agree china, i took it for about a month when i was not pregnant, and i was planning on suggesting my own cocktail based on a lot of my own research to him. i'm not sure why he's in love with haldol. that remains a mystery. maybe i'll ask him sometime that why, in light of some good evidense that you and others bring up, he is in love with haldol. yeah, he had me take it and claimed it was right up there with regular AAPs!

anyway, off topic.

sorry about your lamictal rash. i've read a lot about lamictal and it seems good in pregnancy. it seems that haldol is NOT! i've questioned some of his med choices in the past (i picked out my current meds).

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sorry about my rambling-

it doesn't seem like it has been too long since you started trying. i've heard of so many couples too that once they stop trying, that's when they conceive! are you timing it, or still just winging it? it has been my luck that as soon as i'm off the pill, and using the sponge but still using something, that's when i get preggers. maybe you should use the sponge (supposed to be funny).

depression is such a horrible monster. and what china said is so true, you don't want to teach your child to be depressed and anxious. it is in the best intesrest of the mother and child to treat the depression in many cases. you probably need an ob who will work with a pdoc who is used to this kind of thing and they can help you better than people who aren't accustomed to it (my theory).

i think you'll have no trouble conceiving and having a healthy baby! it will probably take just one sponge (ha) cycle to get you the positive pregnancy test you want!

loon

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At the risk of sounding crass ansd materialistic, he's probably getting nice perks from the folks that make/sell Haldol. I'cve had too much experience with private docs and the big pharms--it happens every day, all day, everywhere. Thats often how docs pick their meds--and sometimes they are even having a little"go" with that cute little blonde drug rep. No shit--

I cannot imagine anyone agreeing to Haldol unless it was an absolutel last resort--it causes side evffects that DO NOT go away when you stop taking them!! That does not sound like your typical Atypical (altho, for me, the side effects are the same--they just go away when I stop the atypicals.) ( NB: is there a typical atypical??? oh, well--)

I saw my mom, who was dying of brain cancer and was sent to a neurologist BECAUSE of tardive dyskensia, PRESCRIBED Haldol, just to sedate her and shut her up. Lets see--you are treating a patent with an irreversable meurological symptom--lets give her some meds that cause the same symptom, only make it worse!!!! Can anyone say "malpractice"?? Hint: both the neurologist and her oncologist who referred her sure could day it, and read it as well. All it took was a letter saying we KNEW what was done was wrong and we wwre going from there. Boom--no more Haldol. Of course, the problems had been created, and never went away--

Sorry for the off-issue rant. I just feel REALLY strong about Haldol. Its evil---

china the nursie--

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