Antidepressants and Pregnancy

Why is treatment for depression during pregnancy important?

If you have untreated depression, you might not seek optimal prenatal care or eat the healthy foods you and your baby need. Experiencing major depression during pregnancy is associated with an increased risk of premature birth, low birth weight, decreased fetal growth or other problems for the baby. Unstable depression during pregnancy also increases the risk of postpartum depression and difficulty bonding with your baby.

Are antidepressants an option during pregnancy?

Yes. A decision to use antidepressants during pregnancy, in addition to counseling, is based on the balance between risks and benefits. The biggest concern is typically the risk of birth defects from exposure to antidepressants. Overall, the risk of birth defects and other problems for babies of mothers who take antidepressants during pregnancy is very low. However, some antidepressants are associated with a higher risk of complications for your baby. Talking to your health care provider about your symptoms and medication options can help you make an informed decision.

If you use antidepressants during pregnancy, your health care provider will try to minimize your baby’s exposure to the medication. This can be done by prescribing a single medication (monotherapy) at the lowest effective dose, particularly during the first trimester.

Keep in mind that psychotherapy is also an effective treatment for mild to moderate depression.

Which’s antidepressants are considered OK during pregnancy?

Generally, these antidepressants are an option during pregnancy:

• Certain selective serotonin reuptake inhibitors (SSRIs). SSRI’s are generally considered an option during pregnancy, including citalopram (Celexa) and sertraline (Zoloft). Potential complications include maternal weight changes and premature birth. Most studies show that SSRI’s aren’t associated with birth defects. However, paroxetine (Paxil) might be associated with a small increased risk of a fetal heart defect and is generally discouraged during pregnancy.

• Serotonin and norepinephrine reuptake inhibitors (SNRIs). SNRI’s also are considered an option during pregnancy, including duloxetine (Cymbalta) and venlafaxine (Effexor XR).

• Bupropion (Wellbutrin). Although bupropion isn’t generally considered a first line treatment for depression during pregnancy, it might be an option for women who haven’t responded to other medications. Research suggests that taking bupropion during pregnancy might be associated with miscarriage or heart defects.

• Tricyclic antidepressants. This class of medications includes nortriptyline (Pamelor) and desipramine (Norpramin). Although tricyclic antidepressants aren’t generally considered a first line or second line treatment, they might be an option for women who haven’t responded to other medications. The tricyclic antidepressant clomipramine (Anafranil) might be associated with fetal birth defects, including heart defects.

Are there any other risks for the baby?

If you take antidepressants during the last trimester of pregnancy, your baby might experience temporary signs and symptoms of discontinuation — such as jitters, irritability, poor feeding and respiratory distress — for up to a month after birth. However, there’s no evidence that discontinuing or tapering dosages near the end of pregnancy reduces the risk of these symptoms for your newborn. In addition, it might increase your risk of a relapse postpartum.

The connection between antidepressant use during pregnancy and the risk of autism in offspring remains unclear. But most studies have shown that the risk is very small and other studies have shown no risk at all. Further research is needed.

A new study also suggests a link between use of antidepressants during pregnancy, specifically venlafaxine and amitriptyline, and an increased risk of gestational diabetes. More research is needed.

Should I switch medications?

The decision to continue or change your antidepressant medication will be based on the stability of your mood disorder. Talk to your health care provider. Concerns about potential risks must be weighed against the possibility that a drug substitution could fail and cause a depression relapse.

What’s the bottom line?

If you have depression and are pregnant or thinking about getting pregnant, consult your health care provider. Deciding how to treat depression during pregnancy isn’t easy. The risks and benefits of taking medication during pregnancy must be weighed carefully. Work with your health care provider to make an informed choice that gives you — and your baby — the best chance for long-term health.

Sources: The Mayo Clinic, NAMI, NIH, NIMH

Paroxetine (Oral Route)

US Brand Name

1. Brisdelle

2. Paxil

3. Paxil CR

4. Pexeva

Descriptions

Paroxetine is used to treat depression, obsessive-compulsive disorder (OCD), panic disorder, generalized anxiety disorder (GAD), social anxiety disorder (also known as social phobia), premenstrual dysphoric disorder (PMDD), and posttraumatic stress disorder (PTSD). Brisdelle™ is used only to treat moderate to severe hot flashes caused by menopause.

Paroxetine belongs to a group of medicines known as selective serotonin reuptake inhibitors (SSRIs). These medicines are thought to work by increasing the activity of the chemical called serotonin in the brain.

This medicine is available only with your doctor’s prescription.

This product is available in the following dosage forms:

• Tablet

• Capsule

• Suspension

• Tablet, Extended Release

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.

Check with your doctor immediately if any of the following side effects occur:

Less common

• Agitation

• chest congestion

• chest pain

• chills

• cold sweats

• confusion

• difficulty with breathing

• dizziness, faintness, or lightheadedness when getting up from a lying or sitting position

• fast, pounding, or irregular heartbeat or pulse

• muscle pain or weakness

• skin rash

Rare

• Absence of or decrease in body movements

• bigger, dilated, or enlarged pupils (black part of the eye)

• convulsions (seizures)

• difficulty with speaking

• dry mouth

• fever

• inability to move the eyes

• incomplete, sudden, or unusual body or facial movements

• increased sensitivity of the eyes to light

• poor coordination

• red or purple patches on the skin

• restlessness

• shivering

• sweating

• talking, feeling, and acting with excitement and activity you cannot control

• trembling or shaking, or twitching

Incidence not known

• Back, leg, or stomach pains

• blindness

• blistering, peeling, or loosening of the skin

• blue-yellow color blindness

• blurred vision

• constipation

• cough or hoarseness

• dark urine

• decreased frequency or amount of urine

• decreased vision

• difficulty with swallowing

• electric shock sensations

• eye pain

• fainting

• general body swelling

• headache

• high fever

• hives or itching skin

• inability to move the arms and legs

• inability to sit still

• increased thirst

• incremental or ratchet-like movement of the muscle

• joint pain

• light-colored stools

• lockjaw

• loss of appetite

• loss of bladder control

• lower back or side pain

• muscle spasm, especially of the neck and back

• muscle tension or tightness

• painful or difficult urination

• painful or prolonged erection of the penis

• pale skin

• puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue

• raised red swellings on the skin, the buttocks, legs, or ankles

• red, irritated eyes

• sensitivity to the sun

• skin redness or soreness

• slow heart rate

• sores, ulcers, or white spots on the lips or in the mouth

• spasms of the throat

• stiff muscles

• stomach pain

• sudden numbness and weakness in the arms and legs

• swelling of the breasts

• swelling of the face, fingers, or lower legs

• swollen or painful glands

• tightness in the chest

• unexpected or excess milk flow from the breasts

• unusual bleeding or bruising

• unusual tiredness or weakness

• vomiting

• weight gain

• yellowing of the eyes or skin

Some 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. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

• Acid or sour stomach

• belching

• decreased appetite

• decreased sexual ability or desire

• heartburn

• pain or tenderness around the eyes and cheekbones

• passing gas

• problems with urinating

• runny or stuffy nose

• sexual problems, especially ejaculatory disturbances

• sleepiness or unusual drowsiness

• stomach discomfort or upset

• trouble sleeping

Less common

• Abnormal dreams

• change in sense of taste

• congestion

• discouragement, feeling sad, or empty

• drugged feeling

• fast or irregular breathing

• feeling of unreality

• headache, severe and throbbing

• increased appetite

• itching of the vagina or genital area

• itching, pain, redness, or swelling of the eye or eyelid

• lack of emotion

• loss of interest or pleasure

• lump in the throat

• menstrual changes

• pain during sexual intercourse

• problems with memory

• sense of detachment from self or body

• sneezing

• thick, white vaginal discharge with no odor or with a mild odor

• tightness in the throat

• tingling, burning, or prickling sensations

• trouble concentrating

• voice changes

• watering of the eyes

• weight loss

• yawn

Quetiapine (Oral Route)

US Brand Name

1. SEROquel

2. SEROquel XR

Quetiapine is used alone or together with other medicines to treat bipolar disorder (depressive and manic episodes) and schizophrenia. Quetiapine extended-release tablet is also used together with other antidepressants to treat major depressive disorder. This medicine should not be used to treat behavioral problems in older adult patients who have dementia or Alzheimer disease. Quetiapine is an antipsychotic medicine that works in the brain.

This medicine is available only with your doctor’s prescription.

This product is available in the following dosage forms:

• Tablet, Extended Release

• Tablet

Take this medicine exactly as directed by your doctor to benefit your condition as much as possible. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

This medicine should come with a Medication Guide. Read and follow the instructions carefully. Read it again each time you refill your prescription in case there is new information. Ask your doctor if you have any questions.

Quetiapine tablets may be taken with or without food on a full or empty stomach. However, if your doctor tells you to take it a certain way, take it as directed.

Swallow the extended-release tablets whole. Do not break, crush, or chew it. It is best to take this medicine without food or with a light meal (approximately 300 calories).

Side Effects

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.

Check with your doctor immediately if any of the following side effects occur:

More common

• Chills

• cold sweats

• confusion

• dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position

• sleepiness or unusual drowsiness

Less common

• Black, tarry stools

• blurred vision

• changes in patterns and rhythms of speech

• chest pain

• cough

• drooling

• fever

• inability to move the eyes

• inability to sit still

• increased blinking or spasms of the eyelid

• lip smacking or puckering

• loss of balance control

• mask-like face

• muscle aches

• need to keep moving

• painful or difficult urination

• puffing of the cheeks

• rapid or worm-like movements of the tongue

• restlessness

• shakiness in the legs, arms, hands, or feet

• shuffling walk

• slowed movements

• slurred speech

• sore throat

• sores, ulcers, or white spots on the lips or in the mouth

• sticking out of the tongue

• stiffness of the arms or legs

• sweating

• swelling of the face, arms, hands, feet, or lower legs

• swollen glands

• trembling and shaking of the hands and fingers

• trouble with breathing, speaking, or swallowing

• uncontrolled chewing movements

• uncontrolled movements of the arms and legs

• uncontrolled twisting movements of the neck, trunk, arms, or legs

• unusual bleeding or bruising

• unusual facial expressions

• unusual tiredness or weakness

Rare

• Dry, puffy skin

• fast, pounding, or irregular heartbeat

• loss of appetite

• menstrual changes

• unusual secretion of milk (in females)

• weight gain

Less common

• Abnormal vision

• belching

• decreased appetite

• decreased strength and energy

• heartburn

• increased appetite

• increased muscle tone

• increased sweating

• indigestion

• sneezing

• stomach discomfort or upset

• stuffy or runny nose

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Antidepressants and Weight Gain?

Weight gain is a possible side effect of nearly all antidepressants. However, each person responds to antidepressants differently. Some people gain weight when taking a certain antidepressant, while others don’t.

Generally speaking, some antidepressants seem more likely to cause weight gain than others. These include:

• Certain tricyclic antidepressants, such as amitriptyline, imipramine (Tofranil) and doxepin

• Certain monoamine oxidase inhibitors (MAOIs), such as phenelzine (Nardil)

• Paroxetine (Paxil, Pexeva), a selective serotonin reuptake inhibitor (SSRI)

• Mirtazapine (Remeron), which is an atypical antidepressant — medication that doesn’t fit neatly into another antidepressant category

While some people gain weight after starting an antidepressant, the antidepressant isn’t always a direct cause. Many factors can contribute to weight gain during antidepressant therapy. For example:

• Overeating or inactivity as a result of depression can cause weight gain.

• Some people lose weight as part of their depression. In turn, an improved appetite associated with improved mood may result in increased weight.

• Adults generally tend to gain weight as they age, regardless of the medications they take.

If you gain weight after starting an antidepressant, discuss the medication’s benefits and side effects with your doctor. If the benefits outweigh the side effect of weight gain, consider managing your weight by eating healthier and getting more physical activity while enjoying an improved mood due to the medication.

You can also ask your doctor if adjusting the dose or switching medications might be helpful — but again, be sure to discuss the pros and cons before making such a decision.

Sources: The Mayo Clinic, NAMI, NIMH

Antidepressants and Alcohol

It’s best to avoid combining antidepressants and alcohol. It may worsen your symptoms, and it can be dangerous. If you mix antidepressants and alcohol:

• You may feel more depressed or anxious. Drinking can counteract the benefits of your antidepressant medication, making your symptoms more difficult to treat. Alcohol may seem to improve your mood in the short term, but its overall effect increases symptoms of depression and anxiety.

• Side effects may be worse if you also take another medication. Many medications can cause problems when taken with alcohol — including anti-anxiety medications, sleep medications and prescription pain medications. Side effects may worsen if you drink alcohol and take one of these drugs along with an antidepressant.

• You may be at risk of a dangerous reaction if you take MAOIs. When combined with certain types of alcoholic beverages and foods, antidepressants called monoamine oxidase inhibitors (MAOIs) can cause a dangerous spike in blood pressure. If you take an MAOI, be sure you know what’s safe to eat and drink, and which alcoholic beverages are likely to cause a reaction.

• Your thinking and alertness may be impaired. The combination of antidepressants and alcohol will affect your judgment, coordination, motor skills and reaction time more than alcohol alone. Some combinations may make you sleepy. This can impair your ability to drive or do other tasks that require focus and attention.

• You may become sedated or feel drowsy. A few antidepressants cause sedation and drowsiness, and so does alcohol. When taken together, the combined effect can be intensified.

Don’t stop taking an antidepressant or other medication just so that you can drink. Most antidepressants require taking a consistent, daily dose to maintain a constant level in your system and work as intended. Stopping and starting your medications can make your depression worse.

While it’s generally best not to drink at all if you’re depressed, ask your doctor. If you have depression:

• You may be at risk of alcohol abuse. People with depression are at increased risk of substance abuse and addiction. If you have trouble controlling your alcohol use, you may need treatment for alcohol dependence before your depression improves.

• You may have trouble sleeping. Some people who are depressed have trouble sleeping. Using alcohol to help you sleep may let you fall asleep quickly, but you tend to wake up more in the middle of the night.

If you’re concerned about your alcohol use, you may benefit from substance abuse counseling and treatment programs that can help you overcome your misuse of alcohol. Joining a support group or a 12-step program such as Alcoholics Anonymous may help.

If you’re at low risk of addiction to alcohol, it may be OK to have an occasional drink, depending on your particular situation, but talk with your doctor.

Also, tell your doctor about any other health conditions you might have and any other medications you take, including over-the-counter medications or supplements. Keeping your doctor informed is important because:

• Some liquid medications, such as cough syrups, can contain alcohol

• As you age, your body processes medication differently and levels of medication in your body may need to be adjusted

• Adding a new medication may change the level of another medication in your body and how it reacts to alcohol

Sources: The Mayo Clinic, NAMI, NIH, NIMH

Antidepressant Withdrawal: Is It Real?

Antidepressant withdrawal is possible if you abruptly stop taking an antidepressant, particularly if you’ve been taking it longer than four to six weeks. Symptoms of antidepressant withdrawal are sometimes called antidepressant discontinuation syndrome and typically last for a few weeks. Certain antidepressants are more likely to cause withdrawal symptoms than others.

Quitting an antidepressant suddenly may cause symptoms within a day or two, such as:

• Anxiety

• Insomnia or vivid dreams

• Headaches

• Dizziness

• Tiredness

• Irritability

• Flu-like symptoms, including achy muscles and chills

• Nausea

• Electric shock sensations

• Return of depression symptoms

Having antidepressant withdrawal symptoms doesn’t mean you’re addicted to an antidepressant. Addiction represents harmful, long-term chemical changes in the brain. It’s characterized by intense cravings, the inability to control your use of a substance and negative consequences from that substance use. Antidepressants don’t cause these issues.

To minimize the risk of antidepressant withdrawal, talk with your doctor before you stop taking an antidepressant. Your doctor may recommend that you gradually reduce the dose of your antidepressant for several weeks or more to allow your body to adapt to the absence of the medication.

In some cases, your doctor may prescribe another antidepressant or another type of medication on a short-term basis to help ease symptoms as your body adjusts. If you’re switching from one type of antidepressant to another, your doctor may have you start taking the new one before you completely stop taking the original medication.

It’s sometimes difficult to tell the difference between withdrawal symptoms and returning depression symptoms after you stop taking an antidepressant. Keep your doctor informed of your signs and symptoms. If your depression symptoms return, your doctor may recommend that you start taking an antidepressant again or that you get other treatment.

Sources: The Mayo Clinic, NAMI, NIMH

Tardive Dyskinesia

Tardive dyskinesia is a side effect of antipsychotic medications. These drugs are used to treat schizophrenia and other mental health disorders.

TD causes stiff, jerky movements of your face and body that you can’t control. You might blink your eyes, stick out your tongue, or wave your arms without meaning to do so.

Not everyone who takes an antipsychotic drug will get it. But if it happens, it’s sometimes permanent. So if you have movements you can’t control, let your doctor know right away. To ease your symptoms, your doctor may:

• Lower the dose

• Add another medication to what you’re taking to act as an antidote

• Switch you to a different drug

Symptoms:

Tardive dyskinesia causes stiff, jerky movements that you can’t control. They include:

Orofacial dyskinesia or oro-bucco-lingual dyskinesia: Uncontrolled movements in your face — namely your lips, jaw, or tongue. You might:

• Stick out your tongue without trying

• Blink your eyes fast

• Chew

• Smack or pucker your lips

• Puff out your cheeks

• Frown

• Grunt

Dyskinesia of the limbs: It can also affect your arms, legs, fingers, and toes. That can cause you to:

• Wiggle your fingers

• Tap your feet

• Flap your arms

• Thrust out your pelvis

• Sway from side to side

These movements can be fast or slow. You may find it hard to work and stay active.

Causes and Risk Factors

Antipsychotic meds treat schizophrenia, bipolar disorder, and other brain conditions. Doctors also call them neuroleptic drugs.

They block a brain chemical called dopamine. It helps cells talk to each other and makes the muscles move smoothly. When you have too little of it, your movements can become jerky and out of control.

You can get TD if you take an antipsychotic drug. Usually you have to be on it for 3 months or more. But there have been rare cases of it after a single dose of an antipsychotic medicine. Older versions of these drugs are more likely to cause this problem than newer ones. Some studies find a similar risk from both types, though.

Your chances of getting TD go up the longer you take an antipsychotic medicine.

Some drugs that treat nausea, reflux, and other stomach problems can also cause TD if you take them for more than 3 months. These include:

• Metoclopramide (Reglan)

• Prochlorperazine (Compazine)

You’re more likely to get it if you:

• Are a woman who has gone through menopause

• Are over age 55

• Abuse alcohol or drugs

• Are African American or Asian American

Diagnosis

TD can be hard to diagnose. Symptoms might not appear until months or years after you start taking antipsychotic medicine. Or you might first notice the movements after you’ve already stopped taking the drug. The timing can make it hard to know whether the medicine caused your symptoms.

Abnormal Involuntary Movement Scale (AIMS): If you take medicine for mental health conditions, your doctor should check you at least once a year to make sure you don’t have TD. He can give you a physical exam called the Abnormal Involuntary Movement Scale, which will help him rate any abnormal movements.

Treatment and Prevention

The goal is to prevent TD. When your doctor prescribes a new drug to treat a mental health disorder, ask about its side effects. The benefits of the drug should outweigh the risks.

If you have movement problems, tell your doctor but don’t stop taking the drug on your own. Your doctor can take you off the medicine that caused the movements, or lower the dose.

You might need to switch to a newer antipsychotic drug that may be less likely to cause TD.

There are two FDA-approved medicines to treat tardive dyskinesia:

• Deutetrabenazine (Austedo)

• Valbenazine (Ingrezza)

Both of these medicines work in similar ways to regulate the amount of dopamine flow in brain areas that control certain kinds of movements. Both can sometimes cause drowsiness. Austedo also has been shown to sometimes cause depression when used in patients with Huntington’s disease.

There’s no proof that natural remedies can treat it.

Source: WebMD

I’m Privileged

I’m privileged:

~ I live in a Western Country with well trained psychiatrists and therapists.

~ I’m white and middle class.

~ I have a college degree and a deeper understanding of my illness.

~ I have good health insurance.

~ I can afford my medications.

~ I have a family that has helped me pay my therapist out of pocket instead of one that my insurance would cover.

~ I have a roof over my head and food to eat.

~ I have a support system.


~ What if I had been poor with no insurance and lacking a support system? Would I be homeless and not medicated? Would I be the “crazy” person talking to himself on the street corner?

~ Having schizophrenia is difficult enough sometimes seemingly impossible, but I can’t imagine how hard and how different my life would be if I wasn’t privileged.

~ I’m no better than anyone else with schizophrenia, just privileged to be born into my social class and all the perks that come with it.

#MySchizLife #Privileged #Schizophrenia