Asked by a college student, New York
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?
Mental Health Expert
Dr. Charles Raison
Emory University Medical School
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.
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