Psychiatric Drugs and Pregnancy. Lessons from the Paxil Story.
> 12/8/2005 6:36:10 PM

I have said for years to my female patients that I will not prescribe medications to them if they become pregnant. I prefer to see that they come off the drugs prior to becoming pregnant. Life, unfortunately, is never so neat and tidy. I stop medications if a patient reports to me she is pregnant and deal with the turmoil that may ensue from abrupt cessation. This is a controversial position amongst physicians and especially Obstetricians. They frequently tell my patients that the SSRI's are safe in pregnancy and that there is no need for discontinuance. I then say if the Obstetrician feels that way then let them prescribe the drug. I have yet to find one willing to do so.

My point in this is that the FDA today released the warning posted in the previous entry regarding Paxil. The reality is that no one can conclusively define the risk of these drugs because that would require a double blind placebo controlled study specifically exposing patients and their fetus to harm from a drug with unknown consequences. So the animal studies are conducted and give some general idea of a drug's potential fetotoxicity but these findings are not always transferable to human models. The next best circumstance is what has happened with Paxil. Cases are reviewed of patients that have taken the drug during pregnancy and evaluated for possible, previously undiscovered fetal abnormalities. This is not good medicine in my opinion and demonstrates the unreliability of animal toxicity studies.

The safety of the fetus is paramount and patients desiring to become pregnant would be wise to slowly decrease their psychiatric drugs before attempting to get pregnant. Coming off medication has to be a strategic part of planning for having a child and physicians need to be fully involved in this process. I will also ask a female patient of child bearing age if they intend to become pregnant and if they do I have a lengthy discussion about how we need to work together on a pregnancy plan that doesn’t include psychotropic drugs. These are critical discussions that physicians/psychiatrists must have with their female patients.



Interesting, and fantastic, approach to female psych patients! Back in my more confused days, I was seeing a psychiatrist for major depression. I mentioned once that I wanted to have children and he told me I was unrealistic and to forget it. Just stay on the meds and everything will be fine. Some dr. huh? Anyway, I had been diagnosed with bipolar disorder at the time. Later on, that diagnosis was ruled out. I have depression from time to time, and attention deficit disorder. Needless to say, the meds for bipolar disorder are not good for a baby at all. So I stopped the meds against the drs advice. Now I have a beautiful two year old son who wouldn't exist if I'd listened to a doctor who was so committed to pharmacutical solutions that he wouldn't even consider the possibility that I could handle life without drugs. The doctor actually did me a favor. He pissed me off so much that I decided I had to find a way to defeat my problem without medication. My son is well taken care of, healthy, and happy. Oddly enough, so am I, for a change. Turns out, I wasn't unrealistic at all. I'm glad to see that there are doctors out there who understand that sometimes it's ok to get off the meds and get on with your life, even if it is a risk.
Posted by: anon 12/9/2005 4:07:22 AM

Anon,Congratulations, on your struggles against uninspired psychiatry. I routinely give all my "Bipolar" patients drug holidays and am constantly surprised at the results. Your story is an inspiration and validates my own belief that the art of "diagnosis" is deeply flawed and the categorization of patients can be horrifically stigmatizing. Enjoy your son he is the best medicine for an achy heart.Bill Hapworth M.D.
Posted by: William E. Hapworth M.D. 12/13/2005 7:41:29 AM

Post Your Comments

Post a comment
Email Address:
Verification Code:
Input the 8 characters you see above:


Drug Abuse
Sexual Addiction
Eating Disorders
Alzheimer's Disease

About TOL | Contact Us | Defining Behavioral Fitness | For Healthcare Professionals | Links | Privacy Policy