# Pregnancy and Cipralex



## Tessykins (Feb 15, 2010)

Hi there, I was hoping you could give me some advice.  I'm 18 weeks pregnant and until this point, despite losing one of my twins at 11 weeks, I've been doing quite well.  I have a history of anxiety which stems from ocd and I've been on and off cipralex over the years due to this (I've been coming off it every time I've had tx).  
I weaned myself off it in July for tx and have stayed off it, but over the last week or so I've been having a lot of anxiety again, I think my anxiety is due to fear of what anxiety could do to my baby (if you know what I mean!)  I went to see my GP during the week and he has referred me for CBT again (which does help me), but it'll take a few months for an appointment to come through.  I'm trying hard to cope without medication but I just wanted to know that, if push comes to shove and I'm finding it too difficult, can I go back on meds again?  I've been researching cipralex in pregnancy and there could be (really scary) side effects if taken in the 3rd trimester.  However, I do very well on cipralex and I'm worried that any others may not be as effective.  Could you give me some advice?  Thanks so much. X


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## mazv (Jul 31, 2006)

To be honest this is a conversation you need to have with your GP as they know your medical history and are best placed to be able to discuss the risks with you versus the benefits. There has been a lot of naturalistic research published in the last few years about the SSRI antidepressants in pregnancy. They do carry differing degrees of increased risk at different points in pregnancy. However I must stress that any increased risk is very small compared to the normal background risk of pregnancy problems anyway (you and baby are more at risk from getting into your car and driving to work every day but most women don't even give that a second thought).

Have you ever tried any other medication before or is it only Cipralex? There's no reason to think that others wouldn't be as effective, as SSRIs all work in exactly the same way. There are subtle differences in side effects and in duration of action but overall they all act in the same way. The issue with cipralex is that it is the most recent SSRI in clinical use, been in Uk for 10 years, comapred to Prozac, which has been around for 24 years. The older the drug the more information we have on it's use in pregnancy as the more likely there is to be data on pregnancy exposure. For this reason if SSRIs are indicated in pregnancy we usually prescribe the older more established medicines.

That being said it all hinges on the risk v benefit to the mother and the baby and extent of illness. There is well documented evidence that untreated mental health conditions can also have detrimental consequences to both mother and baby. It really is a very complicated area and a fine balance between risk/benefit that has to be considered separately for each individual woman. If it helps my specialist field is in mental health and I've seen a lot of women treated with medication during pregnancies with no adverse outcomes to the babies.

I would try CBT first to see if that helps. Do you have access to online self help materials at all? I can post some links if it would be helpful?


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## Tessykins (Feb 15, 2010)

Mazv, thanks so much for your response.  I'll certainly speak to my GP or consultant about this.  It would be great if you could post me some links for some self help materials that I could look at.  One of my main concerns this week has been that it the old anxiety kicks in again at full throttle I'll not be able to do anything about it (i.e. take medication), but the fact that there are some suitable meds out there if I need them is reassuring. If I were to go back on anxiety medication, would prozac be the best choice for me do you think? I hope you don't mind me asking this it's just so that I can discuss it with my GP or consultant.  Thanks again. xx


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## mazv (Jul 31, 2006)

Links that I use for my work are below (realise they contain geographical info but also have leaflets and links to other resources)

http://www.edspace.org.uk/default.asp?page=112
http://www.moodjuice.scot.nhs.uk/anxiety.asp

In terms of medication this would only usually be prescribed if anxiety was considered to be severe. First choice would usually be the SSRI drug sertraline (although it doesn't have a Product licence in anxiety there is very good evidence of benefit). On the plus side this drug is considered one of the better choices in breastfeeding if necessary.

Hope this is helpful x

/links


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## Tessykins (Feb 15, 2010)

Mazv, thanks so much for all of your advice and for the links.  I have managed to get an appointment for cbt for a few weeks time (super quick for the nhs!) and I really hope that it'll help me.  Thanks again for everything. xx


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## Tessykins (Feb 15, 2010)

Hi Mazv, me again.  After struggling with this anxiety for several weeks I went to my gp and was prescribed sertraline (50mg per day).  I've only been on it for four days but I feel absolutely dreadful - my anxiety has shot up today to the extent that I'm panicking.  I know that it can cause anxiety to get worse before it gets better - do you know how long this'll take to settle. I'm just finding it very hard, I'm in a flap and I'm panicking about going to work tomorrow (fear that I won't sleep tonight due to anxiety/ panic).  I never had the increased anxiety side effect when on cipralex.  Thank you.


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## mazv (Jul 31, 2006)

Sorry to hear that side effects difficult  As you say it can happen on starting treatment with SSRIs. Usually expect this to ease off after a coule of weeks at the most. Are you able to try some self help/ CBT techniques to try and get you through the initial weeks? If it's too debilitating then go back to see GP to discuss. Hope you start to feel better soon x


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## Tessykins (Feb 15, 2010)

Thanks Mazv, it has eased off a wee bit so I'm going to see if I can ride this out until I start to feel better again. I've a CBT appointment next Monday so hopefully that'll help too.  Thanks again. X


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