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06 Oct 2009

Pregnancy on Effexor
Hi Cybershrink

I posted to you a few years ago and you were most helpful. I' m in a bit of a quandry at the moment. I' ve been married for about 4 years and I would like to get pregnant in the near future.

I had major depression with psychosis about 8 years ago and have been on Effexor ever since. Whilst I did recover very well from the depression, my doctor told me that my main issue is GAD. I know you are not in favour of it and I understand why, but Effexor has been tremendous for my anxiety and has got
me through some stressful times.

I am currently on 225mg (have tapered down from 300mg) The bottom line is that I am worried about taking Effexor when pregnant and what the long-term effects would be on my child. I have discussed this with my doctor (she is a good psychiatrist), but she couldn' t really advise me properly in this regard. I have been referred to another psychiatrist who I' ve been told would be able to help me. I am only able to see her in a month.

In the interrim, I am using one or two anxiety self-help books to try and develop my own coping mechanisms. I know you are very much in favour of CBT and from what I' ve read, one can eventually learn to manage anxiety without medication.

But, I have to deal with the here-and-now and I know my anxiety can be overwhelming. Are there other Antidepressants that have the same efficacy as Effexor (in terms of anxiety) but with more established long-term effects or are known to be " safer"  in pregnancy? Prozac was one that was suggested. On the other hand, would lowering the dosage of the Effexor cause less harm to the foetus? Any suggestions you have would be greatly appreciated.

Answer 424 views

01 Jan 0001

Hello again S !
Well, Efexor isn't unique in this ( and I'm pleased that it has seemed to suit you so well ) as most antidepressants are also very useful in managing GAD and anxiety problems. One of the many reasons I like CBT ( Cognitive-Behaviour Therapy ) for anxiety and for depression is that apart from the excellent evidence that it works and has lasting benefits, it has no side-effects, and is utterly safe in pregnancy ! So I like at least adding it to medication when these conditions are chronic.
The issue of using ADs in pregnancy is complex. There are some risks involved in using them during pregnancy, varying somewhat betwee them, and with the stage of pregnancy at which they are taken ; but then if there is a significant risk of a recurence of severe Depression, for instance, well, that also has some risks for the pregnancy.
So it's good for you to get a second opinion, to weigh the different possible risks and select the best course of action. Maybe a different medication would help ; maybe it would be safe for you to gradually come of your AD for the duration of the pregnancy. Starting formal CBT with a good local therapist might be wise, to give you the power to control those anxiety symptoms you dread, and lose the anxiety about anxiety, too.
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