Should you stop your Zoloft if you are trying to conceive? Or your Prozac, Wellbutrin, whatever? Should you stop your psychotropic drugs before you try to conceive, before you get pregnant, once you are pregnant?
So many people take antidepressants and anti-anxiety medication that this becomes a relatively common question.
Remember that pregnant women are people too — pregnant women deserve medical care. Why is it that once you are pregnant, you no longer deserve to be treated for depression, anxiety, asthma, whatever it is that ails you?
The key is individualization of therapy. Talk with your doctor first. Talk with your obstetrician, your reproductive endocrinologist, your therapist. This is not a decision to take lightly. You started these drugs for a reason. Has that reason disappeared now that you are trying to conceive? Now that you are pregnant?
This is a fertility risk benefit equation. Yes, unnecessary drugs are not good for the fetus. But depression or anxiety left untreated may also have a negative impact upon pregnancy and children. The riskiest time for severe mental illness and for suicide in a woman’s life is post partum — after delivering a baby.
The risks of treatment must be weighed against the risks of no treatment, and many times, the risk of no treatment may outweigh the risks of treatment. The good news is that modern anti-depressants such as Prozac and Zoloft do not seem to be associated with significant risks to the fetus. These drugs are categorized as SSRIs — selective serotonin reuptake inhibitors. A large registry of patients exposed to SSRI’s during pregnancy has not yielded birth defect rates any different from birth defect rates seen in the general population.
In general, if you need it, then you should stay on it. Also, the answer does not have to be so cut and dry — many women can stop during the first trimester and may need it during the second or third trimester. Most women who function much better on antidepressants should restart once they deliver if they stopped during pregnancy, because postpartum is such a high risk time.
I usually ask my fertility patients to talk with their therapist. If you do not have a therapist, now is a good time to get one. A therapist can be a resource. S/he can help you decide whether or not you are functioning well, whether it’s reasonable to stop or wean off the antidepressants, or now that you are off, how you are doing and should you restart. Sometimes stepping up the therapy can allow you to take lower doses of your medication.
This is not a decision to just wing on your own, yet many women do just that. Suddenly they stop because they are afraid of harming their baby. You will not harm your baby; in fact, you may harm your baby more if you harm yourself by stopping suddenly. Get some help. Find someone to talk to — someone who can help you assess the pros and the cons and come up with a plan that works for your particular situation. Sometimes that means staying on the Zoloft. Sometimes that is OK.
Serena H. Chen, M.D. is Director of the Division of Reproductive Endocrinology in the Department of Obstetrics and Gynecology at Saint Barnabas Medical Center in New Jersey. Dr. Chen is also the Director of the Ovum Donation (Egg Donation) and Third Party Program at the Institute for Reproductive Medicine and Science at Saint Barnabas.
Dr. Chen is a board certified fertility doctor — she is board certified in Obstetrics and Gynecology and Reproductive Endocrinology. She specializes in hysteroscopy, and has pursued special clinical interests in PCOS (polycystic ovarian syndrome), recurrent miscarriage, PGD (preimplantation genetic diagnosis), and sperm and egg donation. Dr. Chen’s professional interests have evolved considerably over the course of her career as a fertility doctor.