Brief Answer:
Recommendations given

Detailed Answer:
Hi XXXX

Thanks for writing in.

I understand that this must be a difficult time for you - going through your pregnancy with the distressing anxiety symptoms and the unwanted thoughts. Now, it is very common for people with pre-existing anxiety problems to experience a worsening or exacerbation of their symptoms during pregnancy. This is the reason why your old anti-anxiety medication Cipralex, doesn't seem to be working very well currently.

According to research evidence and international guidelines, SSRIs - namely Citalopram, Escitalopram, Sertraline and Fluoxetine are considered as the first-line medication in the treatment of GAD in pregnancy. These are the ones which have the maximum research data available about their effectiveness / risks in pregnancy.

Though there is a comparatively increased risk of problems in the newborn associated with the use of these medication during pregnancy, yet the overall risk remains quite low. Moreover, the risk of the untreated illness or relapse could be more than that due to the medication.

In your case, since you have been on an SSRI for 10 years and still appear to require a good dose of the medication, the best option would be to continue an SSRI. But if you are not feeling comfortable with Cipralex and are worried about weight gain with Sertraline, then the recommended option would be to try Fluoxetine. Since Fluoxetine has a very long elimination 'half-life', the potential risk for a neonatal withdrawal syndrome is also relatively much less.

Though benzodiazepines like Xanax can provide quick and effective relief from anxiety symptoms, they are not a recommended option as they have a variety of potential risks in the newborn.

So, my opinion would be to discuss with your psychiatrist about switching over from Ciplalex to Fluoxetine. Also psychological therapy like CBT (Cognitive Behaviour Therapy) can be a very effective and safe treatment option for your unwanted thoughts. So, please ask your doctor to arrange for a few sessions of psychological therapy as well.

You can also try relaxation techniques like deep breathing, progressive muscle relaxation, yooga, meditation, etc. as these simple remedies can help decrease the intensity of your anxiety symptoms and keep you more relaxed.

I hope you have a comfortable pregnancy and a safe delivery.

Best wishes.

Dr. Jonas Sundarakumar MBBS., DPM., MRCPsych.(U.K.)
Consultant Psychiatrist

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Brief Answer:
Not ideal, but can be helpful in your situation.

Detailed Answer:
Hello XXXX

Although changing medication during pregnancy is not the ideal thing to do, in your case, since your symptoms are uncontrolled and causing you a lot of distress, we can consider this option. Also, we need to consider the fact that many women with anxiety problems experience an increase in their symptoms around the time of delivery. So, if you are not feeling comfortable now itself, there is a possibility that you can get even more distressed later on.

The other point is that because your anxiety symptoms are not getting controlled with Cipralex, you have resorted to taking Xanax also. So, if the change of SSRI is able to control your symptoms better, then we can avoid the Xanax altogether.

Moreover, since both Cipralex and Fluoxetine belong to the same category of medication (SSRIs), the transition should be relatively easy.

Regards,
Dr. Jonas Sundarakumar MBBS., DPM., MRCPsych.(U.K.)
Consultant Psychiatrist

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