Suggest Treatment For Generalized Anxiety Disorder During Pregnancy
Am 37 weeks pregnant and i am known case of generalized anxiety disorder for more than 10 years .. I mange my anxiety with medicine beginning i was in ecitalopram and then shifted to zoloft 100mg od and now am taking 50 mg as my due date is soon and to prevent withdrawal .. As my date is near am panicing over ssri use and association of persistant pulmonary hypertension .. I read alot of research says that its not more than the baseline .. And asked my psychiatry say nothing have been proof and this even can happen to ordinary baby .. I need help as am starting to loose it
The risk of Pulmonary hypertension is almost equal to normal births
Detailed Answer:
Hello thanks for asking from HCM
You are 37 weeks and have GAD (generalised anxiety disorder) since last 10 years. You are currently taking 50 mg Sertraline tapered from 100 mg per day.
If we consider pulmonary hypertension to new born in normal pregnancy the risk is about 1.2-1.3 per 1000 births. The risk increased if woman is smoker or have poor health or taking multiple drugs.
A lot of research studies were done on pregnant females who were on SSRIs (or Sertraline) and the risk came near about 2.7-3 per 1000 children. Though it appears that risk increases to two fold but there were a lot of limitations in that studies and the sample size of these studies were low.
Most of these studies were done of small populations and were retrospective studies based on statistical data obtained from population registers or from other studies. Prospective studies are very limited and found nothing. Associated risk factor like maternal smoking, clinical condition of mother, other drug uses etc were not taken into account. So though some studies denote increased risk of Pulmonary hypertension to child but the risk is practically insignificant and is almost equal to children born to healthy mothers. So there is no need to panic for that. I have given Sertraline to a number of patients in my clinic and I didn't came across any incidence of pulmonary hypertension in children born to them.
So please you have already reduced the doses and now about to deliver in coming weeks so please don't worry about anything. As per my opinion the risk is almost equal to normal females. (I have used some medical words in answer just to reassure you and to understand you better about the research studies available)
Thanks, hope this reduces your anxiety. Don't hesitate to ask again for more doubts
Xanax is safe to use if taken with prescription
Detailed Answer:
Hello again
As per my opinion increasing the dose of Sertraline will do nothing as its symptomatic anxiety. Taking Xanax on SoS basis is a good option and this will help to reduce symptoms. Take the medicines in consultation with your doctor. If C-section has been planned tell the doctor about your drugs. Xanax can be taken safely in low doses in pregnancy.
Thanks
Keep the doses in lower range
Detailed Answer:
Hello again
Keep the doses in lower range and that will reduce anxiety. Doses of 025-0.5 are totally safe and no need to worry. Apart from cognitive therapy, Behaviour therapy with relaxation exercises will reduce anxiety. Try Yoga to keep your anxiety away.
Thanks, wish you a good health.
The risk is almost same in both cases
Detailed Answer:
Hello again
Yes SSRIs have nothing to do and the risk if almost equal to the females who were not taking SSRIs or those who took late. The various studies have many confounding factors so cant be taken to measure the risk. The risk is almost same as the risk in females who are not taking the drug.
So don't take stress for that.
Thanks, hope this reassures you.
Zoloft is relatively more safe than Cipralex
Detailed Answer:
Hello thanks for asking again
First of all I would like to tell you that there is no need to feel sorry for a lot of questions. Its my duty to answer all your questions and to relieve your anxiety. No need to feel bad for that.
Sertraline (Zoloft) and Escitalopram (Cipralex) both are SSRI drugs but if we consider overall safety in pregnancy then Zoloft is considered as safest SSRI drug in pregnancy as per guidelines.
- Once you give birth and plan breastfeeding you can increase the doses again to 100 mg per day without any fear. SSRIs are relatively safer drug in breast feeding. But if your anxiety and panic came under control with low doses then there is no need to increase drug.
- As Sertraline is relatively safer so as per my opinion you should stick to Zoloft and don't think to shift to Cipralex. Zoloft is better tolerated than Cipralex in pregnancy.
- Cipralex 20 mg was a high dose and this will not be safe to take at present time. You can shift to the drug after delivering baby. No risk at that time.
Make any change in your prescription by consulting your doctor only.
Thanks, hope this helps you. Please don't hesitate to ask again for more doubts.
Its safe to shift from Escitalopram to Sertraline
Detailed Answer:
Hello again
As Zoloft and Cipralex from same class of drugs i.e. SSRIs so this was the reason that your new psychiatrist advised to reduce the doses of Cipralex rapidly while in the same time increased the doses of Zoloft. This cross tapering doesn't cause withdrawal symptoms and is safe method.
No changing in medicine from Cipralex to Zoloft is not dangerous, in fact its safe.
Your baby is good on scans so don't worry about unnecessary things. Try to keep yourself happy and keep smile on your face, this will improve growth of developing baby.
Thanks.
Wish you a good health
Detailed Answer:
Thanks for your compliments.
I wish you and your baby a good health. Take care
Thanks, if you have any doubts in future you can ask again through my profile by clicking "ask me a question"
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=65151
Thanks
Yes, dose should not be taken in night before surgery.
Detailed Answer:
Hello,
Thanks for asking again.
Yes, the dose of Sertaline should be stopped at least one day before surgery. In usual practice, if a patient is taking high doses then the doses are stopped for at least 3 days before surgery. As C-section is usually done under spinal or epidural anaesthesia so there will be no effect of drug on surgery.
You should avoid using Xanax before surgery but 0.25 mg doses will do good. Before admitting for C-section explain about your drugs intake.
Both drugs will not have any bad effect on your surgery.
All the best for your surgery and I wish you and your baby a good health.
Thanks, don't take undue tension about your drugs and surgery. C-section is a short and safe procedure and you will not have any anxiety during surgery.