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Taking medicine for anxiety and sleep problem. Found out pregnancy. Planning for D&C. Any thoughts?

Mar 2013
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Practicing since : 1998
Answered : 5956 Questions
I am on Ambien CR, Celexa, Pristiq, Lammotrigine, Xanax. 99% of the time I don't take it all. I'm frustrated with my Dr for prescribing it all to me. I run a business and have a hard time sleeping because I'm always thinking of deadlines, I'll lay in bed for hours on end before I can fall asleep.. So I asked for help with sleeping. I also asked for help with my anxiety which is where the Xanax comes in.. I don't know about the others, I hate taking them because I don't feel that I need to be so medicated. I just found out I was 7-8 weeks pregnant. :/ I am set to have a D&C tomorrow morning, because I'm worried after all the medication I've been taking?
Posted Mon, 18 Mar 2013 in Pregnancy
Answered by Dr. Aarti Abraham 1 hour later
Thanks for your query.
Let us deal with each drug one at a time, because it sure sounds like a whole drug cocktail prescribed to you.

Ambien CR is zolpidem.

According to one case report, zolpidem apparently crosses the placenta, cases of severe neonatal respiratory depression have been reported when zolpidem was used at the end of pregnancy, especially when taken with other CNS depressants.

Zolpidem has been assigned to pregnancy category C by the FDA. Animal studies have revealed evidence of incomplete ossification and increased postimplantation fetal loss at doses greater than seven times the maximum recommended human dose or higher; however, teratogenicity was not observed at any dose level. There are no controlled data in human pregnancy. In one case report, zolpidem was found in cord blood at delivery. Zolpidem is only recommended for use during pregnancy when benefit outweighs risk.

Celexa or citalopram Is also pregnancy category C. Several studies have shown no congenital malformations in fetes, while one recent large study found increased risk of cardiovascular malformations. Beyond 20 weeks, it's use causes persistent pulmonary hypertension in newborns, and withdrawal symptoms.

Next comes Pristiq.

Taking Pristiq during pregnancy may lead to persistent pulmonary hypertension of the newborn, FDA lists Pristiq as a Pregnancy Category C medication.
Pristiq is the brand name of the drug desvenlafaxine, which is considered a new generation antidepressant.

A 2006 study published in the New England Journal of Medicine indicated that infants born to women who take certain antidepressants while pregnant may have a significantly increased risk of developing life-threatening birth defects. According to this study, infants who were exposed to certain antidepressants in utero were six times more likely to develop PPHN than infants who were not exposed to the medications. Some antidepressant medications like Pristiq may cause substantial complications for infants when taken during pregnancy, some of which may be fatal.
Potential antidepressant side effects associated with antidepressant use and pregnancy:
Cleft Lip
Cleft Palate
Heart Malformations
Neural Tube Birth Defects
Spina Bifida

Similarly, Lamotrigine is an anticonvulsant which is Pregnancy category C again, and some studies have shown birth defects in infants born to mothers using it.

The last one, Xanax is pregnancy category D , and absolutely unsafe in the first trimester.

Whew ! Quite a list. Seriously cannot figure out if any doctor would indeed prescribe such a mammoth list for what you say, was a mild need for a sedative.
Having taken these, I definitely cannot advise you to continue the pregnancy, as the risks of having a defective baby are pretty high.
That said, if you really have not taken most of it, and the need for a baby overcomes all other factors, you CAN go for a genetic counselling, have detailed risk analysis, and then figure out whether to take on the calculated risk of continuing the pregnancy.

Obviously, you would require invasive genetic testing to determine any birth defects, if you do decide to continue.
You are only 26 so you can afford to try for a pregnancy again the future, and be very careful with what you ingest in the future.

Take care, and feel free to ask for further clarifications.

Above answer was peer-reviewed by
Follow-up: Taking medicine for anxiety and sleep problem. Found out pregnancy. Planning for D&C. Any thoughts? 54 minutes later
Thank you for your response.
He told me that by prescribing the Pristiq, Lamotrigine (which he keeps uping he dose, it was 25MG, 50MG, 100MG now 200MG) and Celexa.. it would knock out xanax and would be better for me in the long run because they are not addictive and as bad. (I've only been on medication for 6 months now). It's not like I've had a long history with medication by any means.

I will literally wait to see him for hours on end for a 5 minute appointment that I feel he barely even listens and I walk out with a new prescription that I feel like I know nothing about. It's irritating.

All I wanted was to be able to sleep and feel less anxious.

I will go through with the D&C.. I have 2 other children *2 & 4*
I can't imagine bringing a child into this world with problems and it being my fault that they had problems, I don't think I'd ever be able to forgive myself for that. So I'm sure it is for the best.

Can I ask what you advise I do with my medications and with my dr?

I do appreciate your time. Thank you!
Answered by Dr. Aarti Abraham 3 hours later
Hi again,
Frankly speaking, I do not agree with his opinion about 3 drugs being prescribed ( including an anticonvulsant ) to knock out one.
I would urgently request you to consult a second Psychiatrist for your medications and your anxiety.
I am sure your decision to go ahead with the D and C is fine, as you have two kids.
Please take the antipsychiatric medications only after a second opinion with a different Specialist .
All the best.
Above answer was peer-reviewed by
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