Psychiatry + Pregnancy = Flexibility

After I posted yesterday’s update about the return of my Generalized Anxiety Disorder symptoms during my second trimester, I went to visit my psychiatrist. I love my new psychiatrist (in a completely appropriate way), because she has this power to immediately impart calm and reassurance whether it’s over the phone in five minutes or during a half-hour session in her office. Her demeanor and her voice just seem to say, “Don’t worry too much. Everything will be just fine, and this is all perfectly normal.” You can imagine that visiting her office last night helped me come to terms with this change.

I want to explain the changes she/we made to my medication regimen in detail, because psych meds are just so often misunderstood. I’m going to go over what each is of my medication is for and why I need two.

First, I take an SNRI, or Serotonin and Norepinephrine Reuptake Inhibitor called Effexor. Norepinephrine is a chemical that seems to help with anxiety, so having more of it in my brain is, apparently, a helpful thing. Serotonin, as you have probably heard, is a chemical that helps make us happy. If there is too little in your brain, you are more likely to become depressed. I started on Zoloft, the most commonly prescribed SNRI, but switched a few years ago to Effexor. (I am a big advocate for No Drugs Without Therapy, because eventually, every drug will stop working. Therapy teaches you coping skills that don’t stop working.) I was supposed to eventually only take an SNRI, but that didn’t work out. Anyway, here are the thoughts on Effexor, me and the second trimester of this pregnancy:

I am feeling more anxious all of the time, not at any one particular time, so that tells me that my “baseline” jumped up. Effexor (especially in the extended release capsules I take) is intended to do its work ’round the clock. To help me feel a little calmer all of the time, my doctor suggested increasing my dose by the smallest increment. She also suggested that I take 150 mg when I wake up and the other 75 mg in the afternoon, to help for all of the day.

Second, I take Klonopin, aka clonazepam, the benzodiazepine that has been such an important and yet difficult part of my treatment. We’re working with a fairly high dose already–3 mg a day (1 mg morning, afternoon and evening) is already half-way to the maximum recommended dose of 6 mg total per day. That’s my ceiling. At one point in my life, I needed that. If we end up going there by the end of this pregnancy, that’s fine with me. But my psychiatrist wants to move slowly, so we don’t hit that ceiling too quickly.

The new regimen (and it feels good so far!) is that I take a 1 mg in the morning, 1/2 mg mid-morning, 1 mg in the afternoon, 1/2 mg early evening, 1 mg before bed. If I didn’t already take pills 80 times a day because of all the vitamins for the baby and me that have to be taken with food or not taken together or taken with a meal that has saturated fat in it if possible (Vitamin D–that stuff does not want to be absorbed by me… what’s your deal, D?)… but I digress. The point is, I remember to take the half-pills, and so far, so good. Sometimes, I worry that I love Klonopin too much, but I have never been tempted to take more than the prescribed dose, so I’m not actually worried about addiction.

And I’m taking it one day at time, so that’s all for now, folks. Ask questions, if you like! I’ll be more generous than Lucy from The Peanuts and not charge you a nickel as I open up my psychiatry booth. ;)

21 Comments

  1. Misty said:

    This is really interesting, thanks! I have been on both Effexor and Zoloft in the past, but never when pregnant. However, my last pregnancy my anxiety got bad in the third trimester, and then went CRAZY in the postpartum period. That’s when I started on the Zoloft. I wonder what the consensus is on starting an SSRI during pregnancy, if you haven’t been taking it all along? Probably best to wait until postpartum…

    May 19, 2012
    Reply
    • Anne-Marie said:

      It depends on the doctor. The more conservative the doctor, the more likely they are to wait. But there’s a lot to be said for starting during the pregnancy. A less anxious/depressed mother is going to have a better birth, and it can take a few weeks for some people to feel SSRIs/SNRIs starting to work. The only consensus that there *should* be is that what’s best for Mom is best for Baby!

      May 19, 2012
      Reply
  2. Kat Geary said:

    I was able to spend 8 months weaning off Effexor, Klonopin and Lamictal prior to conceiving and am now 9 months pregnant and been off meds for over a year.

    I credit this to the intensive therapy I completed at The Meadows. I did the “Survivor’s” workshop.

    (I also changed my diet- little processed foods, quality vitamins, supplements and Krill oil. Lots of fresh veggies and clean protein.)

    I am enjoying reading your articles and highly encourage you to look into doing the Survivor’s workshop before baby comes.

    It is the best money I ever spent and surely my child will benefit.

    themeadows . com

    God bless you.

    Katharine

    May 23, 2012
    Reply
    • Anne-Marie said:

      Thank you, Katharine. I’m glad those things worked for you. I cut out processed foods, took quality vitamins and supplements, including cod liver oil. I really did try everything. For almost a year. And I’m in therapy twice a week. It just doesn’t work for all of us.

      May 23, 2012
      Reply
    • Kerry said:

      I would love to hear more about the survivor’s workshop. I’ve been looking into this myself. Can you really make a lot of progress in 5 days?

      September 8, 2012
      Reply
  3. Jane said:

    I think I’ve said this to you before, but I’ll say it again – you are doing something awesome by describing your experience here. I remember when I was pregnant I seemed to only see messages that medication during pregnancy = bad, when it’s just so much more nuanced than that. Thank you for sharing your experience of meds throughout pregnancy with your doctors’ support. It’s important for all of us to know that this is okay when we need it and that it’s just one more careful decision to make with expert help, like so many other parenting decisions. Thank you.

    May 26, 2012
    Reply
    • Anne-Marie said:

      That is why this blog exists. I had wonderful doctors who told me to think of my mental illness as diabetes or asthma; something must be done to make sure it stays under control so that I can live my life. Some people don’t need medication to manage these health problems, and some do. My hope is that, one day, everyone will see anxiety and depression as similar to diabetes or asthma. Serious, but nothing to feel shame about.

      May 26, 2012
      Reply
  4. Amelie said:

    I’m pregnant and your blog has been a great comfort to me. I stopped taking all of my prescribed meds except klonopin when I found out. My normal dosage was 3 mg a day, which I have weaned down to 1.5-2. And I still feel so guilty! But I could literally not function without it – not drive, not go to work. My psych said it’s healthier for the baby if I am not having panic attacks. I have done so much research and haven’t found anything bad! So thanks for writing this and sharing your story.

    December 12, 2012
    Reply
    • Anne-Marie said:

      I’m so glad my story has helped! There is *far* too much fear around psych meds and too little attention paid in the research. I took 4 mg every day during my pregnancy and my baby could not be healthier. I know it’s only anecdotal, but I hope it makes you feel less guilty. Your dr is right–you and your baby need you to function! It sounds like you really minimized the risk. I’m writing a post soon about breastfeeding; if you want to breastfeed, please read it. I was shocked to find that it’s much safer than most doctors will tell you!

      December 12, 2012
      Reply
      • Troi said:

        I took about one klonopin (.25mg) a week while breastfeeding. If even that. My OB made me feel like a criminal. I ended up taking Prozac (recommended by her, and fine for many breastfeeding moms) at 8 months and my baby stopped growing. I didn’t know until he was 10 months old that anything was wrong and I immediately stopped. Research studies have shown in already small babies (like mine) this is an uncommon but very real side effect of Prozac. He is still very small, head circumference well below 1st percentile, and isn’t yet talking at almost 18 months (no history of this on either side of the family and I’m a speech therapist). I feel guilty. I have researched every article and research study extensively on klonopin and I believe taking a small amount daily instead of having gone on the prozac would have been much better for both me and my baby. I’m not knocking SSRI use (in fact zoloft and lexapro barely transfer into milk — I just can’t take those, the only one that works for me is prozac), but it is just upsetting that klonopin is treated as a DO NOT BREASTFEED medication when that simply isn’t accurate.

        May 29, 2016
        Reply
        • Anne-Marie said:

          It isn’t listed by any medical organization as a “do not breastfeed” medication. I’m sorry to hear about what happened with your baby! My friend’s child became anorexic (a baby with anorexia–possible) in reaction to the smallest therapeutic dose of an antidepressant. It’s a reaction not unlike an allergic reaction. I know a big handful of moms who have stopped eating dairy while they’re nursing, because they’re babies have terrible, nightmarish reflux and skin problems. Every baby doesn’t react well to everything in mom’s milk. Big hugs for this happening to you. I know it’s so hard not to take it personally, but you were simply making the best decision you could make with the information you had at the time.

          May 29, 2016
          Reply
  5. Laura said:

    I’m so glad to have come across your blog. Thank you. I am suffering right now through my second pregnancy. I take a combo of Zoloft and Klonopin. Every doctor I’ve seen wants me to stay off the Klonopin. It’s looking increasingly like I need to stay with my routine. Your words inspire me to do what’s best for my body and my baby.

    November 14, 2013
    Reply
    • Anne-Marie said:

      I’m glad that I can be a voice that says: trust your gut. I was just talking to my psychiatrist about how Klonopin is so far from the ideal drug, but we tried so many other things. It works. I have to go with what works for me, not the “average” or (yikes!) the “ideal.” Whatever you decide, I hope it works for you! I hope you don’t have to “suffer through” your whole pregnancy and get to enjoy it.

      November 14, 2013
      Reply
  6. Sarah said:

    Thanks for posting this–even though it was awhile ago! I am on 3 mg of Klonopin a day right now, for neurological disorders. My husband and I are ready to have a child, but I have talked to my doctors about weaning off of Klonopin and I’m not looking forward to the pain and how long it will take. I’m ready and willing to wean off, but if we could have a child while I am taking Klonopin, that would be ideal. I am planning on seeing a high risk ob-gyn, after consulting with a new neurologist about my medications. Anyway, I am glad I found your blog through Google!

    September 20, 2014
    Reply
    • Anne-Marie said:

      It feels like yesterday. It wasn’t an easy choice, and I don’t envy you. Now that my baby is about to turn 2, and I’m about to turn 30, people are starting to ask if we will have another child. I can’t explain that the thought of making this decision again is too much, right now. I don’t want to do it, the way that I did, with all my heart, when we had our beautiful boy. I am so happy that we went forward, and that our family feels whole. I hope that you find that same feeling, wherever your journey takes you.

      September 20, 2014
      Reply
  7. ang said:

    I have been prescribed 3 1 mg klonopin a day for the past 6 yrs, for PTSD, and anxiety disorder. My husband and I got pregnant around 6 months ago. My Dr never said a word to me about my medication. The nurse on the other hand, told me the Dr wanted me off until around 12 wks. I weened myself to .5-1mg a day, and tried not to take at all, but most days I failed at that. My Dr never said another word about my medication at my next appt, I go again here in the next few wks, should I try to talk to him about it? I appreciate all the posts on this site. A lot of research suggests not to take benzo’s during pregnancy, but for some of us, it is necessary. Is there a trimester safer than the other to take klonopin? And if, I cannot completely stop my medication within the next few months before baby is born, will my baby detox? So far all I know about baby, is she is healthy. .for that I am thankful, and continue to pray everything is good with her!

    October 6, 2014
    Reply
    • Can I ask what the research you’re citing is? I’d love to see it. When I looked (2-3 years ago, now) there was no research that came to any concrete conclusions about benzos and pregnancy. There’s a suggestion that women taper to the lowest possible dose during the first trimester because that’s when the so much development happens (from a few diving cells to a beating heart! amazing!) and when most miscarriages occur; there may be an increased risk of miscarriage, but my psychiatrist was not sure this was a true correlation, let alone certain about the cause being the medication. Remember, women who take medication for anxiety have a lot going on – what’s triggering the anxiety? Is the fact that she’s taking the medication, or reports that she is (because we can only research this topic by asking questions–no scientist is taking blood samples, here) an indication that her treatment is successful in alleviating her anxiety? Is she self-medicating with anyone else? That’s quite common. These are just a few of the reasons why I have issues with making decisions based on the research.

      In my opinion, we all balance the risk involved in taking the medication (mostly unknown, but risk is there) vs. the risk involved in the symptoms of our mental illness. To be blunt: the trimester thing is about doctors worrying about 1st trimester heart and brain development (based on speculation) and miscarriage, 2nd trimester not so much of anything, 3rd trimester, withdrawal symptoms after birth.

      Here’s what shocked me: nothing, NOT ONE SYMPTOM, involved in a newborn getting used to life after birth (not sharing a blood stream with a mother taking an Rx dose of clonazepam) is unique to “detoxing” – not a term I would use. Any of the symptoms associated with withdrawing from your meds might occur in any newborn, even one born to a mother who took no more than a Motrin during her pregnancy. My son experienced some extra tension in his muscles and extra sleepiness, and it all went away by the time we took him home in under 48 hours. The pediatrician was never concerned. If you are birthing in a hospital, remember that the staff there treats babies who are withdrawing from drug-abuse levels of these same chemicals. They know exactly what to do, should your baby end up being particularly sensitive. There is no reason to panic!

      October 7, 2014
      Reply
  8. Michelle said:

    I have been on 2mg-3mg of Klonipon for 2yrs. I just found out I was pregnant. I can see this site is old, but I don’t know where else to turn. All my doctors want me off. I believe its going to do more harm than good. I had such terrible anxiety yesterday and today that I took 2mg in the morning and evening of Klonipon, just to breathe. My Dr.’s put me on such a rapid taper. I dropped to 1.5mg fast. I would wake up and my heart would be pounding. I started twitching, and not sleeping. My dr. wants me to rapidly taper off of Klonipon .5mg for 5days and .25mg for the next 5 days. I just took 8mg within 2 days..I need help. I want this baby to be healthy, happy, but if I’m sick, will this baby even have a shot?

    August 15, 2015
    Reply
  9. Heather said:

    I am 32 weeks pregnant and before I was pregnant I was on lexapro for my anxiety disorder. They tapered me off of the lexapro and put me on something called buspar. It seemed to work great for me in the beginning. Once I hit my 3rd trimester my anxiety attacks started coming back and I couldn’t sleep for more than an hour at a time without jumping up out of mid sleep with my heart pounding. I could do daily every day things without a struggle. So my doctor put me on Zoloft 25mg for the first week then 50mg after but it just made me feel worse and make my anxiety a lot worse. She them put me on klopoin of .5 mg – 1mg on an as needed basis. She told me there is risk factors in every medicine during pregnancy but putting all my anxiety and stress on the baby is only harming her. And with me being so far along the baby is not taking much of anything from me but food and vitamins. Somehow your cord rejects medicines that can harm a fetus.

    September 30, 2015
    Reply
  10. I see this is an older post, but this is honestly the most helpful information I’ve been able to find! I got pregnant unexpectedly last fall, and was on a drug holiday from my antidepressant, but still taking Klonopin “as needed”, probably 1-1 1/2 mg 2-3 times a week. I stopped completely when I found out I was pregnant. Things snowballed pretty quickly and my psychiatrist put me back on a small dose of Citalopram for depression, and said in the second trimester that small doses of Klonopin are fine. But my OB has told me, “just go for a walk” when I ask her if it’s ok, and I want to shake her and be like, “you don’t get it!” Anyway, everything turned out fine for you? Did you wean back off in the third trimester to avoid withdrawals in baby? Desperate for some firsthand knowledge!

    March 10, 2017
    Reply
    • Anne-Marie said:

      My son is now 4.5! I took 1 mg, 3 times a day for my entire pregnancy. After a beautiful, calm, perfect HypnoBirth, the nurses in recovery gave me a hard time for my baby being “too sleepy” and “hypertensive.” When I finally asked them if they were sure this had been caused by my meds, they said, they see this in babies fairly often. Oh, and they tried to tell me that he was too sleepy to eat and his blood sugar was therefore in danger of dropping too low. The real problem was called a tongue tie, something I didn’t know runs in my family, where the skin on the bottom of his tongue, connecting it to the bottom of his mouth, was too stiff. He couldn’t latch. A pediatrician/IBCLC fixed it. In other words, no one could point to anything and say my meds had cause my baby any harm, for a single moment. At birth, he was alert, with wide open eyes. He was happy and didn’t even cry!

      March 10, 2017
      Reply

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