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Anxiety Medications During Pregnancy

Pregnancy is supposed to be a beautiful time - a time of considerable joy as you await bringing a new life into the world. It's depicted as a stress free time of anticipation, but the reality of pregnancy is that it can be filled with stresses, and the hormonal changes alone can alter your body's chemistry and create a considerable amount of anxiety.

Unfortunately, most anxiety medications cannot or should not be taken during pregnancy. Only a few are approved for use while pregnant, and even then it's best to try to find solutions that are not drug related.

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Drugs for Anxiety

Drugs are usually the last resort for anxiety. You should strongly consider alternative options. Because pregnancy is limited to 9 months, any pregnant women that have never experienced anxiety in the past (or have not sought treatment) should strongly consider avoiding all psychiatric drugs. All drugs carry risks, and even those drugs that are safe for pregnant use should be avoided unless necessary.

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The Reason Drugs Are Used

The main reason that drugs are prescribed for pregnant women, however, is because anxiety and stress themselves can affect the pregnancy, and in some cases may also pose a significant risk to the child. Doctors are quicker to prescribe medications because they believe that the risks of some medications are less than the risks of allowing prolonged stress to take place.

As always, you should trust your doctors opinion above all else. Your doctor knows your body and your anxiety, and can tell you whether or not medication makes the most sense for relieving you of anxiety symptoms.

Drugs and Pregnancy Side Effects

Anxiety drugs during pregnancy are popular, but any drug that alters brain chemistry and releases or controls neurotransmitters is potentially going to be risky for any child. Generally, the following is the accepted wisdom on which medications may affect pregnancy:

Probably Safe

  • SSRIs (Such as Prozac, Zoloft, and Paxil)
  • Tricyclic Antidepressants
  • Buspirone

Probably Unsafe

  • Benzodiazepines (may cause addiction in infants)
  • Monoamine Oxidase Inhibitors (MAOIs)
  • Lithium

What the Science Says

A study in 2005 reviewed all research published in the National Institute of Health (NIH) using specific keywords related to using psychotropic medications during pregnancy. What they found was the following:

  • Very few studies were adequately conducted on pregnant populations, indicating that not nearly enough research has been conducted to adequately state whether or not the use of anxiety medications is safe for pregnancy.
  • Very few studies have been performed to gauge the effects of panic disorder and anxiety on pregnancy. But studies do indicate there is a very real risk to the developing fetus.
  • Pregnancy affects all four phases of medication use (absorption, distribution, metabolism, and elimination), and nearly all anxiety medications do appear to have an effect on the placenta and nearby tissues.
  • Several medications show a negative effect on children in utero, but the only studies that have tracked the health of children over time appear to show few differences in IQ or functioning.
  • The study strongly recommends the use of cognitive behavioral therapy, or some other type of non-drug therapy, to be the first option recommended by a physician or therapist whenever possible.

Based on all available evidence, there is simply no way to be 100% confident that any anxiety medication is safe during pregnancy. Few studies have looked at the results adequately, and most of the drugs that are believed to be safe were tested on animal pregnancies, indicating that they could still affect human beings differently.

What You Should Do

If you're pregnant and living with anxiety, the smartest thing to do is speak with your doctor and listen to their advice. Different physicians have different views on psychotropic drugs, and if you trust your doctor, their recommendation should be paramount against all others.

You should also strongly consider upon the advice of your doctor seeking out alternative and effective non-medicinal solutions. Support groups, meditation, therapy, yoga, and exercise are all still valuable, provided there aren't any complications that could arise with your pregnancy.

You can also consider alternative therapy treatments. But be warned - taking herbal medicines does not guarantee safety. Few herbal medicines have been tested, and any herbal remedy that provides psychotropic benefits is likely to have an effect on the developing fetus as well. If you choose any alternative treatments, herbal and naturopathic remedies are unlikely to be any safer than prescription medicines.

Your best course of action is to talk to your doctor. Take my free 7 minute anxiety test to learn more about your own psychological symptoms.

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References

Dolovich, Lisa R., et al. Benzodiazepine use in pregnancy and major malformations or oral cleft: meta-analysis of cohort and case-control studies. Bmj 317.7162 (1998): 839-843.

McElhatton, Patricia R. The effects of benzodiazepine use during pregnancy and lactation. Reproductive toxicology (Elmsford, NY) 8.6 (1994): 461.

Cohen, Lee S., and Jerrold F. Rosenbaum. Psychotropic drug use during pregnancy: weighing the risks. The Journal of clinical psychiatry 59 (1998): 18.

Cohen, Lee S., Vicki L. Heller, and Jerrold F. Rosenbaum. Treatment guidelines for psychotropic drug use in pregnancy. Psychosomatics: Journal of Consultation Liaison Psychiatry (1989).

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