Class D medicines? (partial vent)

Re: Class D medicines? (partial vent)

• SleepingBeauty79 member

  May 2014

  Hi, i take klonopin and my dr said if i need it during pregnancy to take it as the benefits do outweigh the risks. In this case very small increase in cases of cleft palate

  
  

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• sleepyavon member

  May 2014

  Weaning or switching would be the best approach. I am on lots of meds which for now are stoppped or switched to be safe for baby. It is hard to deal with these severe symptoms, but a necessary sacrifice for my child. 

  

  
  

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• mirizzi&A member

  May 2014

  (I'm lurking from TTGP)

  
  

  @mommy62408 Motherisk is a great resource for information on medications during pregnancy. Benzodiazepines, the category of drug that clonazepam falls into, have some contradictory evidence about whether or not they cause problems with fetal development during early pregnancy. Cohort studies show no increased risk, while case-control studies show a slight increase risk of cleft lip/palate. The current recommendation is to have an additional ultrasound to screen for an oral cleft deformity. It's important to remember that medication safety during pregnancy is not well studied, because of the ethical issues in exposing a fetus to an unknown risk. This means that any evidence we have comes from a small number of pregnant participants, and all the analysis is done "looking backward" rather than "looking forward". The recommendation to avoid a medication during pregnancy is often based on "it might be harmful, but we don't know for sure, so you shouldn't take it". 

  
  

  Here's the article the above info comes from: https://www.motherisk.org/women/updatesDetail.jsp?content_id=326 (click full story to get all the nitty-gritty medical jargon information) 

  
  

  @greeneyes842 Quote: " Regular doctors really have no business prescribing psychotropic medications. "  -> I'd like to try to convince you that it is appropriate for non-psychiatrist to prescribe psychotropic medications. 

  
  

  15% of a primary care practice is psychiatric. 20% of Canadians will experience some form of mental illness during their lifetime (not sure about US numbers, but they're likely similar). 

  
  

  General practitioners see a lot of mental illness, and are generally well versed in the management of mild to moderate depression and anxiety, and the use of SSRIs and benzos. I agree, they shouldn't be making a diagnosis of bipolar disorder and NOT referring to a psychiatrist, but there just aren't enough psychiatrists to see everyone with uncomplicated mental illness. General practitioners have gone to medical school, and completed a residency, which includes additional training in psychiatry. General practitioners may also prescribe psychotropic medications for non-psychiatric reasons. For example, an SSRI for menopausal symptoms, or a benzo for bereavement-related sleep disorders. (As a disclaimer, I'm not a primary care physician)

  
  

  In my practice, as a non-GP and non-psychiatrist, I use fast acting benzos (midazolam) to assist in securing the airways in trauma patients, to treat hospital-associated insomnia in post-operative patients, and to prevent alcohol-related withdrawal seizures in chronic alcohol users who abruptly stop drinking (often secondary to a trauma that has required their admission to hospital on an emergent basis). 
  

  
  

  If, as a "regular doctor", I didn't have the privilege to prescribe psychotropic medications, I think my patients would suffer.  

  
  

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• AlanaB2010 member

  May 2014

  mirizzi&A and @Greeneyes842 come from one of you practicing in the Canadian medical system and the other within the US medical system.  The latter is sadly lacking in comparison with the former, and issues of access to treatment, lack of treatment, etc. are far worse in the US.

  
  

  OP, I really hope you've been able to get better answers this week!  Take care!

  

  
  

  
  

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• mirizzi&A member

  May 2014

  @Greeneyes842 You make a lot of great points! Particularly, Quote "I really feel that therapy is also equally as important to develop coping tools to manage feelings of depression/anxiety long term, instead of just relying on medication alone". I couldn't agree more with this statement and I really wish therapy was more readily available. 

  
  

  @AlanaB2010 I'm really surprised that Canadians tend to have better access to mental health care than in the US; I'd always just assumed it was the other way around. 

  
  

  I'm glad we had this discussion: it made me think. 

  
  

  
  

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• Ardmhs83 member

  May 2014

  A lurker on here...for now.  TTGP :-) 

  
  

  This thread is a few days old, so I'm sure you've already gotten in contact with your doctor.  I'm sure they will slowly wean you off this medicine or switch you to something that is probably class B.  As far as klonopin, I used it for 2 years straight and I still have a prescription for it, but use it very rarely.  I don't plan on using it while being pregnant and I've done really well weaning off of it.  I suggest dropping down .5 mgs every couple weeks.  I dropped down .5mgs every month b/c I was on 2mgs and that is a pretty high dose.

  
  

  My psychiatrist told me that once I was pregnant, if I really needed my .25mgs every so often, that it was fine.

  
  

  Good luck with everything! I know how hard this is...

  PPD/PPA Mom...it has been super hard, but I'm making it! Slow steps...
  Mom to Carter (6), and Calianne (1).  
  Proud VBAC, natural birth, breastfeeding, cloth diapering momma!

  
  

  
  

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