SS: Conflicting info from OB and Primary Care Doc

Kmlinville · May 2014

Forgive the SS post, but I'd love to hear input from other preggos. I've been taking Lexapro for a number of years (after a very unsuccessful attempt to go without), and I have continued through pregnancy with my OB's blessing. Today, I had an appointment with my primary care doctor, who monitors the Lexapro (first time I've seen him during my pregnancy). He recommended weaning off during the last couple weeks of gestation so baby doesn't have serotonin withdrawal, which could make her very fussy. This was the first I heard of such a possibility, and both I and my doc were surprised my OB didn't provide me with this information. He also recommended I switch to Zoloft after delivery, as its safety is more proven during BF.

I have much more trust in my primary care doctor, but at the same time, my OB is obviously a specialist. I am wondering if my primary is overestimating the side effects to the baby, or if my OB is minimizing them. The scary part is that he never even mentioned it, even after I brought up the safety of Lexapro at the beginning of my pregnancy as well as at the start of 3rd tri.

What do you all think?!

diagonalley · May 2014

I think you take this information to your OB and see what they have to say about it.

KarynNMarc · May 2014

I just Googled & would definitely have a more in depth conversation with your OB about the risks now that your in late into your 3rd trimester.
We depend on our Drs to know everything and treat us with only the best care. But in the end they are human and we all make mistakes or might not know everything there is to know.

Taymiller · May 2014

Don't google medical stuff! Talk to your OB about your concerns.

ElTrain5 · May 2014

Is there any way you can get a second opinion from a psychiatrist with experience in treating pregnant patients? They typically have WAY more infomraiton about psychotropic meds than PCP's or OB's.

Mizoo · May 2014

I agree with PPs about taking that info to your OB and seeing what they say about it. If your OB doesn't seem concerned and wants you to continue the Lexapro then I might consider seeking a third opinion.

CJnKR2014 · May 2014

amoot890 said:

MommyP710 said:

I think you take this information to your OB and see what they have to say about it.

WSS

What they said.

curlylocks3 · May 2014

Agree with all of the above posters...and also suggest calling the pediatrician you have chosen for their input as well, since they will be the expert from the baby side. It's also something I would imagine they have encountered many times in the past.
Good luck, I hope with all the information you can develop a plan you are comfortable with.

ElTrain5 · May 2014

curlylocks3 said:

Agree with all of the above posters...and also suggest calling the pediatrician you have chosen for their input as well, since they will be the expert from the baby side. It's also something I would imagine they have encountered many times in the past. Good luck, I hope with all the information you can develop a plan you are comfortable with.

Good call! I never would have thought about that!

(Making a mental note to decide on a pediatrician...)

shellbell813 · May 2014

Good advice from those above. I will also say that I am not sure about Lexapro and it's side effects, but I know that with Zoloft (which is what I am on) the whole negative effects from withdrawal that the baby would experience is pretty minimal. I honestly am a little surprised that your PCP would think the possibility of the baby being a little fussy for a couple of days would be worse than you suffering PPD because you weaned yourself off an antidepressant at one of the most vulnerable stages of pregnancy. Take this as a non-medical opinion, however my doctor is planning to up my dosage right before birth in order to avoid postpartum depression.

But you definitely need to speak with your OB.

chloephoebecali · May 2014

Your ob no doubt has lots of experience regarding this and I would go by what they say. My ob is comfortable with me on Zoloft and recently went up a bit in dose because I was having trouble functioning well. Yes, there is a chance that baby could have withdrawal fussiness, but I honestly would not have made it to delivery day well if we didn't up my dose. It's one of those weighing the good versus bad. I'd be nervous to mess around so close to the end. Plus the risk of ppd.

allrightmeow · May 2014

No Googling. Talk to your OB. My primary ran a test on me that OBs avoid because pregnancy always makes the numbers go crazy high. Long story short, Primary prescribed me blood thinners. I called OB to confirm this and she was like NO! The entire office was talking about it and felt that my primary should have known better and said thank goodness I called them before I filled it. She pretty much told me to look for a new primary and she said she has NEVER had to tell anyone that.

Taymiller · May 2014

Also doctors don't have a problem talking to each other. Have your PCP call your OB or visa versa and they can discuss the plan.

sarahlynnc317 · May 2014

Talk to your pharmacist, they will be able to provide you with the most information.

MrsP419 · May 2014

shellbell813 said:

Good advice from those above. I will also say that I am not sure about Lexapro and it's side effects, but I know that with Zoloft (which is what I am on) the whole negative effects from withdrawal that the baby would experience is pretty minimal. I honestly am a little surprised that your PCP would think the possibility of the baby being a little fussy for a couple of days would be worse than you suffering PPD because you weaned yourself off an antidepressant at one of the most vulnerable stages of pregnancy. Take this as a non-medical opinion, however my doctor is planning to up my dosage right before birth in order to avoid postpartum depression.

But you definitely need to speak with your OB.

This.

I am on 50mg of Zoloft and have been this whole pregnancy. I intend to increase to 100 as soon as my babies are born since that is my typical therapeutic dosage. I have had PPD before, and I will do anything the OBs OK to avoid that happening again. Of all the people listed to talk to, I personally would go with the OB overall and then the pediatrician. My primary can prescribe a basic dose, but she does not have an expertise on how it would affect a fetus or breastfeeding infant. A pharmacist is going to tell you the risks attached to the drug, some of which an OB would say are minimal in comparison to untreated or undertreated depression. The pharmacist can really only speak to the drug directly and not the risk/benefit part. My psychiatrist was very helpful with determining a proper dosage and specific drug to address my symptoms, but she was pretty conservative and did not recommend Zoloft for breastfeeding. Zoloft is considered to be the most mild drug you can go on for PPD, and both my OB and the kids' ped OK'd it. Good luck! I know it is overwhelming. But trust me when I say that some of the risks associated in the drug are FAR outweighed by the benefits of you as the mama being healthy and happy.

MrsCase1 · May 2014

I agree with everyone suggesting you talk to a psychiatrist. Their drug knowledge far surpasses that of regular docs. I'm actually kinda surprised your PCP will do long-term monitoring of that sort. When I lived in CA no doctor would give me more than a 3 week supply. Not sure if it was law but they all said you needed "proper" maintenance and monitoring and that they couldn't provide it.

Kmlinville · May 2014

Thanks for the input, everyone. I did communicate with my OB about things, and he said he has had many mothers on SSRIs throughout their pregnancies with no problems for baby. He also said that if he were to recommend weaning off, it would have been around 20 weeks, not now at the most vulnerable time. He said that LO will get trace amounts of Lexapro in breast milk, which will minimize any symptoms of withdrawal. I have a call in to my pharmacist as well and hope to talk to her tomorrow. Can't check with the pediatrician, as I've only picked an office but the actual doctor won't be determined until after delivery. I'm going to talk with DH when he gets home, but at this point I'm leaning towards no change. Thanks again for all the good advice!

iris427 · May 2014

Kmlinville said:

Thanks for the input, everyone. I did communicate with my OB about things, and he said he has had many mothers on SSRIs throughout their pregnancies with no problems for baby. He also said that if he were to recommend weaning off, it would have been around 20 weeks, not now at the most vulnerable time. He said that LO will get trace amounts of Lexapro in breast milk, which will minimize any symptoms of withdrawal. I have a call in to my pharmacist as well and hope to talk to her tomorrow. Can't check with the pediatrician, as I've only picked an office but the actual doctor won't be determined until after delivery. I'm going to talk with DH when he gets home, but at this point I'm leaning towards no change. Thanks again for all the good advice!

I think listening to your OB here is probably the way to go. I'd be concerned about you going into the already vulnerable postpartum period newly weaned off meds, and many women take SSRIs during pregnancy and through delivery.

Have you tried calling the peds practice? Even if you don't have a specific doctor at the practice picked out, you can probably call the nurse's line and have them talk to one of the doctors and get back to you. I'd take a pediatrician's opinion way more seriously than I'd take a pharmacist's on this kind of thing.

MrsRahl · May 2014

Just speaking from my own experience, I was on lexapro lowest dosage and just quit cold turkey after at one point and it was a VERY bad idea. I should have taken my doctors orders on weaning myself off of it. There were so many glitches that I cant really describe in words of my memory other than like skipping live time like a scratched dvd. It was terrible. So I guess my question to your docs would be how is the transition going to be for baby from their exposure now to on their own verses your weaning time (if that is even still on the table for you). You said the weaning if you so chose should have started at 20 weeks, so like I said just my humble opinion I wouldnt wean too fast but then again I dont know what that would mean for the baby or how much they actually got crossed over the placenta (which could be very minimal) Their weaning time and yours im sure is much different depending on how much really crosses over to them.

Sfarrell1124 · May 2014

I am on Lexapro and have also had the same conversation with my OB. We both felt like the risk to the baby was far less than the risk of PPD for me without meds. She did mention that if I decided not to BF, the baby might be more irritable for a few days but I do plan to BF so we decided not to wean or mess with the dose.

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