Here's a link to the clinic in case anyone is interested in reading any of the data and research they have:
MGH Center for Women's Mental Health
I'm getting a report from the doctor tomorrow, but here is what I remember and what I took notes on (before she said I don't have to spend my time taking notes because I'll get the report).
The appointment was only 40 minutes but we covered a lot! We first went over medications and ways to handle my depression. I'm on such a small dose of Lexapro, that this doctor feels it should not be a problem. This doctor also had a problem with the letter grading of medications and essentially called them a load of crap. She thinks the intention is good, but the way the grading is done tells you nothing, however, her thinking on it makes sense. She said new medications are automatically graded A because there is no data to support that they may cause birth defects. She also said that medications are graded down if there are cases reported of birth defects while the mother was on the medication. She prefers to research each individual medication rather than take the word of the letter grading system.
That said, she did get into the concern about anti-depressants while pregnant and nursing. I'm not going to go into the specifics, but suffice to say that there was nothing significant found in any future studies and she says the research shows that it's actually more harmful to the mother and baby if depression is untreated while pregnant. She said that a lot of anti-depressants now recommend a woman wean herself off before birth so the baby doesn't have withdrawal after being born, but research is showing it puts the mother at a higher risk for postpartum depression. She recommends I stay on my Lexapro throughout pregnancy and breastfeeding.
When I mentioned taking Evening Primrose Oil and Fish Oil, she was happy I was taking the fish oil, but recommended I triple my dosage from 1000mg to 3000mg. She recommends women who have tendancies towards depression take about 1000mg of EPA and DHA daily because it can have an anti-depressant effect while giving even more benefits for the baby. She recommended I don't take the EPO, even if I am not pregnant, because the EPO can block the benefits of the EPA and DHA. So, basically I may as well have not been taking the fish oil. At least I know now!!
The one thing that left me feeling more down about it is she said that women with depression are more likely to miscarry and are also more likely to have babies with birth defects (1-3% for women without depression vs. 7-9% for women with depression). They are unsure of the cause. She said the best way to minimize the risk is to treat the depression.
As far as the ADHD goes, she said that it's good I don't plan to take the Ritalin while pregnant or breastfeeding, but it would be okay to take it while TTC, especially since I chart and would know early on if I was pregnant. She said that there is no real research on stimulant medication when taken in therapeutic doses, but that with the information we have for drug abusers that it's just better to be safe than sorry, especially through the first trimester. She said if I really need it once in a great while (like for a presentation) it would be okay to take it, but that I should avoid taking it if at all possible.
She also said that if my OB gives me a hard time about taking the Lexapro that I should find an OB who is more open to women's mental health issues. She said that at this point she'd recommend me staying with this medication because I know it works and I don't need much at all. She said there's no point in putting my body through potential side effects when I could become pregnant soon if we know how this goes for me.
We talked about a lot of other things, but that's pretty much all that's generally pertinent to people. I'm so glad I had this appointment! I hope my blood draw results go as well tomorrow!
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Gabriel 12/23/2011
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