Managing Anxiety Medications During Pregnancy: A Guide for Expecting Mothers

Medication Use During the Second Trimester of Pregnancy

Dear Doctor: I am currently 22 weeks pregnant.
I have a history of panic disorder and was treated for a year, after which I stabilized and stopped medication.
However, I started experiencing anxiety and tension in the fourth month of my pregnancy.
My doctor prescribed a B-class anxiolytic medication (SEPIRONE), and I have increased my dosage from two pills a day to five pills a day, which is approximately 25 mg.
However, I still feel anxious and panicked whenever my family is not around, and I do not feel comfortable.
Unlike before my pregnancy, when I was regularly taking the medication and felt happy, I am now constantly worried about having an episode.
I feel uneasy when no one is home and am afraid to go to the market or places far from home.
I feel like I have regressed.
After discussing this with my doctor last week, he prescribed ZOLOFT, which has antidepressant effects but is a C-class medication.
If I take half a 25 mg pill a day, will it affect my baby? However, if I do not take it, I easily experience anxiety when I go out, which can lead to uterine contractions.
Should I increase the dosage of SEPIRONE instead? Does this medication have no effect on the central nervous system?

Miss Zhang, 30~39 year old female. Ask Date: 2013/12/10

Dr. Song Chengxian reply Psychiatry

The use of medications during pregnancy indeed raises concerns for every expectant mother.
The U.S.
FDA (Food and Drug Administration) classifies the safety of medications for pregnant women into five categories: A, B, C, D, and X.
Below are the classification standards for each category:
Category A: There is no risk of teratogenic effects, and these medications are considered safe.
They have been studied in controlled trials involving humans, with minimal potential harm to the fetus.
There are few drugs in this category, as ethical considerations limit research on pregnant women, so most substances in this category are components found in natural foods, such as vitamins.
Category B: Animal studies have shown no risk to the fetus, but controlled studies in pregnant women have not been conducted.
Some animal studies may indicate adverse effects on the fetus, but controlled studies in pregnant women have not confirmed harm.
Category C: Animal studies have indicated adverse effects on the fetus, but controlled studies in pregnant women have not been conducted.
Some medications have not undergone animal or human trials.
Drugs in this category should only be used if the potential benefits to the fetus outweigh the potential risks based on clinical experience.
Category D: There is sufficient evidence indicating a risk to the fetus, but if the benefits of the medication to the pregnant woman are deemed significant, it may be used despite the fetal risks.
Category X: Both animal and human studies have shown that these medications can cause fetal abnormalities and pose a risk to the fetus.
These drugs are absolutely contraindicated in pregnant women.
The two main periods of concern regarding the adverse effects of medications on the fetus are before implantation (approximately two weeks after fertilization) and during the early stages of pregnancy (from one to three months).
If a medication has a significant impact during the period from fertilization to implantation, it can lead to embryo death and genetic abnormalities in the fetus.
It is clear that you have done your research, but still feel uneasy.
If you have concerns about medications, it is advisable to discuss them directly with your healthcare provider rather than bringing home medications along with your worries.
Additionally, you may inquire whether the hospital offers non-pharmacological treatment options, such as relaxation training or psychotherapy, though not all hospitals may provide these services.
Wishing you peace of mind,
Dr.
Song

Reply Date: 2013/12/10

More Info

Managing anxiety during pregnancy is a complex issue that requires careful consideration of both the mother's mental health and the potential risks to the developing fetus. As you navigate this challenging time, it is essential to work closely with your healthcare providers, including both your obstetrician and a psychiatrist, to ensure that you are making informed decisions about your treatment options.

Firstly, it is important to understand the classifications of medications during pregnancy. The FDA categorizes medications into different classes based on their safety profiles. Class A is considered the safest, while Class X is contraindicated in pregnancy. The medications you mentioned, such as SEPIRONE (Buspirone) and ZOLOFT (Sertraline), fall into different categories. Buspirone is classified as Category B, which means that animal reproduction studies have not shown a risk to the fetus, but there are no adequate studies in pregnant women. On the other hand, ZOLOFT is classified as Category C, indicating that risk cannot be ruled out, and it should only be used if the potential benefits justify the potential risks to the fetus.

Given your history of panic disorder and the anxiety you are currently experiencing, it is understandable that you are seeking effective treatment. The increase in your anxiety levels during pregnancy can be attributed to hormonal changes, physical discomfort, and the emotional stress of impending motherhood. It is not uncommon for women with a history of anxiety disorders to experience a resurgence of symptoms during pregnancy, especially if they have previously relied on medication for management.

In your case, the decision to increase the dosage of SEPIRONE or to start ZOLOFT should be made in consultation with your psychiatrist. It is crucial to weigh the benefits of medication against the potential risks. If your anxiety is significantly impacting your daily life and causing physical symptoms like uterine contractions, it may be necessary to continue medication. However, if you feel that the current dosage of SEPIRONE is insufficient, discussing an increase with your doctor is a valid option.

Additionally, it is essential to consider non-pharmacological interventions that can help manage anxiety during pregnancy. Cognitive-behavioral therapy (CBT) is an effective treatment for anxiety disorders and can provide you with tools to cope with your feelings of panic and anxiety. Mindfulness practices, relaxation techniques, and support groups for expecting mothers can also be beneficial.

It is also worth noting that some studies suggest that untreated anxiety during pregnancy can have adverse effects on both the mother and the baby, including increased risk of preterm birth and low birth weight. Therefore, managing your anxiety effectively is crucial not just for your well-being but also for the health of your baby.

In conclusion, while the use of medications like SEPIRONE and ZOLOFT during pregnancy requires careful consideration, it is essential to prioritize your mental health. Collaborate closely with your healthcare providers to find the best approach for managing your anxiety. Remember that you are not alone in this journey, and seeking support from mental health professionals can make a significant difference in your experience during pregnancy.

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