Has anyone taken antidepressants during pregnancy?

Which drugs are suitable for which illness during pregnancy and breastfeeding?

Allergies

Hay fever, allergies to house dust or pet hair can cause severe symptoms. Under certain circumstances, drug treatment may therefore also be necessary during pregnancy or while breastfeeding. This can be done locally with eye or nose drops, but also by taking tablets. For local therapy, preparations with the active ingredients cromoglicic acid, azelastine, levocabastine or budesonide are possible.

Loratadine, cetirizine and clemastine can be taken in the usual therapeutic dosage in the form of tablets. If the nose is blocked, nasal sprays or drops containing xylometazoline or oxymetazoline can also help temporarily. However, they should not exceed the generally recommended maximum duration of use of around one week.

bronchial asthma

Regardless of whether you have suffered from bronchial asthma since childhood or whether it has occurred for the first time, you must also be adequately treated with suitable drugs if medically necessary during pregnancy and breastfeeding. Because during pregnancy, in addition to the well-being of the expectant mother, an optimal oxygen supply for the unborn baby must also be guaranteed. Smoking, which pregnant and breastfeeding women should refrain from anyway, must also be avoided at all costs.

Depending on the severity of the symptoms and the degree of therapy control, various medications can be used. From the group of inhalable bronchodilators, short-acting agents such as salbutamol and long-acting agents such as formoterol can be used. A combination with inhalable glucocorticoids, which mainly intervene in the inflammatory process, is also possible - for example with the well-proven budesonide. If these therapeutic approaches fail, further treatment options are available, for example the oral administration of glucocorticoids such as prednisolone. Talk to your doctor if you have the feeling that your prescribed medication is not (no longer) helping you adequately.

These recommendations apply to both pregnancy and breastfeeding.

Bacterial infections

If you develop bacterial infections such as tonsillitis, bladder infections or pneumonia during pregnancy or breastfeeding, these can be treated with a suitable antibiotic. Agents from the group of penicillins (e.g. amoxicillin) and cephalosporins (e.g. cefuroxime) are best tried out during pregnancy and breastfeeding, but macrolides (e.g. erythromycin) can also be used.

Older representatives from the respective drug groups often have a great deal of experience and should therefore be preferred. For some infectious diseases or certain pathogens, another antibiotic may be required - treatment is also possible in such cases, but it should always be checked whether the above-mentioned agents of choice are possible. With any antibiotic therapy, you must strictly adhere to the prescribed dose and the treatment period.

High blood pressure (arterial hypertension)

The treatment of high blood pressure in pregnant and non-pregnant women differs considerably. On the one hand, this is due to the fact that some drugs, which are very effective in non-pregnant patients, must not be used during pregnancy. Their safety has not been adequately proven or they have even been proven to damage the unborn child.

For example, after use in the second and third trimester of pregnancy, antihypertensive agents from certain groups (ACE inhibitors and angiotensin receptor blockers) were found to be damaged. Medicinal substances in this group are, for example, captopril, enalapril, lisinopril, ramipril or candesartan, losartan, olmesartan, valsartan and others. If you are unsure whether your medication belongs to one of these groups, please speak to your doctor or pharmacist.

On the other hand, the aim of drug-based blood pressure lowering differs: outside of pregnancy, the main aim is to lower the risk of secondary diseases such as heart attacks and strokes. However, maternal complications should be avoided during pregnancy. At the same time, undisturbed child development must be guaranteed. The aim here is to reduce the risk of "pregnancy poisoning" (late gestosis, preeclampsia), premature placenta detachment, premature births and prenatal deficiency development in children.

A blood pressure of 140/90 mmHg is the limit. However, there are still no standardized recommendations for the treatment of chronic high blood pressure during pregnancy. Primarily α-methyldopa, but also metoprolol or nifedipine are possible.

Metoprolol, nifedipine, urapidil and, to a limited extent, dihydralazine / hydralazine have proven themselves in the forms of hypertension caused by preeclampsia, which are more endangering mother and child.

Dehydrating drugs are not part of the standard therapy for hypertension and edema of pregnancy. Their use is reserved for special diseases.

Metoprolol or α-methyldopa are preferred during breastfeeding. Breastfeeding is also allowed with dihydralazine or nifedipine. Dehydrating medication should not be used primarily to treat high blood pressure during breastfeeding, but may be necessary in individual cases for certain diseases.

Inflammatory bowel disease

Crohn's disease and ulcerative colitis are the most important chronic inflammatory bowel diseases. Severe disease progression increases the risk of miscarriages and premature births, lower birth weight and birth complications.

Chronic inflammatory bowel diseases must also be treated during pregnancy and breastfeeding according to their level of activity. Mesalazine is well tolerated by the unborn child and must be dosed as high as required. Sulfasalazine is also an option. Glucocorticoids can be used both rectally (e.g. budesonide) and in tablet form (e.g. prednisolone) during pregnancy. If azathioprine is required, it can also be taken during pregnancy.

Mesalazine, prednisolone and budesonide can also be used during breastfeeding. Sulfasalazine and azathioprine are also possible, but (slight) side effects cannot be completely ruled out. During azathioprine therapy, the pediatrician can check the infant's blood count if he considers it necessary.

depressions

Of course, depression must also be treated during pregnancy and breastfeeding. This applies regardless of whether they are new or already exist. However, it is not uncommon for women to abruptly discontinue their antidepressants after they are diagnosed with pregnancy for fear of malformations.

Planning a pregnancy in good time is optimal. If a psychiatric illness was straightforward before pregnancy, neither clear improvement nor significant worsening can be expected. In severe cases, however, there is an increased risk of relapse, especially around the time of birth and in the puerperium. In such cases, discontinuing therapy is particularly risky. They may require an inpatient stay, a significantly higher drug dose or even a combination of several drugs.

If a medication (antidepressant) is necessary, it is best to treat it with a well-proven active ingredient. The dose must be sufficient.

The drugs of choice are citalopram or sertraline. Most positive experiences are available for these substances. They belong to one of the drug groups best studied during pregnancy - the serotonin reuptake inhibitors (selective serotonin reuptake inhibitors, SSRIs).

On the other hand, the substances called "tricyclic antidepressants" due to their chemical structure have not been well researched. However, there is no serious evidence of malformation-causing effects in humans. This group of drugs has most of the positive experiences with amitriptyline and nortriptyline.

If you are psychologically stable under therapy and actually need antidepressant medication, you should continue the medication unchanged during pregnancy. This also applies if your antidepressant is not one of the above. Failure to do so could lead to threatening crises for you and your child. In particular, if your drug control has proven difficult, discontinuing it prematurely could be risky.

If you take antidepressants (one of the above or another) continuously, your child may show drowsiness, poor drinking, or restlessness after birth. Therefore, you should aim for delivery in a clinic with a neonatal unit.

If you are taking antidepressants, please discuss the issue of having children with your doctor in good time. If you have become pregnant unexpectedly while taking antidepressant medication, do not stop taking your medication on your own - but inform your neurologist about the pregnancy.

Your neurologist should also consider the period of breastfeeding when hiring new employees.

The antidepressant of choice for breastfeeding is sertraline; Citalopram is also an option. Of the tricyclic antidepressants, amitriptryline and nortriptyline are the drugs of choice. A stable setting during pregnancy, with whatever antidepressant, should not be uncritically changed or discontinued after the birth. No antidepressant that you were already using during pregnancy requires you to stop breastfeeding or to restrict breastfeeding from the outset. This also applies to newly started therapies during breastfeeding. If your breastfed child has symptoms that cannot be explained in any other way, such as drowsiness, poor drinking or restlessness, inform your pediatrician immediately.

In the case of a new appointment during the breastfeeding period, the tolerability in a possibly subsequent pregnancy must of course also be taken into account.

Even if you are breastfeeding, do not stop taking your medication without consulting a doctor.

If you feel that your medication is not helping you (any longer) adequately, you should tell your doctor.

diabetes

The most important thing for a woman who wants to have children or a pregnant woman with diabetes mellitus is a well-controlled blood sugar level before and during the entire pregnancy. Otherwise there is an increased risk of miscarriages, premature births, malformations or diseases in newborns.

Ideally, an HBA1c value ("long-term blood sugar value") of less than seven percent, better still under 6.5 percent, should be aimed for three months before the start of pregnancy. This value should also be checked regularly during pregnancy.

The currently optimal medication for diabetics during pregnancy, but also during their planning, is insulin therapy, which then has to be continuously adapted to the changing metabolic conditions in the course of pregnancy. The best researched is human insulin. But a woman who has already been well adjusted to the short-acting insulin insulin lispro or insulin aspart before pregnancy does not necessarily have to be switched over because of her pregnancy.

Long-acting insulins, on the other hand, should be switched to human insulin as early as possible before pregnancy. Human insulin is also recommended as the best tested insulin for new appointments.

Many substances for diabetes that are taken in tablet form have not been adequately studied for pregnancy. Even if the better investigated substances such as glibenclamide or metformin have not yet described an increased risk of malformations, a switch should be made to human insulin. Ideally, this should happen before the pregnancy begins.

Gestational diabetes is a special form of diabetes mellitus. It occurs during an ongoing pregnancy without the pregnant woman having previously had diabetes. Gestational diabetes occurs in up to ten percent of pregnant women. If left untreated, it leads, among other things, to an increased risk for the child and complications during childbirth. If diet and physical activity are not sufficient in a pregnant woman with gestational diabetes, therapy should be given with human insulin.

The delivery should take place in a maternity hospital with a perinatal focus, in the case of insulin-dependent diabetics if possible in a perinatal center. Therefore, you should aim for delivery in a clinic with a neonatal unit.

Colds

In general, you should ensure that you drink enough fluids if you have a cold. Another non-drug measure is inhalation therapy with steam.

If you suffer from a cough with thick, stuck mucus, you can also treat this with medication if non-medication measures are not enough.

You can take the cough relievers acetylcysteine ​​or ambroxol both during pregnancy and while breastfeeding. There are no indications of harmful effects for various herbal remedies such as ivy leaf extract, thyme, ribwort and marshmallow root. So far, however, there are no studies on tolerability. Please note that medicinal products containing essential oils can change the taste of breast milk during breastfeeding and thus affect the baby's acceptance.

Cough suppressants can be used if there is a pronounced urge to cough, which can be excruciating, especially in the evening and at night. However, you should only use them for a short time, in single doses and not at the same time with expectorants. Dextromethorphan is best suited for pregnancy and breastfeeding. The prescription codeine may also be prescribed for you if your doctor deems it necessary. The duration of use must always be limited to a few days.

If you are hoarse, you can also use lozenges with Icelandic moss or dexpanthenol, for example. Take care of your voice and ensure you are drinking enough fluids.

If the nose is blocked, you can use decongestant nasal sprays or drops containing the active ingredients xylometazoline or oxymetazoline in the usual dosage. However, they should not exceed the generally recommended maximum duration of use of around one week. Preparations with saline solutions, sea water or dexpanthenol often provide relief.

If you need painkillers for colds (for example headaches or sore throats), you can go to "Which medications are suitable for pain?" check.

If the symptoms are severe or persistent, if you develop a high fever or produce purulent mucus, your doctor should determine the cause. If necessary, he or she can prescribe an antibiotic for you (see "Which drugs are suitable for bacterial infections?").

Glaucoma (glaucoma)

Even though it rarely occurs during pregnancy and breastfeeding due to age dependency, glaucoma in pregnant or breastfeeding women cannot be completely ruled out. As a rule, glaucoma is treated with eye drops applied locally. Compared to systemic administration (for example in the form of tablets), the quantities that reach the unborn child are very small. Nevertheless, if you are planning a pregnancy, if you are pregnant or if you are breastfeeding your child, you should tell your ophthalmologist. The beta blocker timolol, which has been on the market for over 30 years, has been tried and tested during pregnancy and breastfeeding. You can also be prescribed the locally administered substances brinzolamide and dorzolamide (carbonic anhydrase inhibitors).

These recommendations apply to both pregnancy and breastfeeding.

Some eye drops used to treat glaucoma contain prostaglandins. Since these substances increase the muscle tension in the uterus and can cause insufficient blood flow in the unborn child, they should not be used as the first choice during pregnancy. However, such effects from eye drops are hardly to be expected.

Due to insufficient experience in breastfeeding, you should first check whether one of the above-mentioned medications is suitable for you. However, the concentrations of prostaglandins used are very low and the active ingredients are broken down very quickly locally, so that effects on the child are unlikely. If you need a prostaglandin, you should preferably be prescribed latanoprost during pregnancy and breastfeeding.

hemorrhoids

Hemorrhoids are treated locally with ointments or suppositories. The substances contained serve to relieve pain, reduce inflammation or work against infections. The usual hemorrhoid remedies are considered safe during pregnancy and breastfeeding.

If absolutely necessary, sclerotherapy with Polidocanol may be carried out. The attending physician decides whether such an intervention is necessary during pregnancy or breastfeeding.

In addition, if you have hemorrhoids, you should ensure that you eat a diet rich in fiber and drink sufficient fluids.

Scabies and lice infestation (pediculosis)

Scabies is transmitted from person to person through skin contact with itch mites and is preferred in facilities such as nursing homes and old people's homes, but also day care centers, schools and even hospitals.So if you already have children, you may well become infected. Both during pregnancy and while breastfeeding you should preferably use permethrin for drug therapy: Permethrin is only absorbed through the skin to a very small extent after external application, is considered safe for the unborn and in the USA is for infants even from the third Month of life approved. You can use benzyl benzoate or crotamiton as a reserve agent.

Head lice are transmitted from person to person through close head contact. Nowadays, physical means are predominantly used in treatment. The main representative of this group and the drug of choice for use during pregnancy and breastfeeding is Dimeticon. Systematic studies are lacking, but due to the nature of the substances and the lack of absorption through the skin, undesirable effects are not to be expected. Alternatively, preparations with coconut oil can be applied or rinses with vinegar water can be carried out. Regular combing out with a nit comb is necessary for optimal therapy success. The above-mentioned agents pyrethrum or permethrin are considered to be second-line lice therapeutics.

migraine

Migraines are one of the most common conditions women suffer from. Unfortunately, migraine attacks cannot be ruled out during pregnancy or while breastfeeding. However, the majority of patients report improvement, at least during pregnancy. A distinction is made between the treatment of a migraine attack and the drug-based migraine prophylaxis, which is recommended for frequent attacks or attacks with pronounced symptoms or neurological failures.

You should treat a migraine attack quickly - about a quarter of an hour after the onset of the attack: Paracetamol is possible during the entire pregnancy and breastfeeding period and can also be combined with codeine or caffeine if the symptoms are more severe.

Alternatively, ibuprofen or acetylsalicylic acid or diclofenac are possible as a reserve agent. You must not use these three drugs (ibuprofen, acetylsalicylic acid, diclofenac) after the 28th week of pregnancy, as this could pose a risk to the unborn child. However, if you have repeatedly used one of these medications in the last trimester of pregnancy, please contact your doctor and, if necessary, the Pharmacovigilance and Consultation Center for Embryonic Toxicology together with him.

In the event of a severe migraine attack, your doctor may prescribe sumatriptan if the above medications do not help or are not suitable. Sumatriptan is the best tested substance from the triptan group of active ingredients during pregnancy and breastfeeding.

You can treat accompanying nausea with metoclopramide in all phases of pregnancy and during breastfeeding. The dose should be chosen as low as possible and the duration of treatment should not exceed a few days.

Beta blockers such as metoprolol or bisoprolol, which have been tried and tested during pregnancy and breastfeeding, are suitable for drug migraine prophylaxis.

Fungal infections

A vaginal yeast infection at the end of pregnancy can infect healthy and mature newborns as well. Premature babies are particularly at risk. The drugs of choice for topical treatment are nystatin or clotrimazole, which are used as suppositories or ointments. These drugs are also suitable for other fungal skin infections and when breastfeeding.

If treatment for a yeast breast infection is necessary while breastfeeding, fluconazole (in tablet form) is the best-studied drug. In this case, the infant must be treated with a miconazole oral gel at the same time so that it does not become infected with the yeast through the milk.

sleep disorders

The causes of sleep disorders can be very diverse - so please consult your doctor if you have frequent sleepless nights without an apparent cause. Only after exhausting all alternatives should you use medication for sleep disorders and avoid long-term therapy with sleeping pills not only during pregnancy and breastfeeding due to the risk of addiction.

You can treat sleep disorders that require treatment during pregnancy with valerian, diphenhydramine or doxylamine. Only if these drugs do not help, you may use the prescription drugs lorazepam, diazepam (benzodiazepine) or zolpidem for a short time. However, the use of these drugs must be critically scrutinized, especially in the last trimester of pregnancy.

Even when breastfeeding, valerian or diphenhydramine should be tried first if it is absolutely necessary to treat them with medication. Of the prescription drugs, lormetazepam, temazepam or zopiclone are preferred during breastfeeding because they have the least amount of excretion into breast milk. The principle of only short-term treatment (no long-term therapy) applies here as well.

If the sleep disorder is based on depression, then this should be adequately treated - instead of taking sleeping pills regularly (see "Which medications are suitable for depression?").

Pain

Mild to moderately severe pain can be treated with paracetamol in all phases of pregnancy and while breastfeeding, and in the case of more severe pain also in combination with codeine.

Alternatively, you can take ibuprofen or single doses of acetylsalicylic acid or diclofenac during the entire breastfeeding period, during pregnancy only in the first two thirds. However, you must not use these three remedies after the 28th week of pregnancy, as this could pose a risk to the unborn child. However, if you have repeatedly used one of these medications in the last trimester of pregnancy, please contact your doctor and, if necessary, the Pharmacovigilance and Consultation Center for Embryonic Toxicology together with him.

If the pain is severe, the above drugs may fail. Then single doses of tramadol from the group of so-called opiates are most likely to be considered during pregnancy. Tramadol may also be prescribed for a short time during breastfeeding.

Please note that you generally only take painkillers when absolutely necessary and avoid the use of combination preparations (these are drugs with several active ingredients).

Heartburn / inflammation of the esophagus and stomach lining

You may experience heartburn and acid regurgitation, especially in late pregnancy. If you have symptoms, it can help if you eat smaller meals throughout the day. You should also sleep with your upper body slightly elevated, as this leads to less backflow of stomach contents into the esophagus. Drinking milk can help you acutely.

If these measures are not sufficient, you can use drugs that bind gastric acid (so-called antacids), whereby fixed combinations of aluminum and magnesium salts and combination preparations should be preferred. Make sure you adhere to the usual dosage. Ranitidine may also be used for a short time. One consequence of reflux can be an inflammation of the esophagus, the so-called reflux esophagitis. In this case, you can use the proton pump inhibitor omeprazole, which has been tried and tested during pregnancy. Talk to your doctor if your symptoms persist.

If you have gastritis, you can also use antacids, ranitidine or omeprazole, depending on the severity of the symptoms, if your doctor considers drug therapy necessary.

In principle, the above drugs can also be used during breastfeeding. Antacids may be taken following the recommendations mentioned above. From the group of active substances of the H2 antagonists, famotidine is suitable for breastfeeding because it only passes into breast milk to a small extent. If proton pump inhibitors are required, you can use omeprazole or pantoprazole. However, you should have your doctor clarify new symptoms or symptoms that do not improve.

Nausea and vomiting

In the first trimester of pregnancy in particular, the majority of women suffer from nausea, which can also be accompanied by vomiting. If you are one of them, first try to avoid food and drinks, but also smells that make you feel sick, and avoid very fatty and difficult to digest meals. Sometimes it helps if you have a bite to eat as soon as you feel sick. Ginger also seems to improve the situation.

If you feel severely impaired or vomit several times a day, medication can be used. Although little researched during pregnancy, doxylamine and dimenhydrinate are considered safe for the unborn child. Metoclopramide may also be taken - in the lowest possible dose and limited to a few days. You can find information at the Pharmacovigilance and Counseling Center for Embryonic Toxicology.

Some women experience severe vomiting, which can be associated with weight loss and water and mineral imbalances, which in some cases may require hospitalization. In such severe cases, you may be prescribed promethazine or the serotonin antagonist ondansetron as a reserve drug.

During breastfeeding, you can also use the above medication for illnesses associated with nausea and / or vomiting.

Worm diseases

In this country worm diseases occur much less often than in tropical and subtropical regions. But we also have worm diseases that are widespread - the most common disease is infection with pinworms (oxyurs). Children in particular are affected, as they can easily become infected by ingesting the worm eggs through their mouths.

If you have become infected while pregnant or breastfeeding, you may be treated with medication with pyrvinium embonate or mebendazole. Both substances are only absorbed from the digestive tract to a small extent, so that a transition to the unborn child or to your breastfed child is unlikely. In addition, there have been no reports of side effects in children after use during pregnancy or breastfeeding.

Roundworms (ascarids) can also infect humans and are best treated with mebendazole during pregnancy and breastfeeding.

If you have a tapeworm, niclosamide is preferred. In the first trimester of pregnancy, the need for therapy should be examined more closely, as there are no systematic examinations. However, since niclosamide is also only slightly absorbed from the digestive tract, effects on the unborn or infant are unlikely and have not yet been reported.

With every worm disease, strict hygiene is to be observed in order to prevent infection of others and renewed self-infection.