1 In 5 At Risk
Driving home today I saw the truck with a runner that is running in support of mental health awareness. That got me thinking. I checked out his site and found that he treats his anxiety with exercise. That is great. But he is encouraging people to meet with mental health workers. That’s fine except for the big push to take medications. I thought I’d check out his links. One of which is CMHA or Canadian Mental Health Association. The first thing that jumps out is that their web site is developed and supported by Wyeth, the makers of Effexor. Their site lists some facts about mental health in Canada. Like 20% of Canadians will suffer a mental illness. Mental illness can be treated effectively. That mental illness costs the health care system to be at least $7.9 billion in 1998 – $4.7 billion in care and $3.2 billion in disability and early death. They estimate that 10-20% of Canadian youth are affected by a mental illness or disorder – the single most disabling group of disorders worldwide. They document that 5% of male youth and 12% of female youth, age 12 to 19, have experienced a major depressive episode. They also claim that the total number of 12-19 year olds in Canada at risk for developing depression is a staggering 3.2 million. They also claim that once they recognize their depression and get help, 80% will return to normal. They also state that mental illness is increasingly threatening the lives of our children, with Canada’s youth suicide rate the third highest in the industrialized world. Suicide being among the leading causes of death in 15 – 23 year olds. These numbers seem to be saying that it’s quite dangerous to be a youth in this day in age. I am scared for my kids. How long until they are “diagnosed” with a mental illness? Until someone deems them a potential lifetime client for a drug company. Not surprisingly my 7 year old son has been diagnosed by a teacher to be in need of medication to help him settle down in school. Not that he’s been tested as gifted and finishes his work much sooner than his classmates and has nothing else to do but get bored. They go on to list what are mental illness problems. The problems start in childhood to adulthood, family life to the elderly. Nobody is safe at any stage. They claim 1 in 5 Canadians will suffer mental illness. 1 in 5! When did this epidemic begin?
I then hopped over to National Resource Center on AD/HD. A program of CHADD children and adults with ad/hd. I was surprised under FAQ about women taking non-stimulate medications while pregnant. They answered;While the stimulants remain the most effective treatment for AD/HD, other medications that are approved for use during pregnancy might also be considered to address either associated symptoms such as the anxiety and depression or for the AD/HD itself. Further investigation may need to be done, but here is some of what we know now.
The antihypertensives (Clonidine and Tenex) are second line treatments for AD/HD and are no longer considered a risk during pregnancy as a result of studies that have shown no significant association between exposure during pregnancy and defects or behavior changes in infants.
The SSRI antidepressants also have been studied and have a large database on pregnancy exposure.
After considerable monitoring, Prozac, Luvox, Paxil, and Zoloft are considered to have no increased risk of major malformations in the infant when used within recommended dosage levels during the pregnancy. There was also no increased risk of miscarriage, stillbirth, or premature delivery noted.
Wellbutrin does not yet have enough data, but has been labeled a Category B as a result of studies done in rabbits. A pregnancy database to monitor its safety was established in 1997 to further investigate its safety in humans and currently contains almost 400 mother-infant cases. The registry may be found at http://pregnancyregistry.gsk.com/bupropion.html
So I looked up Paxil and found:The American College of Obstetricians and Gynecologists recommends that pregnant women and women planning to become pregnant should avoid using paroxetine. According to the prescribing information “epidemiological studies have shown that infants born to women who had first trimester paroxetine exposure had an increased risk of cardiovascular malformations, primarily ventricular and atrial septal defects (VSDs and ASDs). In general, septal defects range from those that are symptomatic and may require surgery to those that are asymptomatic and may resolve spontaneously. If a patient becomes pregnant while taking paroxetine, she should be advised of the potential harm to the fetus. Unless the benefits of paroxetine to the mother justify continuing treatment, consideration should be given to either discontinuing paroxetine therapy or switching to another antidepressant. For women who intend to become pregnant or are in their first trimester of pregnancy, paroxetine should only be initiated after consideration of the other available treatment options.” These conclusions are supported by multiple systematic reviews and meta-analyses that found that, on average, the use of paroxetine during pregnancy is associated with about 1.5-1.7-fold increase in congenital birth defects, in particular, heart defects. A recent non-systematic review in the Journal of Clinical Psychiatry, with the lead author, Salvatore Gentile, reporting to have received material or financial support from GSK, came to a different conclusion: “the teratogenic potential of paroxetine that has been reported in some studies remains unproven.” Gentile called for large, epidemiologic, prospective, controlled studies on “mothers who accept taking paroxetine during pregnancy”. Other reviews vary on whether the teratogenic risks outweigh the risk of disease relapse if the drug is discontinued: some advocate discontinuation, while others suggest caution; even where the overview of antidepressants generally is favorable, paroxetine is singled out for specific risks.
Abrupt discontinuation of psychotropic drugs during pregnancy can also lead to serious adverse effects.
Counseling is effective in reassuring women to adhere to therapy, but neonatal paroxetine withdrawal symptoms described above have been documented from mothers taking Paxil during pregnancy.
I then checked the question about using a stimulant medication while pregnant and they answered; With more and more women being diagnosed and treated for AD/HD, the question of safe use of stimulant medications during pregnancy has become more critical. In general, stimulants (either the amphetamines like Adderall or methyphenidate like Concerta, Ritalin LA and Metadate CD) are all considered “Category C” teratogens. That means that they should only be used when the risk to the mother outweighs the risk to the fetus.
To date, the effects of stimulants during pregnancy have only been studied in animals, where defects were seen in the offspring when the mothers were given very high doses of the stimulants. The doses of stimulants given to animals for these studies have been 41x and 12x the usual human dose. The literature contains individual case reports of women who have taken stimulants during their pregnancy and, clinically, there have been many other women who have taken stimulants and have had normal babies.
The important questions for a woman who is being treated for AD/HD and who is thinking about getting pregnant or who recently learned that she is pregnant are the following:
Should she discontinue stimulants prior to becoming pregnant?
Should she continue stimulants after her first 3 months?
Should she discontinue medication during the entire pregnancy?
What are the risks both to the mother and the baby if her AD/HD goes untreated?
Each woman needs to decide the answers to these questions for herself after considering all of the available information and discussing the issue with both the child’s father and her physician. The problems with the stimulants have to do with cardiac defects, which usually occur because of problems during the formation stages of each organ system during the first trimester. To date, there are no large-scale studies to provide us with answers.
While we have tried to answer your question by providing information, this information should not be considered a substitute for medical advise and a women should always discuss such information with her treating physician.
That’s great. I was told my benefits outweighed my risks. My doctor believed that too. It’s scary to go to someone that doesn’t have all the facts. He didn’t understand why my pregnancies were getting more and more difficult. He didn’t know that one of the side effects of Effexor is dramatic blood pressure shifts. I was so ill with Matthew and my blood pressure shifts were so severe, I was at least 30 points different from sitting to standing. I would lose consciousness if I wasn’t laying down. I was put on bed rest for the last two months of my pregnancy. Why didn’t my doctor inform me of these risks when I told him I was pregnant. He didn’t know. I thought I was going to stop having children. Why was my first pregnancy a breeze and then the remaining 5 after starting Effexor getting more and more dangerous? Not to mention my miscarriage, Jacob’s low birth weight and severe breathing problems, and Cole & Andrew’s heart murmurs. This is a very dangerous game the drug companies are playing. Those of us taking the medications are the ones at risk. What consequences do they face? They may get lawsuits, but does that really bother them with the amount of money they make? They just have to spit out a “new and better” drug. Just keep convincing the medical world that these problems are on the rise and everyone is at risk. That we are all potential customers. When will it end? How many more need to die?