Seroquel and fluoxetine when trying to conceive

[paulo]

Hi.

My partner is 40 years old and we are trying to conceive our second child. She has a diagnosis of bipolar II and was taking 400mg seroquel (standard release) and 60mg fluoxetine to deal with the condition. We were advised that she should not be on any medication during pregnancy (though it was our choice) so she has tapered down the meds and is no longer on any however 5 weeks after stopping all medication she is really struggling with her mood, motivation and suicidal thoughts and so we were searching for some advice about whether starting up medication again would be an option and if so which medications (alternatives to seroquel/fluoxetine are ok) would be appropriate and what dosages would be best. She has also previously taken venlafaxine (between 75 - 150mg, I can't remember at the moment) with the seroquel.
Advice that we have had previously has been lacking in information about possible risks to the child and prevalence rates and it has been very much left up to us with the advice that it is better to be on no medication which hasn't been particularly helpful.

Thanks

[Sandra]

Paulo,

Seroquel (quetiapine) is rated a P3-unknown, risk to the fetus cannot be ruled out. No apparent increased risk of congenital anomalies in a small number of studies. (Koren, Tenyi, Taylor, McKenna, Gentile) Risk of maternal weight gain with subsequent increase in diabetes mellitus and thromboembolic events and neonates large for gestational age. (Koren)

Quetiapine or Seroquel is an atypical antipsychotic drug used in the treatment of schizophrenia and bipolar disorders.[1] It is thought to work by blocking the dopamine and serotonin receptors. In a study conducted on the use of atypical antipsychotics during late pregnancy, it was found that Quetiapine had the least amount of passage through the placenta compared to other atypical antipsychotics (i.e. olanzapine,haloperidol, and risperidone).[2] In a case report published in the Archives of Women?s Mental Health, a 30 year old woman with bipolar disorder who developed a manic episode during her second trimester of pregnancy was followed. She had been on lithium in the past and was now started on Quetiapine. She delivered a healthy full term infant who had normal development at 3 months of age.[3]

Prozac (fluoxetine) is rated an P3-unknown, risk to the fetus cannot be ruled out. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI). Compared with other drugs used in the treatment of depression, SSRIs have less side effects. [1] Fluoxetine crosses the human placenta. Although some studies refute it, others suggest that there is an association between the use of fluoxetine in the first trimester and cardiovascular malformations.[2] In the third trimester, fluoxetine use does not seem to cause any complications to the fetus and neonate.[3] It is important for mothers to continue using their antidepressant medication postpartum since there seems to be an association between depression in pregnancy and postpartum depression.[4] Meta-analysis reviews have not proven any relationship between fluoxetine usage in the first trimester and congenital malformations in humans.[5]

1.##Briggs G, Freeman R, Yaffe S. A Reference Guide to Fetal and Neonatal Risk: Drugs in Pregnancy and Lactation. Vol 1. Seventh Edition ed. Philadelphia, PA: Lippincott Williams & Williams; 2005.
2.##Newport DJ, Calamaras MR, DeVane CL, et al. Atypical antipsychotic administration during late pregnancy: placental passage and obstetrical outcomes. Am J Psychiatry. Aug 2007;164(8):1214-1220.
3.##Cabuk D, Sayin A, Derinoz O, Biri A. Quetiapine use for the treatment of manic episode during pregnancy. Arch Womens Ment Health. 2007;10(5):235-236.

1.##Morrison JL, Riggs KW, Rurak DW. Fluoxetine during pregnancy: impact on fetal development. Reprod Fertil Dev. 2005;17(6):641-650.
2.##Diav-Citrin O, Shechtman S, Weinbaum D, et al. Paroxetine and fluoxetine in pregnancy: a prospective, multicentre, controlled, observational study. Br J Clin Pharmacol. Nov 2008;66(5):695-705.
3.##Goldstein DJ. Effects of third trimester fluoxetine exposure on the newborn. J Clin Psychopharmacol. Dec 1995;15(6):417-420.
4.##Cohen LS, Heller VL, Bailey JW, Grush L, Ablon JS, Bouffard SM. Birth outcomes following prenatal exposure to fluoxetine. Biol Psychiatry. Nov 15 2000;48(10):996-1000.
5.##Addis A, Koren G. Safety of fluoxetine during the first trimester of pregnancy: a meta-analytical review of epidemiological studies. Psychol Med. Jan 2000;30(1):89-94.

I hope this helps. If you have any other questions please call the InfantRisk Center at 806-352-2519. Thanks,

Sandra Lovato R.N.
InfantRisk Center