Low dose Cymbalta during pregnancy and breastfeeding

[mollysunshine]

Dear Infant Risk team,

I have suffered with anxiety and depression for the last 15 years and have been on and off various medications while in treatment. I had been off medication for several years and had a rebound episode of moderate to severe anxiety/depression about a year ago. My doctor started me on Zoloft, it helped initially but made me extremely lethargic and almost unable to function, even taking it at a pretty low dose. I then switched to cymbalta 30mg q day, which has helped tremendously. After being on the cymbalta for a few months I found out I was pregnant with twins. I am now 11 weeks along. I have read various things about weaning off antidepressants in the 3rd trimester and that cymbalta carries certain risks to my babies like infant withdrawal syndrome and even scarier pulmonary hypertension. However I am afraid weaning off will derail my progress and make me worse off. I wanted to ask, are the risks associated with this medication dose dependent? Is this medication safe to continue during pregnancy and breastfeeding or should I consider switching? Is there any additional risk with carrying multiples and taking this medication? Any additional information you can provide will be much appreciated, thank you!

[admin-james]

Hi, thanks for your post.

There are no controlled clinical trials of pregnant women on Cymbalta, nor are there likely to be in the foreseeable future. Research boards are very intolerant of uncertainty when it comes to experiments in this population. What we do know about this drug comes from case reports. There is a certain inherent bias to case reports, in that they are only published when something bad happens. However, it's pretty clear that Cymbalta and other SSRIs and SNRIs are associated with a mild increase in risk for a withdrawal syndrome, feeding difficulties, and lung problems, all of which are temporary. Many, many women have taken these medications during pregnancy with no ill effect on the baby.

There is also good evidence that untreated or poorly treated depression/anxiety has negative effects on the baby's health and development. See the InfantRisk.com articles for more information on that. The question of risk vs benefit is a difficult one and will require a lot of input from your various doctors. I can tell you that the risks associated with Cymbalta and other SNRIs are dose-dependent, so there may be an acceptable middle ground for you. The safety profiles of the different drugs in this class are all pretty similar. If Cymbalta is working for you, you should not switch to a different drug because of safety concerns. The same is true for breastfeeding; stick with something that works. In breastfed babies, the principle side effects are sedation and diarrhea. We do not know of any long-term dangers for infants exposed to small amounts of SSRIs or SNRIs.

Please call us at the InfantRisk Center if this has not completely answered your question.*(806)352-2519

-James Abbey, MD