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Wellbutrin + Serequel during Pregnancy and Breastfeeding

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  • Wellbutrin + Serequel during Pregnancy and Breastfeeding

    Hi all! I have been very worried about my medication usage during pregnancy based on the contradictory opinions between my Drs. and information I have read online. I am currently 20 weeks pregnant and was unaware I was pregnant until 8 weeks. I have continued my medications during pregnancy bc two different OBGYNs reassured me that everything would be fine from the beginning, and that staying on the medications would outweigh the risks associated with not taking them. I am worried bc I'm actually taking three Category C drugs: Wellbutrin SR (300 mg.), Serequel (200 mg), and Asthmanex (twice daily). I take the Wellbutrin for depression/anxiety/ADHD, Serequel for sleep issues/anxiety, and Asthmanex for the control of my asthma. I started these depression medicines about a year and a half ago and they have helped me tremendously and I finally feel well balanced and my depression is gone and my anxiety is drastically reduced. My asthma is also under control with the Asthmanex. I actually feel normal again.

    Everything was fine until I visited my general Dr. the other day, bc my ObGYN said I should still see him too. He had no clue I was even pregnant because I hadn't seen him in awhile. He became very worried about my medication usage and called my ObGYN to discuss. My general Dr. then sent me a message stating that these drugs are all category C and I need to reduce usage because the effects on the fetus are not known and there are unknown risks that could have traumatic effects on its health. It was very scary and made me feel like I was doing something awful to my baby. I have tried to lower the amounts before and every time I end up feeling unbalanced again. I feel so guilty for even taking my medicines.

    After this email I called my ObGYN who basically told me that everything would be fine and that my general Dr. isn't an ObGYN and basically overreacted a bit. Then I started feeling relieved but I can't stop wondering if my ObGYN is right plus I have read scary things online.

    I am constantly paranoid that something awful will happen to my baby and it will be all my fault. Thank God, so far my baby has been normal and all the ultrasounds looked great. I even did genetic testing even though we have no known risks, and everything came back normal.

    Sorry for the long rant but I would just like to know your expert opinion on my medication usage and if there are known birth defects associated with these medications. Should I keep using them or is the risk too high? I also plan to breastfeed and want to know if this is safe while taking these? Thank you for your help!!

  • #2
    Hi, thanks for your post.

    The short answer is that I agree with your OB; you should continue to take these medications as prescribed while you are pregnant. They are also reasonably safe for breastfeeding.

    For all three of these drugs, the Category C rating comes from animal studies in which the animals received several times the maximum recommended human dose. These drugs are used commonly in pregnant women and existing retrospective data have not yet shown an increase in adverse fetal outcomes. The FDA is moving away from the lettered category system because it can be misleading in cases like these. More info on FDA categories here:
    http://mommymeds.com/node/1001942

    Asthmanex (mometasone) is an inhaled steroid. When you inhale it, the drug acts locally on the air passages in your lungs and very little of the medication is actually absorbed. Compared with the risks of untreated asthma, this drug is a safer choice. We discuss asthma in pregnancy in more detail here:
    http://mommymeds.com/content/asthma-medications-pregnancy

    We discuss steroids in breastfeeding here:
    http://mommymeds.com/frequently-asked-questions/steroids

    For Wellbutrin (bupropion) and Seroquel (quetiapine), the biggest known risk with both drugs is withdrawal symptoms after the baby is born. This risk can be reduced by decreasing your dosage for a couple of weeks before delivery. This is NOT a worthwhile strategy if you find that temporarily decreasing your dosage leads to crippling anxiety. Remember, a healthy mom makes a healthy baby. My OB/GYN colleagues tell me that their general policy is not to change a woman's medication if what she takes is working for her, unless there is an overwhelming reason to do so. The American College of Obstetricians and Gynecologists (the professional thinktank that writes practice guidelines for OB/GYNs) is very clear that mothers with depression/anxiety should be treated during pregnancy because "Maternal psychiatric illness, if inadequately treated or untreated, may result in poor compliance with prenatal care, inadequate nutrition, exposure to additional medication or herbal remedies, increased alcohol and tobacco use, deficits in mother–infant bonding, and disruptions within the family environment."

    We have published several articles about depression in pregnancy that may interest you:
    http://mommymeds.com/categories/diseases-and-conditions/depression

    Birth defects and other adverse fetal outcomes can still happen to anyone. The "background" rate of birth defects in the USA, in other words, problems that have nothing to do with something the mother did wrong, is around 2-4% of all pregnancies. The best thing you can do for your baby right now is to take care of your own health as much as possible.

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

    -James Abbey, MD

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    • #3
      Thanks for all of the helpful information. I do have one more question though. You mentioned that the baby may have withdrawal symptoms. Is the baby exposed to less of the medication during breastfeeding vs. being in the womb? I also take the Serequel for sleep and was wondering if it will make the baby unusually sleepy or have any other negative effect on his behavior? I'm hoping that the effects will be minimal because I would hate to disrupt my baby's natural behavior.

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      • #4
        Yes, the baby is exposed to less medication via breastfeeding than in the womb. Withdrawal symptoms are very uncommon with Welbutrin and Seroquel exposure during breastfeeding. These meds can make the baby a little sleepy, but it's hard to predict how significant that effect will be before you see it. Likely, it will not be noticeable.

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