Q: Can you take trazadone while in 1st trimester of pregnancy? I have
bipolar and the effexor is keeping me from sleeping at all. If not, what sleep
med can I take?
Dear Paula --
One might think this would be an easy question. And fortunately, demonstrating
that something is "safe" in pregnancy takes a very long time and a lot of
dedicated attention. For example, a medication that I use a lot, called
lamotrigine (Lamictal) has been studied rather closely now for nearly a decade
using a "registry". Every case that can be found of a woman who was taking
lamotrigine won her pregnancy was conceived, and no other medications, has been
entered into a research database. The outcome of that pregnancy is then
observed.
Using this method, one can see whether the rate of fetal abnormalities exceeds
the background rate -- the rate among women not taking any medication at all,
which is about 2% of pregnancies. Not all of these abnormalities are dramatic,
or serious, but something happens that can be recognized as "not normal". In
women taking a given medication, a rate of fetal abnormalities greater than 2%
means the medication is "not safe in pregnancy".
But you can imagine how long this takes: suppose the rate of abnormalities
caused by something like lamotrigine is 3%, or 4%. In order to detect that
slight difference, compared to the background rate, you have to watch hundreds
of pregnancies, probably close to a thousand or more. Unfortunately, only when a
company that makes a medication is trying to establish that their medication is
"safe", and thereby obtain a competitive advantage they can trumpet -- and
thereby make millions of dollars --, only then are such "registries" carefully
maintained.
Otherwise, we simply have to wait until so many fetal abnormalities have
occurred in association with a given medication -- like trazodone -- that
someone begins to pay close attention. Not a good system.
That's where we are with trazodone now. Most other antidepressants like it,
which affects serotonin, were until quite recently thought to be "safe".
However, with closer scrutiny in the last 2-3 years, concerns are beginning to
be raised about even an old standard like fluoxetine (formerly "Prozac").
So unfortunately, the bottom line of all this is that one cannot really assume
any medication "safe" in pregnancy unless it has had detailed attention to me
for many years. The only psychiatric medications which come even close to this
mark are the old-generation antipsychotics (e.g. Haldol, Thorazine, Mellaril --
that gang).
The other "bottom line" which emerges from all this is that women with bipolar
disorder have to be extremely careful about planning their pregnancies, having
detailed and thorough conversations with their psychiatrist.
While you're having a conversation with your psychiatrist (I hope that is
possible), you should probably also be discussing whether Effexor is clearly
helping and therefore should be continued, even when it is causing a problem
like this sleep disturbance you mention. Good luck with the process --
Dr. Phelps
Published April, 2008 |
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