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How to Treat Anxiety Symptoms During Pregnancy

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Given the limited information on the reproductive safety of certain medications, it is common for women to discontinue anti-anxiety medications during pregnancy. However, many women experience worsening of their anxiety symptoms during pregnancy, and it seems that the first trimester may be particularly difficult. Cognitive-behavioral therapy and relaxation techniques may be very useful for treating anxiety symptoms during pregnancy and may reduce the need for medication.

Some women, however, may not be able to remain symptom-free during pregnancy without medication and may instead elect to continue treatment with anti-anxiety medications. When choosing a medication for use during pregnancy, it is important to choose an effective treatment with a good safety profile. We have the most information on the reproductive safety of Prozac (fluoxetine) and the tricyclic antidepressants. These medications are effective for the treatment of anxiety disorders, and research indicates that there is no increase in risk of major congenital malformation in infants exposed to these medications in utero. Nor is there any consistent evidence that these medications are associated with any serious complications during pregnancy. There is also one report on the safety of Celexa (citalopram), indicating no increased risk of major malformation in exposed children. We have less information available on the safety of other serotonin reuptake inhibitors (SSRIs), including paroxetine, sertraline, and fluvoxamine.

Data regarding the use of benzodiazepines (such as Klonopin, Valium, and Ativan) during pregnancy is somewhat controversial. Early reports suggested that there may be an increased risk of cleft lip and palate associated with first trimester exposure to these medications, estimating the risk to be about 0.7%; however, more recent studies have suggested that the risk may be even lower. Since this risk is restricted to the first trimester, benzodiazepines may be used without risk of teratogenesis during the second and third trimesters. Symptoms of toxicity have been reported in newborns, and these include sedation, decreased muscle tone (floppiness), and breathing problems. In general, these symptoms appear infrequently but probably occur more commonly in women taking higher dosages of medication. There are also some reports of benzodiazepine withdrawal occurring in newborns exposed to benzodiazepines in utero, including irritability, sleep disruption, and, less commonly, seizure.

How anxiety in the mother may affect the pregnancy has been a topic of recent research, and several studies indicate that women who experience clinically significant anxiety symptoms during pregnancy are more likely to have preterm labor and low birthweight infants, as well as other complications, including pre-eclampsia. Thus it is crucial that women with anxiety disorders be monitored carefully during pregnancy, such that appropriate treatment may be administered should anxiety symptoms emerge during pregnancy.

Ruta M. Nonacs, MD PhD

Glover V. O’Connor TG. Effects of antenatal stress and anxiety: Implications for development and psychiatry. British Journal of Psychiatry. 180:389-91, 2002.

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21 Responses to How to Treat Anxiety Symptoms During Pregnancy

  1. bubbles September 25, 2009 at 9:14 pm #

    I found this website very helpful, i am thinking about having another child with my second husband and am nervous that I will have anxiety attacks again. It is reassuring to know that medication could be an ok alternative to coping.

  2. Jennifer November 6, 2010 at 11:41 am #

    I also found this article very helpful compared to other information on the web. I suffer from severe anxiety and my doctors have taken me off Cymbalta and Xanax cold turkey. Bad idea. My anxiety is worse then ever and Im having a hard time trying to find a doctor that understands what I am going through. I will however let them know what I have read and see what opinions they offer.

  3. MAMIOF ANGELS March 15, 2011 at 8:31 pm #

    Love this web site, i was feeling very anxious, and to know that things that i’m feeling are normal.

  4. Samantha March 28, 2011 at 9:38 am #

    this is the first website I have found that has helped my research my options being almost 5 months now I can no longer go without medication and this has helped tremendously

  5. Thinking of one more September 12, 2011 at 6:48 am #

    I found this article very helpful… I want to have one more child but suffer from anxiety and take medication… Now that I know I can be pregnant and take my medication it seem like a real possibility to have another baby….

  6. Lisa November 4, 2011 at 9:32 pm #

    So helpful all of the information on your site. I was taken off all anxiety and depression meds for ivf which failed twice, the second one leaving me practically incapacitated with panic attacks. I have since been put back on Prozac and klonopin but am traumatized with the panic following embryo transfer. I will share this site with my doctors.

  7. Rachel McKernan February 13, 2012 at 11:09 pm #

    I have GAD and slight OCD. Though never being officially diagnosed by a doctor, I am pretty sure these would be the diagnoses given. Since I have been pregnant, my anxiety has increased significantly. Today has been especially hard. I am about 8 weeks. I just keep trying to relax and keep telling myself I can get through this. What I hate most is breaking down in front of my four old daughter. She does not know what is going on and it is confusing to see mommy so distraught. In turn, it gives me more to worry about=more anxiety. I really think I should go talk to a therapist. Any thoughts?

  8. MGH Center for Women's Mental Health February 22, 2012 at 11:02 am #

    @Rachel McKernan, There is good data to support the use of certain types of therapy, including cognitive behavioral therapy, for treating anxiety symptoms. As women with generalized anxiety and OCD are more susceptible to postpartum worsening their symptoms and postpartum depression, the goal is to learn how to manage anxiety during pregnancy.

  9. corinne March 30, 2012 at 5:58 pm #

    Any mothers out there who have taken both ssri’s and benzos and had healthy outcomes with their babies?

  10. tara July 15, 2012 at 1:26 pm #

    @corinne, I have had a very healthy baby on klonipin, zoloft, ambien and a HIGH dose of trazodone. Had to ween off klonipin for the whole first trimester, only used ambien for emergency and finally adjusted to the zoloft and trazodone. I am pregnant again on the zoloft and trazodone, but still take a half mg of klonopin for emergency. Everything so far so good. I lost my last baby, but doctor said she didn’t think it was the meds. WIth or without meds, anything can happen. Try not to worry yourself to death and just do what you can do. Some people have no choice but to take their medicine and people who say “dont be selfish and do what’s best for the baby” obviously don’t have real anxiety or clinical depression. If they did, they would never say that! lol Prolly some life related sh*t that they can work through themselves. Physical anxiety and depression is a different animal altogether.

  11. Lesley R October 1, 2012 at 10:02 am #

    @MGH Center for Women’s Mental Health,
    I am 41 years old and 6 wks pregnant with my second child. I am usually on Paxil (20mg) for anxiety but weaned off a few months ago as we were planning to get pregnant. I am finding that my anxiety level has risen drastically and I find it hard to calm myself down, despite using techniques used from therapy, hypotherapists etc. My doctor is suggesting I go on Zoloft but I’m worried about going back on an SSRI as I read a study that indicated increased risk of autism (and given my age, there’s an increased risk with maternal age anyway). So, I’m left with suffering through, going on the SSRI despite worry about autism, or taking ativan on an as needed basis later in pregnancy. I’m wondering which of these options you feel would be less risky to the baby? Your insight would be really appreciated.

  12. Julia October 30, 2012 at 8:40 pm #

    Has anyone had experience with Remeron/Mitzpartine during pregnancy? I am weaning off after a miscarriage and it’s hard. I want to try to concieve again and my OB wants me off of it. I have a history of panic disorder. It’s really hard to know what the best option is. I’m glad I found thus forum.

  13. Aleida Rossi December 4, 2012 at 12:02 am #

    Ocd..bipolar..severe GAD..

    I am 8 weeks pregnant and sadly for us pregnant woman there is not much out there for us. Im still withdrawing from neurontin,clonazepam and topomax . AWFUL. Im a crazy , depressed mother of a wonderful 9 year old and wife of a great husband. Hubby sticks around bc im having his child but id understand if he took off without looking back ! Since almost all drugs are said to be avoided during first trimester..i can tell you its been hell for me . Yes what even doctors wont admitt are the damages a mothers severe anxiety and depression can have on a fetus esp in brain development during the first trimester. This is so exhausting .
    Liz

  14. Bobbie Jean porter January 2, 2013 at 3:04 pm #

    I am 25 and going on my 4th child. I’m just a few wks along and suffer severe anxiety and severe depression. I’ve been on Klonopin and Celexa. Should i quit taking these medications?? And why?? I suffer daily without them. Can’t even go out in public. Please help me. Is there something else i can take???

  15. Mrs. Craig June 13, 2014 at 12:10 pm #

    Hello,

    I am currently taking 40 mg of Celexa and .50 mg of Klonopin. I had my 4 year in 2010 and the labor was long and then ended up having a blood transfusion after she was born due to loss of blood. Then, I went back on birth control pills 3 weeks after she was born and a few weeks later I was diagnosed with a DVT in my lower right leg. That was the most traumatic experience in my life, which left me very depressed and anxious. I was afraid that I was going to die and leave my husband and precious baby girl behind and the thoughts of that terrified me.

    I now want to have a second child but am worried about getting pregnant and taking celexa and Klonopin. Any advice? Should I be worried? Any suggesstions?

    Thanks.

  16. MGH Center for Women's Mental Health June 15, 2014 at 9:31 pm #

    Sounds like a horrible experience, but I suspect the Celexa and Klonopin had little to do with what happened to you. Birth control pilla and simply being postpartum are associated with higher risk of blod cots, so I would think those two factors were at play here. It might help to discuss this with your OB so that you better understand your risks and can do whatever you need to do to prevent this from happening in the future.

  17. nicole November 24, 2014 at 9:00 pm #

    I am 11 and a half weeks pregnant. I found out I was pregnant around 2months. My obgyn told me to stay on my klonopin .05 mg 2x a day. And I juat saw my dr who prescribes them and he randomly lowered me to 20 pills with buspar to take and wean off the klonopin . I’m so affraid of the withdrawls and possible seizures… I need advice and help. Does anyone know any reasonable drs in ct that actually understand ???

  18. Tab December 13, 2014 at 8:27 am #

    I am 43 and have severe panic attacks and take Ativan on an as needed basis only. Last year the day I found out I was pregnant I was bed ridden for days with a panic attack because I was afraid to take the Ativan. I miscarried and wonder if it was from the panic attacks. Here it is a year later and I just found out I am pregnant again (unplanned), this would be my first child. I can not go without the Ativan. After my miscarriage I tried Buspar but that did nothing at all. I have the added stress of my age and the fact that my doctor does not think pregnancy is a good thing for me emotionally. Has anyone had a healthy baby who has taken this medication? Again, I only take small doses as needed, typically 6-7 times a month.

  19. carey May 2, 2015 at 3:09 pm #

    Im 28 weeks pregnant. I suffer from severe panic attacks and anxiety and ptsd. Im high risk and my Dr. Said I needed to go back on klonopin because the risk to my daughter from the anxiety would be worse for her. He wouldn’t put me back on in the 1st trimester because thats when it will harm the baby and I tried hard and made it through my 2nd trimester but the anxiety would keep me from going to my appt or anywhere. He sent me to see another high-risk OB specialist and he agreed I need to be on klonopin immediately. I feel so much better. Im still worried about taking it but I trust the Drs.
    Last year I didn’t take anything except zofran for Hyperemisis gravidarum. And when I had my son he was beautiful. I hemorrhaged and went unconcious. Was taken into surgery when I woke up my Abram had passed away in that short amount of time. So even though I did everything right with him I still lost my baby.
    Good luck to all who are pregnant and suffer from anxiety etc.

  20. Tiffany July 16, 2015 at 5:39 am #

    I suffer from severe anxiety and panic attacks. I am 11 weeks pregnant. I was on 1 mg daily of clonazepam and am now weaned down to .5 mg daily. The anxiety got much worse as the weaning started. I couldn’t handle the anxiety anymore because it was so severe, so I called my physiatrist and he gave me lorazepam. They are 1 mg tablets that I take only as needed. My other doctor and my family don’t want me on any medication because it can harm the baby. All of this is very tough on me. I don’t want anything to happen to my baby but I also can’t live with the constant anxiety and panic attacks. I’m so confused about everything. So, I’m really looking for some expert advice about this so that I know for sure what I need to do. Please help.

  21. MGH Center for Women's Mental Health July 16, 2015 at 12:09 pm #

    We cannot give advice to you or speak to your particular situation, but you might want to share the folowing articles with your physician.

    http://womensmentalhealth.org/posts/anxiety-during-pregnancy-options-for-treatment/

    http://womensmentalhealth.org/posts/anxiety-during-pregnancy-predicts-worse-outcomes/

    http://womensmentalhealth.org/posts/new-data-anxiety-medications-pregnancy/

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