Should pregnant women take depression medications? This is a complicated question and requires an individual assessment of the woman’s needs. The risks of taking depression medication have to be weighed against the risks of not taking it. We know that some drugs can cause birth defects especially if taken during the first trimester. Some babies experience medication withdrawal after birth if their mothers took antidepressants during pregnancy. On the other hand, we also know that untreated depression during pregnancy carries its own risk to the baby such as preterm labor, smaller head size and lower birth weight. Also, babies born to untreated, anxious, depressed mothers are more difficult to soothe and may have slowed motor development.

So what’s a woman to do? I tend to be on the conservative side of the spectrum with regards to avoiding medication if at all possible, especially during the first trimester when the baby’s organs are forming. However, I think the general trend has been to use SSRI’s even in mild cases of depression. There are definitely women who cannot continue the rest of their pregnancy off depression medication without putting their life and the life of their unborn baby at risk. In general the findings seen in this study should make us give more consideration as to which women should continue on depression medication throughout their pregnancy and which ones should continue off depression medication and be monitored closely.

Not everyone who is clinically depressed feels sad. But let’s say you take depression medication and notice improvement in your level of anxiety, your sleep problems resolve and you feel less irritable and hopeless. What then happens when you lose your job? You will be upset and experience the emotions you would have felt if you were not on medication. In other words, the depression medication does not protect you from grieving a loss or responding to hardships with emotional upset.

Some people expect to sail through a difficult situation unscathed if they are on depression medication. If a crisis hits and they have a dip in their mood, they fear they are having a relapse. You may be having breakthrough symptoms, but you may be having the usual and expected response to a difficult situation.

I often say having your depression treated with an antidepressant medication helps give you a stronger foundation to weather the storm more effectively than you could if you were depressed. It’s like kicking an athlete in top form versus kicking a sick man who’s already down.

Similarly, a common side effect of Wellbutrin is increased activation or agitation. Many patients can take Wellbutrin without this unwanted side effect, but I’ve had some patients feel increased anxiety or agitation when they switched to generic Wellbutrin.

This is all antedoctal, that is, it’s not based on a head to head study of the generic medication versus the brand. Nevertheless, in my experience, it’s happened enough to take notice. Does this mean that the generic lamictal or generic Wellbutrin are not as good? No. It just means that the different generic manufacturers may have different inactive ingredients that can affect you differently. You don’t know what manufacturer you local pharmacy will use, and they may use a different company the next time you refill. The only way to insure consistency is to use the brand because you know what you will get each time.

For the many people who notice no difference when they take the generic drug, then by all means continue to save money by taking the generic drug. But for those who may be more sensitive to medication side effects, you may need your doctor to write “brand neccesary” on the prescription to avoid an unnecessary substitution to the generic drug.

Zolpidem, the generic of the short acting Ambien has a half life of 2.5 hrs.  The controlled release version, Ambien CR has a half-life of 2.8 hours.  What does this mean?  It takes roughly 3 half-lives for a drug to be eliminated from your body. By two half lives, the drug level is at the low end of the curve (meaning little noticable effect if any).  So if a person only sleeps 6 hours, they have still passed two half lives of the drug and should show no impairment in their driving ability.  This is in contrast to drugs like Trazadone that has a half life of 4-7 hrs or Restoril which is 10hrs.  It’s the long half-life that can make people who take these drugs for sleep feel groggy in the morning.

The research group based their findings on a study of 68 women undergoing chemotherapy for breast cancer. They were treated with Provigil for 8 weeks to combat fatigue. However, the women found they had significant improvement in their ability to concentrate as well as memory and learning.

Provigil is a drug prescribed for excessive daytime sleepiness due to Narcolepsy (which is a problematic sleep condition) and shift-work sleep disorder. Provigil activates the brain in the same way as stimulants like amphetamines and caffeine. Why not just use Adderall or caffeine? Provigil does not have the negative effects on the heart as does Adderall so it is potentially safer.

The study uses a small group of patients and is funded by the drug company who makes Provigil.  Despite this, the results are promising. If future studies confirm that Provigil improves cognitive deficits due to chemotherapy, this could significantly improve the quality of life for patients undergoing chemotherapy.