Q:  Seroxat and Seroquel & Pregnancy

Dear Dr. Phelps

I have bi-polar disorder, and have been successfully treated with lithium (600Mg) combined with seroxat (30 mg) for the past seven years.

At the age of 35, my husband and I are keen to start a family.  I have therefore been 'weened' off Lithium and have been taking seroquel (400mg) for the past 3 months.  Please would you advise me what your thoughts on this medication and the effects which may be detrimental during the pre and post natal stage?

Being aware of the difficulties reported of multiple drugs during pregnancy, it is indeed my intention to reduce the seroxat over a sensible time period.

Your advise would be greatly apprecicated.

Regards
 

Dear Ms. C' -- 
This is such a controversial area, largely because we lack the most basic information about safety, I'm afraid I cannot advise or really even comment much.  There are no good answers, no way to even lay out a spectrum of options and rank them based on their respective safety levels (isn't that frustrating? on the other hand, think how long it takes to accumulate enough data to be able to do that reliably; lithium is really the only one of those you name where we know much about risk -- somewhat with the Seroxat (paroxetine; Paxil), almost nothing with the Seroquel except that theoretically it's in roughly the same family as the old-generation antipsychotics which over many, many years have appeared to be relatively safe -- at least no obvious problems as we've seen for other agents.) Sorry about that. I face the same problem counseling my own patients on their options. 

Dr. Phelps

Published September, 2005