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AD/HD Medications During Pregnancy
Since approximately 3 - 5% of the adult population struggles with symptoms related to AD/HD, including women who are planning on having children, there are frequent questions about use of medications during pregnancy.
Stimulant medications, including methylphenidate (Ritalin, Concerta, Metadate CD, and others), mixed amphetamine salts (Adderall, Adderall XR), and dextroamphetamine (Dexedrine) remain the first-line medication for treatment of AD/HD.
There have been no well-controlled studies of stimulant use during pregnancy (ethically, a study giving a stimulant medications to pregnant women would not be authorized by the FDA). Stimulants are classified as Category C by the FDA (Animal studies show adverse effects, but there are no controlled human studies).
Amphetamines (Adderall and Dexedrine) given to mice in doses much higher than the usual human dose have reported cardiac defects. Studies of women addicted to amphetamines have shown higher rates of low birth rate and pregnancy complications. Another study found that children of women exposed to Dexedrine had a higher incidence of heart defects at three-year follow-up. A study of 48 women exposed to methylphenidate during pregnancy found higher rates of premature birth, growth retardation, and symptoms of withdrawal in the infants.
Modafanil (Provigil) and atomoxetine (Strattera) are also category C drugs, with inadequate information available to assess risk. There is also not enough information about bupropion (Wellbutrin) to assess risk, and although it's a category B drug (preferred over category C drugs), there is some concern about its use during pregnancy and a potential for congenital heart defects.
All medications are excreted into breast milk, exposing them to the infant. Amphetamines are concentrated in breast milk which causes concern about typical side effects of stimulant medications as well as withdrawal symptoms. There is no information about methylphenidate during nursing. There is too little information available about atomoxetine and modafanil to recommend their use during breastfeeding.
More information is needed regarding medications used to treat AD/HD during pregnancy and while nursing. Although the risks versus the benefits of using medications during pregnancy and while nursing should be thoroughly discussed with someone's physician, there is currently no information to indicate that treatment of AD/HD with medication is a safe choice.
Alternatively, I recommend working with an ADD Coach/ Organizer (or experienced therapist) on skills for planning, organization, time management, and follow-through.
Dr. Richard Sogn
Related Topics: Pregnancy Antidepressants: Baby Risk, Dads Get PostPartum Depression, Too
Technorati Tags: AD/HD, pregnancy, stimulant medication
Stimulant medications, including methylphenidate (Ritalin, Concerta, Metadate CD, and others), mixed amphetamine salts (Adderall, Adderall XR), and dextroamphetamine (Dexedrine) remain the first-line medication for treatment of AD/HD.
There have been no well-controlled studies of stimulant use during pregnancy (ethically, a study giving a stimulant medications to pregnant women would not be authorized by the FDA). Stimulants are classified as Category C by the FDA (Animal studies show adverse effects, but there are no controlled human studies).
Amphetamines (Adderall and Dexedrine) given to mice in doses much higher than the usual human dose have reported cardiac defects. Studies of women addicted to amphetamines have shown higher rates of low birth rate and pregnancy complications. Another study found that children of women exposed to Dexedrine had a higher incidence of heart defects at three-year follow-up. A study of 48 women exposed to methylphenidate during pregnancy found higher rates of premature birth, growth retardation, and symptoms of withdrawal in the infants.
Modafanil (Provigil) and atomoxetine (Strattera) are also category C drugs, with inadequate information available to assess risk. There is also not enough information about bupropion (Wellbutrin) to assess risk, and although it's a category B drug (preferred over category C drugs), there is some concern about its use during pregnancy and a potential for congenital heart defects.
All medications are excreted into breast milk, exposing them to the infant. Amphetamines are concentrated in breast milk which causes concern about typical side effects of stimulant medications as well as withdrawal symptoms. There is no information about methylphenidate during nursing. There is too little information available about atomoxetine and modafanil to recommend their use during breastfeeding.
More information is needed regarding medications used to treat AD/HD during pregnancy and while nursing. Although the risks versus the benefits of using medications during pregnancy and while nursing should be thoroughly discussed with someone's physician, there is currently no information to indicate that treatment of AD/HD with medication is a safe choice.
Alternatively, I recommend working with an ADD Coach/ Organizer (or experienced therapist) on skills for planning, organization, time management, and follow-through.
Dr. Richard Sogn
Related Topics: Pregnancy Antidepressants: Baby Risk, Dads Get PostPartum Depression, Too
Technorati Tags: AD/HD, pregnancy, stimulant medication
14 Comments:
I am an attorney recently diagnosed with AD/HD, and several other mental health conditions that severely impact my work.
I am under a doctor's care, but he is not experienced with suggesting reasonable accommodations for people in my profession.
My employer has agreed to provide me with accommodations, but I'm not really sure what exactly to seek. A reduction in workload, more time on certain assignments, teaming up with another attorney? I was hoping someone could share some specifics.
Thanks,
Trying to pay attention in Oakland.
Anthony:
I have also been DX w/ adult ADD. My initial response was one of relief, but this was soon eclipsed by the infinite nature of the question, "what now?" The most valuable resources for realistic life-management skills that I have encountered (at the advice of my incredible doctor) are John Ratey and Ed Hallowell's books "Delivered From Distraction," and "Driven to Distraction." The latter focuses more on adult ADD, which is refreshing. I've heard that Dr. Ratey has an even newer book called "A User's Guide to the Brain." I hope this is helpful and wish you the best of luck.
I have been on medication for ADHD, for over 12 years. Now I am pregnant and was told to not take the medicine. I am starting a new job and can already tell that I am going to fall off the deep end because I am unable to take my meds. Does anyone know of woman who have taken ADHD drugs while pregnant and not experienced problems with delivery and child. Thanks, advise is really needed right now.
i am 5 months pregnant and have severe anxiety and add. I have always taken adderall and xanax but now that i am pregnant they swithed me to clonazepam and lowered my dose of adderall, they say it can cause low birth weight if taken in high doses.
I'm a 22 years old army wife and mother of 1 and expecting another recently diagnosed with adhd... Or so i've been told... see I think i'm in denial. ALl my life my school problems were laziness and lack of motivation on my own part, no disease and my mom still thinks it's a misdiagnosis. I don't know how to explain to her that it's real if I myself don't believe it. How is it my whole life I was a screw up and now it's not my fault???
i am 13 weeks prenant with my second child, the first prgnancy i stoped taking my ritlin but stayed on my welbutrin for depression, even so my whole life still feel apart with out my normal meds i was used to. this time they are trying to tell me to go off the ritlin again but i havent, i cant afford for my life to fall apart when i have another child to take care of. what i dont understand is welbutrin and ritlin are both class C drugs, but you can take welbutrin duriing pregnancy only because they have done more studies on it and have had no proof of birth defects in humans only animals. same with ritlin though, they just havent done as many studies with the ritlin. so they left the choice up to me but advised me to not take it.
To JeiMtz:
ADHD is usually mistaken for laziness since many time people who suffer from it are able to concentrate at things they like and are interesting to them. I would suggest you do your research and try meds. You could be pleasantly surprised
To JeiMtz:
I am too a military wife and have two children of my own. I also take adderall. As a child I was always told "you have so much potential" Now that my oldest daughter is 6 and in the first grade. she too has ADD/ADHD. Although I have never taken this medication while preg. I found that as a military wife your "life" is much diff than others. I have noticed that taking adderall helped me focus and concentrate on "one thing at a time" which is hard with 2 kids and a hubby that is on his fourth deployment. If you need someone to talk to or whatever please don't hesitate to e mail me pretty_poison1981@yahoo.com
If anyone is ever weery about the thought of not having your medication there is an easy solition. First, I would't stop at the beginning. You might have withdraw and thats no good for anyone . Second, ask your doctor for a lower dose of medication. If already taking the lowest dose possible, buy a pill cutter and half the pills yourself. Then the days you take them change. Instead of daily, try every other day. Just until you are comfortable and still able to function normally. Last thing, don't ever stop taking them all at once because you might feel fine for a while but when the symtoms reappear they hit hard then you feel like "Oh great I have to start this all over again,daily pills how fun"(not really I would rather not but usually docs no what they should).
DCF took my infant son,
because I took my legally prescribed Adderal XR. Can anyone provide informative help? ASAP?
Would you be willing to share with me the Dr.'s names that permitted you to continue taking your medication while pregnant? DCF took my 3-week-old infant because I was taking my RX medication, as prescribed, Adderall XR 30mg. My son was born with Apgars of nine, and nine; weight at birth: 6lbs 11 oz (I am very thin, with a high metabolic rate...I gained more than 25lbs. during gestation). He has no abnormalities with the exception of esophageal reflux, which runs in the Father's family, and is quite common in infants irregardless if the Mother was on medication or not. As of right now, I am pumping and dumping breast milk while I wean myself off my medication, but if I can not get DCF's decision changed by Nov. 9th...I will have no chance to have my son back for nine whole months. My medication did not harm him, but being separated from his Mother with only 6hrs of contact (supervised in some strange room,) a week will undoubtedly harm his neurological development. In addition, I had been visiting him at the hospital---and caring for him---for three weeks,(while they ran tests to ensure his normalcy and pumped him full of antibiotics,) before DCF came and took him. Now, I can not even do "status checks," and am grieving the loss of contact with my son.
In the past, I have exclusively breastfed two children...including tandem nursing. Also, I hosted a "bf support," e-mail list, with over 300 subscribers, and therefore I know how important breastfeeding is. Did you manage to successfully BF and take your medication?
Any information will be greatly appreciated.
Sincerely Yours...
I am 4 months pregnant, gratefully. I am 35 years old and I have been treated for ADHD for years. Before being properly diagnosed, I was labeled a problem in most situations. After beginning the medication, and with continued care, I have seen so much improvement in my life. I am a single mother of an 11 year old girl. Without medicine, making dinner, helping her with her homework, communicating with her calmly and attentively was difficult. I also used to think ADHD medicines were dope and they were wrong. You imagine how difficult it was for me to accept help at first. but the results have been so positive that I am grateful for proper medical care.
My relationship with my family has even been healing after many years of struggle for my parents because they didn't know what was going on with me. The medicine gave me a breath where I didn't have one before, to look around myself, and see. This helps me to make better decisions. I am not currently on any medicines because of my pregnancy. Although, this pregnancy, no matter how welcomed, was not planned, so I was on 54mg Concerta, 20mg Lexapro, and 10mg Ritalin until I first found out I was pregnant. Then I only took the Ritalin during the first month of pregnancy.
Another element of this learning situation for me is Hurricane Ike. We were living in Galveston, Texas when Ike hit this year. I recieved excellent care from doctors at UTMB. We evacuated and are not going to move back to Galveston. Now we are living with family in a rural town of Texas. Finding care for ADHD has been difficult. The first psychiatrist I saw immediately decided I had something else wrong with me, bipolar, post traumatic stress, pesonality diorder, etc. I was a little dissappointed and angry. Of course there are other doctors better educated to give me better care. But it took so much for me to accept the right diagnosis of ADHD and then be willing to consider medication, that doctors like the new one I tried out are hurtful. I really think someone in a position that reguires such care and understanding should know her information better and be more caring of the patients. Thank you for listening while I rant.
I am not too concerned with not having treatment for this as I am pregnant and am planning on nursing. I found this website because I am looking for what I can do for treatment during pregnancy. It really does look like medicine is out through nursing. I think I will be alright. The time I have had on the medication gave me the opportunity to learn some really good adaptive behaviors. Although at first, when I found out I wouldn't be able to continue taking medication through my pregnancy I felt a lot like the other mothers described on this website. I didn't know if I could make it. The medicine really does help me to be a better mom and contributing member in the community.
Another part of my situation is that I am returning to school in January to become a Registered Nurse. Before school starts I am doing what I can to have solutions for situations that might come up during the school year. I hope and pray I do well in school. I couldn't finish school before. And I realized after I was recieving treatment that really worked for me, that if I ever decided to attend college again I would need to be on medicine. Right now I am like the little engine that could, "...I think I can..."
The new baby is such an amazing surprise. I am willing to do anything I can to contribute to my baby's health. I say that now, but there are plenty of times in the past the task of succeeding through pregnancy without medication seemed impossible. Honestly, the other difference in my life is prayer. I am still worried about how I will do in school. The medicine has made such a good difference in my life, and it sounds like it has for a lot of other people too. I really do hope and pray that other adults with ADD and ADHD find the answers they need and positive results they search for.
I feel so bad for that woman that is away from her child. I pray that GOD brings them back together immediately.
Okay, so I wouldn't have written on this sight I just found on the internet for this long when I should be studying for my placement tests if I was on my medicine, but oh well, I really enjoyed it and hopefully what I wrote helped someone else. I don't have an excuse for everything I do.
God Bless,
Kristina
Anthony,
I am a Patent Attorney in DC with severe ADHD, if untreated.
I have had ADHD all of my life and have been on Ritalin since I was in third grade.
I can tell you that ADHD is nothing to be afraid of or upset about. In fact, once you recognize it and learn to control it, I believe that the extra energy, the hyperactivity, can be a blessing.
I don't know that accomodations are really as necessary as learning to control your ADHD.
I take 40 mg of Ritalin every 4 hours 3 times a day. This is a relatively high dose. However, I can admit that even with the medication my focus can wander. However, you can learn to control this with time.
You should remember that you have had ADHD all your life, including during law school. This is nothing new to you. It is good that someone finally found the root of your distractions.
Find a medication and dosage that works for you.
If I were you, I would find a psychiatrist that specializes or at least has experience in adult ADHD.
Also, if the other mental health conditions you mention involve depression, the ADHD medication will help with that.
You can be a great attorney with ADHD. Just find the doctor and medication that work for you.
Good Luck,
DC
Does anyone have the reference for the "48 case reports" referred to in this article? I want more information and have been trying in vain to find it. I haven't even seen a citation anywhere.
JeiMtz- I understand where you are coming from. I made it through 37 years of life including shcool, college, and a Master's program hearing those comments that I just never worked up to my potential and needed to be better organized. By trial and error, I found that I did really well in really busy and stressful jobs that required tons of energy and moving in about ten directions at once, becuase as soon as things calmed down, I got distracted and lost interest. It wasn't until I had the stressful job and two children that I finally reached a point where things just fell apart. I was even falling apart physically - I was missing periods but not pregnant.
My OB thought it was depression and anxiety, but there was almost no improvement after treatments. My wonderful primary care doctor finally made the connection and correct diagnosis, given that I have a son diagnosed and responding well to ADHD meds and life has been so much better (job, friends, marriage and parenting) ever since.
You said you have trouble accepting this when you have believed other statements about yourself for so long. I understand that! It's really hard to change thoses statements we believe about ourselves.
Chances are, you were actually smart enough to come up with some of your own coping strategies along the way, and had some support systems you could use as well. For me, earlier in life, these things always kept me functioning but just barely. I was able to keep things together just enough to be viewed as "normal, but lazy and disorganized" rather than crossing over that line to the point of needing further evaluation and help. That fact that I could also completely zone out and lose myself in things that REALLY interested me added to the appearance that this was something I could consciously control if I just tried harder. Let's face it, 20-30 years ago, there was not as much knowledge and information available in this area. Character flaws were the more likely diagnosis in those days, but I never MEANT to be a slacker! It just, sort of, always happened.
At first, I was like you and thought it had to be wrong. Then, I was really mad that I had to go through so much in life, when assistance could have made such an improvement! While I still feel ADHD may be overdiagnosed in some children, I certainly appreciate the value of treatment for those who really have it.
My suggestion is always, try the treatments suggested, including meds, and see if they help. If they do, others will start seeing the improvements and begin to understand. While it won't be an overnight transformation, you should start noticing positive changes realitively quickly. I felt more in control within about three or four weeks. If you don't, then it might be time to consider other possibilities.
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