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Deaths unexplained; Effexor cited as possible contributor, risk factor
By Kathy Tomlinson CBC News
Posted: Sep 20, 2011 6:52 AM PT
Last Updated: Sep 20, 2011
Two B.C. families whose infants died inexplicably are sounding the alarm about mothers taking antidepressants while pregnant.
Both mothers took Effexor, which Health Canada has warned can have adverse effects on babies.
Nicole Rawkins is convinced her use of antidepressants contributed to her baby’s death. (CBC) “I took the pills. I didn’t question. I trusted my doctor,” said Christiane Shultz, whose son Matthew died shortly after his birth in Kamloops in 2009.
An autopsy did not determine a cause of death. However, it listed the antidepressant drug taken by his mother as a contributing factor.
‘Contributor to death’
“Since there was venlafaxine [Effexor] exposure, this is a consideration as a contributor to death,” the report said.
Matthew’s father Amery Shultz said his son was blue at birth and stopped breathing in his arms.
“I had rocked him to sleep and I made the assumption he was still breathing. That was not the case,” Shultz said. “Imagine … watching your child die before your eyes, very traumatically. We still relive it every day.”
Effexor is not approved for use during pregnancy, so when doctors prescribe it for pregnant women it is considered “off label” use. Shultz said she initially went on the drug because of depression over a previous marital breakup. To avoid the severe withdrawal symptoms, she kept taking it for eight years.
“Every time I got pregnant, I asked ‘Should I wean? Should I get off of these?’” Shultz said. “I was actually encouraged to stay on them because, what if you get depressed while you are pregnant?’”
Drug company warnings
The drug company Pfizer warns babies can suffer from “complications at birth requiring prolonged hospitalization, breathing support and tube feeding. The company lists reported symptoms as “feeding and/or breathing difficulties, seizures, tense or overly relaxed muscles, jitteriness and constant crying.”
Health Canada issued warnings to pregnant women in 2004 and 2006 also saying babies could suffer adverse effects or complications from withdrawal.
“We will never prove that this drug killed our son,” Shultz said. “But it’s our life’s mission to make sure other families know [about his death]. That’s Matthew’s legacy.”
Another baby born in Kamloops, seven-week old Greyson Rawkins, also died unexpectedly this year. His mother took Effexor during pregnancy and while she was nursing.
“Why was I taking a drug where there was no studies done for pregnant women? That’s ludicrous,” Nicole Rawkins said.
She was taking 450 milligrams of the drug daily, twice the usual recommended dosage. In March, Rawkins woke up to find her son dead.
“I knew something was wrong right away because he was so cold and he was lying next to me and he wasn’t moving,” Rawkins recalled. “I totally think it was the drug.”
Greyson’s autopsy called his death “unexplained” but cited his mother Nicole’s use of Effexor as a possible risk factor.
Warning from nurse
Rawkins said when Greyson was born, he was immediately sent to the intensive care unit for several days. She said a nurse told her he was suffering from drug withdrawal and she should watch him closely.
Greyson Rawkins was seven weeks old when his mother found him dead. “She said that I had to keep an eye on him. I wish that I had taken her advice better,” Rawkins said. “She said it’s from the Effexor.”
After she started nursing effectively giving him the drug again Rawkins said he slept most of the time.
“Most people don’t want to talk about him, but he was a little person. He should still be here,” Rawkins said.
Duncan Ross, the Shultz’s family doctor, said he is more hesitant to prescribe antidepressants to pregnant women as a result of Matthew’s death.
“It certainly led me to back away from [prescribing] them during pregnancy,” Ross said. “There is reason enough to be suspicious.”
Drugs overprescribed: doctor
Ross said he believes, in general, that antidepressants are overprescribed.
“There isn’t a fear of them [among doctors] that would hold anybody back,” he said. “It is a blanket treatment for … minor psychological issues.”
He said doctors are complacent because the conventional wisdom is the drugs are safe. He said doctors also fear taking a woman off antidepressants could endanger her health by putting her through withdrawal and making her more depressed.
“Evidence of harm outweighs any evidence of benefit,” insisted Barbara Mintzes, a researcher with UBC’s Therapeutics Initiative, a group that analyzes existing studies on the effects of prescription drugs.
“To me, it seems crazy that pregnant women are getting the message not to have a single drink in pregnancy, but that they should be taking antidepressants, because of a depression they had three years ago,” Mintzes said.
She said doctors should be more aware of the potential risks, particularly if their patients are only mildly or moderately depressed.
A 2001 analysis of Pharmacare records indicated five per cent of pregnant women in B.C. take antidepressants, twice as many as three years earlier.
“It would be useful to have a conversation with women of reproductive age … just to let them know [antidepressants] are not approved for use in pregnancy and there really isn’t any evidence of benefit from use in pregnancy,” Mintzes said.
Christiane Shultz said she weaned herself from Effexor right after Matthew died. She has since given birth to a healthy boy.
“I felt better off of them than when I was on them,” she said. “Sure, I was in the deepest hole of burying my child [while going off the drug] but I was also starting to regain my other children back. I haven’t been this happy in a long time.”
“Before you trust your doctor you’ve got to do some research on your own,” advised Nicole Rawkins. “Doctors are overworked and you can’t blame them. They are trying to help you, but they can’t read every detail.”