Trandate & Paxil During Pregnancy: Risks and Management

Question
Hi Dr. Rappaport.  I'm 36 years old and pregnant for the first time.  The first day of my last period was October 28.  I saw a GP yesterday to discuss my meds, etc.  He said that my blood pressure medication (trandate - 200 mg twice a day)is okay to use during pregnancy.  I also take Paxil (40 mg per day).  

He wants me to stop Paxil as he has read a recent study showing that its use can cause heart defects in newborns. He is weaning me off of it (30 mg for 2 weeks, then 20 for 2 weeks, and so on).  I am confused about this.  Last night, I read some info on the recent study; this study says that the birth defects (heart) in newborns are a result of Paxil use in the first trimester.  By the time that I am 'weaned off' of it, I will be in the second trimester, to be sure.  I've taken Paxil for a decade and I don't know how I am going to do without it.  If I'm depressed, it can't be good for the baby, can it?  Are there other anti-depressants that are safer to use in pregnancy?  What do you know of/think of this recent study?  Everything that I had read beforehand had been encouraging as far as Paxil use in pregnancy was concerned.  I don't know what to think.  Do you have any advice?  Sorry this is so long.  :)  Your insight will be appreciated!

Answer
Paxil is a caterory C drug and can be used during pregnancy if absolutely necessary. It is thought to manifest its antidepressant activity as a selective serotonin reuptake inhibitor. In reproductive studies with rats and rabbits, Paxil was not teratogenic at doses up to 50mg//kg/day.  Animal reproductive data and limited human pregnancy experience does not appear to indicate that Paxil poses a major teratogenic risk. However, the available human studies lack the sensitivity to identify minor anomalies because of the absence of standardized examinations.  Withdrawal symptoms were reported in four infants exposed to Paxil during gestation.  The potential for behavioral teratogenic effects cannot be excluded. Because of these uncertainties, both short and long term studies  of exposed infants are warranted.Another antidepressant, Prozac, has been used much more favorably during pregnancy and, if at all possible, you should use Prozac rather than Paxil. Of course, if you can do without any antidepressant, so much the better.