Antidepressants: Safe during pregnancy?
Antidepressants: Safe during pregnancy?
Antidepressants are central to treating depression — but during pregnancy, it's important to weigh the risks.
Antidepressants are a primary treatment option for most types of depression. Antidepressants can help relieve your symptoms and keep you feeling your best — but there's more to the story when you're pregnant or thinking about getting pregnant. Here's what you need to know about antidepressants and pregnancy.
How does pregnancy affect depression?
Pregnancy hormones were once thought to protect women from depression, but researchers now say this isn't true. In addition, pregnancy can trigger a range of emotions that make it more difficult to cope with depression.
Is treatment important during pregnancy?
Depression treatment during pregnancy is essential.
If you have untreated depression, you might not seek optimal prenatal care, eat the healthy foods your baby needs or have the energy to care for yourself. You also might turn to smoking or drinking alcohol. The result could be premature birth, low birth weight or other problems for the baby — and an increased risk of postpartum depression for you, as well as difficulty bonding with the baby.
Are antidepressants an option during pregnancy?
A decision to use antidepressants during pregnancy is based on the balance between risks and benefits. Overall, the risk of birth defects and other problems for babies of mothers who take antidepressants during pregnancy is very low. Still, few medications have been proved safe without question during pregnancy, and some types of antidepressants have been associated with health problems in babies.
Which antidepressants are considered OK during pregnancy?
Generally, these antidepressants are an option during pregnancy:
- Certain selective serotonin reuptake inhibitors (SSRIs). SSRIs are generally considered an option during pregnancy, including citalopram (Celexa), fluoxetine (Prozac) and sertraline (Zoloft).
- Serotonin and norepinephrine reuptake inhibitors (SNRIs). SNRIs are also considered an option during pregnancy, including duloxetine (Cymbalta) and venlafaxine (Effexor XR).
- Bupropion (Wellbutrin). This medication is used for both depression and smoking cessation. Although bupropion isn't generally considered a first line treatment for depression during pregnancy, it might be an option for women who haven't responded to other medications or those who want to use it for smoking cessation as well.
- Tricyclic antidepressants. This class of medications includes amitriptyline and nortriptyline (Pamelor). Although tricyclic antidepressants aren't generally considered a first line or second line treatment, they might be an option for women who haven't responded to other medications.
Some research associates use of citalopram, fluoxetine and sertraline with a rare but serious newborn lung problem (persistent pulmonary hypertension of the newborn) when taken during the last half of pregnancy.
Other rare birth defects have been suggested as a possible risk in some studies, but not others. Still, the overall risks remain extremely low.
Which antidepressants should be avoided during pregnancy?
The SSRI paroxetine (Paxil) is generally discouraged during pregnancy. Some research suggests that Paroxetine may be associated with a small increase in fetal heart defects.
In addition, monoamine oxidase inhibitors (MAOIs) — including phenelzine (Nardil) and tranylcypromine (Parnate) — are generally discouraged during pregnancy. MAOIs might limit fetal growth.
Are there any other risks for the baby?
If you take antidepressants throughout pregnancy or during the last trimester, your baby might experience temporary discontinuation symptoms — such as jitters or irritability — at birth. However, tapering dosages near the end of pregnancy isn't generally recommended. It's not thought to minimize newborn withdrawal symptoms. In addition, it might pose challenges for you as you enter the postpartum period — a time of increased risk of mood and anxiety problems.
Should I switch medications?
The decision to continue or change your antidepressant medication is up to you and your health care provider. Concerns about potential risks must be weighed against the possibility that a drug substitution could fail and cause a depression relapse.
What happens if I stop taking antidepressants during pregnancy?
If you stop taking antidepressants during pregnancy, you risk a depression relapse. In addition, stopping an SSRI abruptly might cause various signs and symptoms, including:
- Nausea and vomiting
What's the bottom line?
If you have depression and are pregnant or thinking about getting pregnant, consult your health care provider. Sometimes mild to moderate depression can be managed with psychotherapy, including counseling or other therapies. If your depression is moderate to severe or you have a recent history of depression, the risk of relapse might be greater than the risks associated with antidepressants.
Deciding how to treat depression during pregnancy isn't easy. The risks and benefits of taking medication during pregnancy must be weighed carefully. Work with your health care provider to make an informed choice that gives you — and your baby — the best chance for long-term health.