Are Antidepressants Safe in Pregnancy?

Table of ContentsView AllTable of ContentsDepression During PregnancyPregnancy and AntidepressantsAntidepressants and Birth EffectsNatural Treatments for DepressionAntidepressant Use While BreastfeedingThe Risk of Untreated Depression

Table of ContentsView All

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Table of Contents

Depression During Pregnancy

Pregnancy and Antidepressants

Antidepressants and Birth Effects

Natural Treatments for Depression

Antidepressant Use While Breastfeeding

The Risk of Untreated Depression

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If you are taking an antidepressant, you might wonder if becoming pregnant might affect your treatment options. Deciding whether to start or continue taking an antidepressant if you become pregnant can be a difficult decision. Letting depression go untreated can negatively impact fetal development and your mental health.

Armed with the facts about each type of antidepressant, you can discuss the pros and cons of your choice with your doctor and mental healthcare provider.

At a GlancePrenatal depression affects about one in ten women. Many of these medications are considered safe during pregnancy and breastfeeding. Some types of medications that may be prescribed include SSRIs, SNRIs, tricyclics, MAOIs, and atypical antidepressants. Each comes with its own risks and side effects, so be sure to talk to your doctor about which one is right for you. Remember, untreated depression also has risks for both you and your child, so sticking to a treatment plan is the best approach.

At a Glance

Prenatal depression affects about one in ten women. Many of these medications are considered safe during pregnancy and breastfeeding. Some types of medications that may be prescribed include SSRIs, SNRIs, tricyclics, MAOIs, and atypical antidepressants. Each comes with its own risks and side effects, so be sure to talk to your doctor about which one is right for you. Remember, untreated depression also has risks for both you and your child, so sticking to a treatment plan is the best approach.

Pregnancy was once believed to provide some protection against depression due to shifting hormones, but research has not supported this theory.In fact, the opposite may be true: Women with a history of anxiety or depression may bemoreat risk for depression when they are pregnant.

During pregnancy, hormone changes can affect the chemicals in your brain, some of which are directly related to depression.

Depression during pregnancy (also calledantepartumor prenatal depression) is one of the most common complications during pregnancy. According to the American College of Obstetricians and Gynecologists (ACOG), about 10% of women experience depression during pregnancy.For reference, around 10% of women in the U.S. have depression.

Blood volume nearly doubles in pregnancy and this impacts the efficacy of some medications. Some women also have changes in metabolism, which can impact how your body absorbs, distributes, breaks down, and eliminates antidepressant medications should you choose to take them.

Between 6% and 8% of pregnant women in the U.S. report being prescribed or using an antidepressant.If you want to continue taking your antidepressant while pregnant, ask your doctor how you can reduce any risks. They may be able to adjust your dosage or start you on a different antidepressant.

The most commonly used antidepressants are SSRIs and serotonin-norepinephrine reuptake inhibitors (SNRIs). Monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), and atypical antidepressants are also used, though less frequently.

Prior to 2018, the Food and Drug Administration (FDA) categorized and labeled all drugs based on research about their safety, including how safe they are to take during pregnancy.The new system provides information on pregnancy exposure, potential risk, and clinical considerations designed to help physicians use clinical judgment to make decisions that are better based on each person’s needs.

Prior to 2018, the Food and Drug Administration (FDA) categorized and labeled all drugs based on research about their safety, including how safe they are to take during pregnancy.

The new system provides information on pregnancy exposure, potential risk, and clinical considerations designed to help physicians use clinical judgment to make decisions that are better based on each person’s needs.

Common Antidepressant Medications

Selective Serotonin Reuptake Inhibitors (SSRIs)

Selective serotonin reuptake inhibitors(SSRIs) are the most used class of antidepressants during pregnancy. Some of the most common SSRIs prescribed to treat depression during pregnancy include:

Hundreds of studies have looked at SSRI exposure and congenital anomalies. Although findings have been mixed, the overall conclusion is that SSRIs are generally considered safe during pregnancy. But they are not without risk.

Specifically, Paxil use during the first trimester was associated with several birth defects, including heart defects, problems with brain and skull formation (anencephaly), and abdominal wall defects. The study also confirmed links between Prozac use and two types of congenital anomalies: heart wall defects and irregular skull shape (craniosynostosis).

The same 2015 study found no evidence of an association between the use of SSRIs like Celexa, Zoloft, and Lexapro and birth defects, even though other studies have.

Up to 30% of SSRI-exposed newborns experience a cluster of symptoms termed the perinatal neonatal adaptation syndrome (PNAS).This syndrome generally presents with symptoms such as jitteriness, irritability, feeding problems, and difficulty breathing. The average time of onset ranges between birth to 3 days of age and may last for up to 2 weeks.It is important to note that PNAS has no negative outcomes or sequelae, and most babies self-resolve within days.

Up to 30% of SSRI-exposed newborns experience a cluster of symptoms termed the perinatal neonatal adaptation syndrome (PNAS).This syndrome generally presents with symptoms such as jitteriness, irritability, feeding problems, and difficulty breathing. The average time of onset ranges between birth to 3 days of age and may last for up to 2 weeks.

It is important to note that PNAS has no negative outcomes or sequelae, and most babies self-resolve within days.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Serotonin-norepinephrine reuptake inhibitors(SNRIs) block the reuptake of both serotonin and another neurotransmitter called norepinephrine.

Common SNRIs include:

Research shows that using Effexor during early pregnancy may be linked to several congenital anomalies, including heart defects, defects of the brain and spine, cleft lip, and cleft palate.However, the risk for these anomalies remains below that of the general population risk.

How Reuptake Inhibitor Drugs Work

Tricyclic Antidepressants (TCAs)

For this reason, they are not used as first-line treatment and are rarely prescribed for use during pregnancy.

The most commonly prescribed TCAs for use during pregnancy include:

There is not enough research to determine whether TCA use during pregnancy has a negative effect on a developing fetus. However, a study published in 2017 indicated that TCAs may be associated with an increased risk of digestive defects as well as eye, ear, face, and neck defects.

Overview of Tricyclic Antidepressants

Monoamine Oxidase Inhibitors (MAOIs)

Because of the associated side effects and the increased risk of hypertensive crisis, MAOIs are not generally not recommended during pregnancy.

Popular MAOIs include:

A 2017 case report published in the journalReproductive Toxicologynoted fetal malformations in the two pregnancies of a woman taking high doses of MAOIs.Both pregnancies resulted in fetal abnormalities, one of which was severe enough to result in stillbirth. The second infant was born with severe physical and neurological disabilities.

The authors of the paper speculated that the high dose of MAOIs contributed to the outcomes of the pregnancies, but it was not clear if (or how) the medications caused the specific malformations. Additional factors may have contributed, such as the other medications taken during the pregnancy and the parents' ages (both were over 40). The family also declined to undergo testing to investigate a genetic cause for birth defects.

Research on the potential risk of Nardil (one of the more commonly prescribed MAOIs) on a developing fetus is limited. The FDA label states that healthcare providers need to weigh the potential risks of Nardil against the benefits when prescribing the medication for people who are pregnant.This recommendation is consistent with the other MAOI antidepressants as well as medications in other classes.

Overview of Monoamine Oxidase Inhibitors

Atypical Antidepressants

Atypical antidepressants are antidepressants that don’t fall under any of the other fourclasses of antidepressants. They’re often prescribed when other antidepressants aren’t working.

Common medications in this group include:

Like SSRIs, the atypical antidepressants tend to cause fewer side effects than other antidepressants.However, like other medications, there are potential risks when used during pregnancy.

There are also non-prescription or alternative treatments for depression such asSt. John’s wort. Rigorous, formal research does not exist regarding the risk of exposure to supplements like St. John’s wart in pregnancy.

However, anyone planning to use St. John’s wort needs to be aware of potential interactions. For example, taking St. John’s wort with medications, supplements, or foods containing5-hydroxytryptophan(5-HTP), L-tryptophan, or SAMe, can increase your risk for developingserotonin syndrome.

As with medications, ask your doctor about taking a nutritional supplement or herbal remedy if you are pregnant or breastfeeding.

Resources for Research

The following selective serotonin reuptake inhibitors (SSRIs) are some of the best-studied medications for use during breastfeeding:

According to multiple studies, the serum antidepressant levels in nursing infants are either low or undetectable, and there have been no reports of short-term adverse effects. For these reasons, they are considered relatively safe for use during breastfeeding.

It is important for people to remain on whichever SSRI is working during pregnancy postpartum while nursing. There is no indication for changing from one antidepressant to another to breastfeed safely.

The Risk of Untreated Depression

It’s important to remember that untreated depression also carries risks. Many studies have demonstrated that maternal stress during pregnancy can negatively affect fetal development and may influence the later behavior and emotional well-being of the child.

The physical and emotional stressors of pregnancy can contribute to or worsen feelings of depression. These symptoms of depression can also affect how well a person can take care of their needs—practicing overall self-care to pregnancy-specific care such as prenatal appointments.

People with depression may also be more likely touse substancesto cope with their symptoms. The risks associated with drinking alcohol and using illicit drugs during pregnancy are well-established.Substance use during pregnancy can have serious long-term consequences for parents and children.

Discontinuing an antidepressant puts you at risk for a relapse of your depression symptoms.The risk may be greater when you are pregnant and right after you give birth.Do not discontinue your antidepressant without talking to your doctor or mental healthcare provider first. Unless they direct you to, do not abruptly stop taking your medication.Withdrawing from antidepressantscan cause side effects, and pregnancy may intensify these symptoms.

Discontinuing an antidepressant puts you at risk for a relapse of your depression symptoms.The risk may be greater when you are pregnant and right after you give birth.

Do not discontinue your antidepressant without talking to your doctor or mental healthcare provider first. Unless they direct you to, do not abruptly stop taking your medication.Withdrawing from antidepressantscan cause side effects, and pregnancy may intensify these symptoms.

Takeaways

Each class of antidepressant medication carries its own set of risks. If you are trying to decide whether to stop taking your antidepressant during pregnancy, talk to your doctor. They can help you weigh the benefits of taking antidepressants during pregnancy against the potential consequences associated with letting your depression go untreated.

What Is Perinatal Depression?

20 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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