Taking antidepressants during pregnancy might pose
health risks for your baby — but stopping might pose risks for you. Get the
facts about antidepressants and pregnancy.
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
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
Generally, these antidepressants are an option during
- 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
Other rare birth defects have been suggested as a
possible risk in some studies, but not others. Still, the overall risks remain
Which antidepressants should be avoided during
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
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.