Is It Safe To Take Antidepressants During Pregnancy?

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Every year approximately 10 to 15% of reproductive-aged women in the US are prescribed antidepressants. The doctor may prescribe pregnancy-safe antidepressants based on the individual’s treatment history, past medications, pregnancy condition, the severity of depression, mental health, and the most up-to-date information on reproductive safety. Untreated depression may contribute to adverse pregnancy outcomes, affecting maternal health and leading to complications (1).

This post discusses the safe use of antidepressants during pregnancy and the risks associated with them.

Why Is Treatment Of Depression During Pregnancy Important?

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Maternal depression is a major risk factor for several side effects in both the mother and fetus. About one in ten pregnant women experience symptoms of depression during pregnancy, as per the World Health Organization. In developed countries, depression during pregnancy may be seen in 15.6% of all pregnant women. Depression and anxiety during pregnancy are associated with:

• Increased risks of preeclampsia, fetal distress, preterm labor and birth, low birth weight, and postpartum depression.
• Unhealthy maternal behavior such as maternal tobacco smoking, excess caffeine consumption, poor nutrition, and inadequate exercise.
• Cognitive and behavioral problems of the child with growth.

Effective treatment can decrease these risks. Abruptly stopping antidepressant treatment in pregnancy in women with a previous history of depression may cause a relapse of symptoms in approximately 60-70% of women. Additionally, perinatal depression may also increase the risk of maternal mortality rates due to suicide (2) (3).

Quick fact

About 15% of all pregnant women experience depression. However, it is more common in the third trimester (14).

Are Antidepressants Safe During Pregnancy?

Studies suggest that antidepressants of the class, selective serotonin reuptake inhibitors (SSRIs), have not been found to cause major malformations with the exception of paroxetine, sold as Paxil. Some other antidepressants, such as selective norepinephrine reuptake inhibitors (SNRIs), Monoamine oxidase inhibitors (MAOIs), and dopamine reuptake inhibitors, may also be used.

Some antidepressant medications have been associated with congenital malformations. Therefore, discuss the risks and benefits of antidepressants extensively with a psychiatric consultant. It can help you identify a safe and effective option during pregnancy (4) (5).

Experts say

According to the research, an increased prevalence of septal heart defects has been observed among children whose mothers were prescribed an SSRI in early pregnancy (15).”

Which Antidepressants Are Commonly Prescribed During Pregnancy?

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Sertraline (an SSRI) did not show confirmed links with birth defects in a study conducted by the Centers for Disease Control and Prevention (CDC). Sertraline (Zoloft) is prescribed most often to pregnant women with depression (6). Other antidepressants prescribed during pregnancy may include (7):

• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Fluoxetine (Prozac)
• Bupropion (Wellbutrin)

The above-mentioned drugs are enlisted in pregnancy category C (Animal reproduction studies have shown potential adverse effects on the fetus, and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of a drug in pregnant women despite potential risks) as per the US Food and Drug Administration (FDA) (8).

Point to consider

The medical treatment for depression is linked to intrauterine growth restriction and increased birth deaths. Your doctor will weigh the benefits and risks before prescribing antidepressants (16).

Can Antidepressants Cause Miscarriage?

Some studies have shown an increased risk of spontaneous abortions (miscarriages) with antidepressant exposure in early pregnancy. However, these studies did not include the contribution of the underlying psychiatric illness and other factors such as poor nutrition, smoking, and substance abuse (9).

What Are The Other Potential Risks Of Using Antidepressants During Pregnancy?

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Doctors need to balance the potential risks of medications with that of the untreated disorder during pregnancy. Antidepressant exposure late in the third trimester of pregnancy may affect neonatal health and cause complications requiring prolonged hospitalization, respiratory support, and tube feeding. Potential risks of prenatal exposure to antidepressants include (6) (8):

1. Fluoxetine has been linked to:

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• Cardiac malformation (heart defect) with obstructed right ventricular outflow tract
• Craniosynostosis (a birth defect in which the bones in a baby’s skull join together too early)

2. Paroxetine may be associated with:

• Anencephaly (baby is born without parts of the brain and skull)
• Atrial septal defects (a type of heart defect)
• Heart defects with obstructed right ventricular outflow tract
• Gastroschisis (structural anomaly of the abdominal wall)
• Omphalocele (a birth defect of the abdominal wall)

3. Other conditions linked to SSRIs are:

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• Persistent pulmonary hypertension (PPHN) in the newborn (failure of the lungs to breathe outside the womb), may increase neonatal mortality risk.
• Neonatal withdrawal syndrome may show symptoms such as seizures, temperature instability, feeding difficulty, gastrointestinal problems, tremors, increased or decreased muscle tone, jitteriness, irritability, mood disorders, and constant crying. These conditions may also be caused by SNRIs.
• Antidepressant exposure late in the third trimester may cause neonatal complications requiring prolonged hospitalization, respiratory support, and tube feeding.

Infographic: Potential Risks Of Depression During Pregnancy

Untreated depression may have untoward effects on the mother and the growing fetus. Although some antidepressants may have side effects, the risk-benefit ratio decides the treatment module during pregnancy. The infographic below highlights the risks associated with untreated depression in expectant mothers.

Illustration: Momjunction Design Team

Image: Stable Diffusion/MomJunction Design Team

Antidepressants must not be taken during pregnancy without a prescription. Watch this video to learn more about antidepressant safety during pregnancy.

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Dr. Kritika Shashank VermaMS

Dr. Kritika Verma is a renowned gynecologist and IVF specialist in Ayodhya. She has done her MBBS from SGRR Dehradun and MS from UP University of Medical Sciences Etawah (Saifai), where she was a gold medalist. With over seven years of experience, Dr. Verma currently runs her own hospital in Ayodhya.more

Dr. Joyani DasM.Pharm, PhD

Dr. Joyani Das did her post-graduation from Birla Institute of Technology, Mesra and PhD in Pharmacology. Previously, she worked as an associate professor, faculty of Pharmacology, for two years. With her research background in preclinical studies and a zeal for scientific writing, she joined MomJunction as a health writer. Her research work was published in international journals and publications, such...more

Rebecca MalachiBSc

Rebecca is a pregnancy writer and editor with a passion for delivering research-based and engaging content in areas of fertility, pregnancy, birth, and post-pregnancy. She did her graduation in Biotechnology and Genetics from Loyola Academy, Osmania University and obtained a certification in ‘Nutrition and Lifestyle in Pregnancy’ from Ludwig Maximilian University of Munich (LMU). She has been into health and...more

Reshmi DasMSc

Reshmi Das has over four years of experience as a clinical coordinator, medical content writer and medical conference coordinator. Her continuous interest in medical journals and writing makes her write well-researched articles for MomJunction. She writes health and wellness articles for children and pregnant and lactating women. Reshmi has completed her post graduation in Biotechnology from MITS School of Biotechnology,...more