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, and the most up-to-date information on reproductive safety. Untreated depression may contribute to adverse pregnancy outcomes, affecting maternal well-being 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?

Maternal depression is a major risk factor for adverse effects in both the mother and fetus. Depression during pregnancy is associated with:

  • Increased risks of preeclampsia, fetal distress, preterm 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 suicide (2) (3).

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) 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 your psychiatrist. It can help you identify a safe and effective option during pregnancy (4) (5).

Which Antidepressants Are Commonly Prescribed During Pregnancy?

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).

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?

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 cause neonatal 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:

  • 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:

  • Persistent pulmonary hypertension (PPHN) in the newborn (failure of the lungs to breathe outside the womb).
  • Neonatal withdrawal symptoms such as seizures, temperature instability, feeding difficulty, gastrointestinal problems, tremor, increased or decreased muscle tone, jitteriness, irritability, 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.

Depression may be treated effectively by combining medication therapy with counseling. Extensive research is required to understand the fetal risks and benefits of each antidepressant drug. Nevertheless, you should consult your doctor for treatment decisions regarding antidepressants. Do not abruptly stop taking or switch medications. Inform your psychiatrist or healthcare provider if you are pregnant or planning pregnancy. Make sure to follow up on all referrals and treatment that your doctor suggests (10).

References:

MomJunction's articles are written after analyzing the research works of expert authors and institutions. Our references consist of resources established by authorities in their respective fields. You can learn more about the authenticity of the information we present in our editorial policy.
  1. Kayla N. Anderson et al.; (2020); Maternal Use of Specific Antidepressant Medications During Early Pregnancy and the Risk of Selected Birth Defects.
    https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2769190
  2. Nancy Byatt et al.; (2014); Antidepressant Use in Pregnancy: A Critical Review Focused on Risks and Controversies.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4006272/
  3. Jennifer L. Payne et al.; (2009); Antidepressant Use During Pregnancy: Current Controversies and Treatment Strategies.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2749677/
  4. Anxiety and Pregnancy.
    https://www.acog.org/womens-health/faqs/anxiety-and-pregnancy
  5. Safety Check: Pregnancy and Antidepressant Drugs.
    https://www.urmc.rochester.edu/news/publications/health-matters/safety-check-pregnancy-and-antidepressant-drugs
  6. Key Findings—A Closer Look at the Link Between Specific SSRIs and Birth Defects.
    https://www.cdc.gov/pregnancy/meds/treatingfortwo/features/ssrisandbirthdefects.html
  7. Antidepressants and pregnancy: More research needed.
    https://www.health.harvard.edu/blog/antidepressants-and-pregnancy-201605199641
  8. Appendix AFDA Antidepressant Drug Labels for Pregnant and Postpartum Women.
    https://www.ncbi.nlm.nih.gov/books/NBK349032/
  9. Kimberly A. Yonkers et al.; (2014); The management of depression during pregnancy.
    https://www.acog.org/-/media/project/acog/acogorg/clinical/files/task-force-report/articles/2009/management-of-depression-during-pregnancy.pdf
  10. Depression During and After Pregnancy.
    https://www.cdc.gov/reproductivehealth/features/maternal-depression/index.html
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Dr. Kritika Shashank Verma

(MS)
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.

Dr. Joyani Das

Dr. Joyani Das is a PhD in Pharmacology with over two years of experience in academics. Previously, she worked as an associate professor, faculty of Pharmacology. 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 as Elsevier, Current... more

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