Antidepressants & Pregnancy: Safety, Risks & Questions to Ask

Why Is Treatment for Depression Important During Pregnancy

Depression is a complicated and potentially severe mental health condition that does not alleviate or pause during pregnancy. Some people may experience new symptoms of depression that emerge during pregnancy, while others will notice their preexisting depression worsen and shift throughout their pregnancy.

Regardless of background or history, there is always a risk of depression during pregnancy, also known as a perinatal mood disorder or peripartum depression.

Depression during pregnancy is likely triggered by multiple issues such as:^1,2

• Biological changes, including body changes and hormonal shifts
• Past trauma
• High stress
• Changing work demands
• Relationship issues

People experiencing new or worsening symptoms of depression may consider an antidepressant to help manage their symptoms. Some reasons it may be particularly important to take antidepressants during pregnancy include:^1,2

• Severe, persistent depression, or double depression
• Personal history of depression during or after previous pregnancies
• Family history of depression
• Difficulty bonding with the newborn
• Trouble sleeping
• New aches and pains that lack an underlying physical cause
• Experiencing hallucinations or believing things that are not true (delusions)

One of the clearest indications that someone should consider an antidepressant is the emergence of suicidal ideation. If the pregnant woman is thinking more about suicide or have made attempts to end their life, they should call 9-1-1, the  National Suicide Prevention Lifeline, or present to the nearest ER.

Of course, not everyone will need an antidepressant during their pregnancy. You may be able to get through your pregnancy without taking antidepressants if you:^1,3

• Speak with a therapist regularly. Therapy can help regulate emotions, change thinking patterns, and boost self-esteem. Cognitive behavioral therapy (CBT) for depression and eye movement desensitization and reprocessing(EMDR) for depression are two great options.
• Exercise. Exercise stimulates the production of several neurotransmitters, including serotonin. These neurotransmitters are the same ones targeted by antidepressants. Walking, yoga, and tai chi are just a few examples of helpful exercises that are possible throughout pregnancy.
• Gather social support. Friends, family, and other loved ones can offer tremendous assistance during a period of depression and pregnancy. Stay in regular contact and consider joining a class for additional support.
• Reduce stress. Pregnancy is a time of stress and change. Take an active role by practicing relaxation techniques, like meditation, throughout to minimize the effects of stress.
• Prioritize physical health. Pregnancy complicates your diet and sleep schedule, so it’s important to make eating healthy foods and getting plenty of rest a priority. You and your baby need both to feel well.

During pregnancy, monitoring changes in your mood and emotional state is important.  Addressing these changes early on in pregnancy reduces the chance of ongoing or severe problems.

People with untreated or undertreated depression may not seek the needed prenatal care or receive adequate nutrition for the baby, due to their severe symptoms associated with their depressive disorder.⁴ These symptoms can lead to problems like low birth weight and premature birth.

Is It Safe to Take Antidepressants While Pregnant?

In general, iit is safe for someone to take antidepressants while pregnant. That does not mean that all antidepressants are safe for all people, though. Women with depression should always weigh the potential risks and benefits of their treatment options with a team of medical and mental health experts.

SSRIs in Pregnancy

Based on the person’s type of depression, the prescriber will recommend a medication for depression that best fits their needs and expectations. Someone with a longstanding history of major depressive disorder may need a different treatment plan than someone with new depressive symptoms triggered by the pregnancy.

Some selective serotonin reuptake inhibitors (SSRIs) are usually safe and effective, even during pregnancy. Some good SSRI options include citalopram (Celexa) and sertraline (Zoloft).⁴

In addition to SSRIs, some other types of antidepressants can be helpful during pregnancy. Other acceptable antidepressants include:⁴

• Serotonin and norepinephrine reuptake inhibitors (SNRIs) like duloxetine (Cymbalta) and venlafaxine (Effexor XR)
• Atypical antidepressants like Bupropion (Wellbutrin)
• Tricyclic antidepressants like nortriptyline (Pamelor) and desipramine (Norpramin)

*These medications have a black box warning, the most serious kind of warning from the FDA for risk of suicidal thoughts and behaviors in certain people. Before starting any of these medications, you should talk with your doctor about these risks. Each option carries a unique level of risk and benefit, so each person should consider side effects with their treatment team to make an educated decision.

What Are the Safest Antidepressants to Take in Pregnancy?

It’s important to remember that there is no single “safest” antidepressant for all people. Every medication has some risk on those who use it, but researchers have found some antidepressants are safer than others.

The Centers for Disease Control and Prevention released a study of the specific SSRIs used by women whose baby did not have a birth detect. The most frequently used SSRIs were:⁵

• Sertraline (Zoloft) with 40% of women reporting use
• Fluoxetine (Prozac) reported by about 26%
• Paroxetine (Paxil) by about 15% Citalopram (Celexa) by about 10%
• Escitalopram (Lexapro) by about 9%

These findings show that any of these antidepressants can be safe during pregnancy with a much larger number of prescribers opting for Zoloft over the alternatives. Antidepressants from other classes like SNRIs and atypicals may be safe as well.

*These medications have a black box warning, the most serious kind of warning from the FDA for risk of suicidal thoughts and behaviors in certain people. Before starting any of these medications, you should talk with your doctor about these risks.

Which Antidepressants Should You Avoid While Pregnant?

Just as there are studies to determine the safest medications, there are researchers looking for the antidepressants that create the highest rates of harm.  Two antidepressants may be linked to increased issues and complications during and after birth – Paroxetine (Paxil)  and Clomipramine (Anafranil).⁴

Reports show that Paxil is associated with an increased risk of a heart defect in the baby. For this reason, prescribers may avoid or limit the use of this SSRI.⁴

Clomipramine (Anafranil) is a tricyclic antidepressant that is generally avoided in people who are pregnant. People who use Anafranil while pregnant may have babies with increased birth defects including heart issues.⁴

Based on their experience, prescribers may have specific antidepressants they prefer over others. Work with your prescribing doctor to gain a clear understanding about their medication choice and how it was made.

*These medications have a black box warning, the most serious kind of warning from the FDA for risk of suicidal thoughts and behaviors in certain people. Before starting any of these medications, you should talk with your doctor about these risks.

Weighing the Risks for Mom & Baby

Taking an antidepressant may carry a small risk for the mother and baby during pregnancy, but for someone with chronic or acute depression, there is a greater risk to not taking medication. Any person in this situation must weigh the pros and cons of each option.

Ultimately, when working with the prescriber and treatment team, they should be able to prescribe the patient a safe medication at the appropriate dose to keep mother and baby safe.

Some groups and organizations practice a more cautious approach to prescribing antidepressants to pregnant people, while other groups are more confident in the safety profile. Experts see a much greater risk from untreated psychiatric issues on the mother and child than the risk that could come from the antidepressant.⁵

The risks of antidepressants on a pregnant woman are very low and uncommon overall. Although rare, some possible risks for women taking antidepressants during pregnancy include:^4,6

• Side effects directly related to the antidepressant
• Miscarriage
• Premature labor
• Gestational diabetes
• Heavy bleeding and blood loss after birth

Again, these risks are rare, and there is no strong evidence to suggest that antidepressants alone cause them.

Similarly, depending on the expert and the study, there could be some possible effects of antidepressants on the baby. Some common risks for babies who get antidepressants in utero include:^5,6

• Several types of heart defects
• Defects to the baby’s brain and skull
• Several types of defects to the baby’s abdominal wall
• Spina bifida
• Cleft lip

Though these complications may sound troubling, it is important to remember that the medications more strongly linked to these outcomes are no longer used in pregnant people. Over time, experts have discovered the safest medications and the safest doses for parents and their babies, so a person can enter the process with confidence.

Antidepressant Withdrawal Symptoms for Baby

Pregnant women using antidepressants during the last trimester may have babies with a form of antidepressant withdrawal syndrome.⁴ Like other risks, this concern is rare but could result in symptoms in the baby like:

• Jitters
• Irritability
• Poor appetite and feeding
• Breathing problems

These symptoms may present for a month before decreasing with time.

Other Factors to Consider Before Taking Antidepressants in Pregnancy

Should a person take antidepressants during pregnancy or choose to rely on support and therapy for depression only? Of course, this question is a personal one that a woman should make with her family, medical health, and mental health treatment team. Many experts agree, though, that the risk of untreated or undertreated depression is much more concerning than the potential risk from antidepressants.

To make the best possible decision, consider:^1,4

• Your support system
• The severity of depression
• Previous pregnancies
• External stressors
• Healthy lifestyle adjustments
• Access to prenatal care

For antidepressant use during pregnancy, there is no “right” answer. A person can only decide what seems best for them at the moment.

Questions to Ask Your Health Team About Antidepressants During Pregnancy

The decision to take antidepressants must be a mutual one between you and your care team. Be sure to ask a lot of questions about the medication, its risks, and potential benefits.

Questions to ask your care team about taking antidepressants while pregnant include:^1,4

1. Do you think I have a depressive disorder based on my symptoms?
2. Do my symptoms warrant an antidepressant?
3. I’m already on an antidepressant, should I switch to another one?
4. Which medication do you suggest, and how did you reach that conclusion?
5. What doses are considered safe?
6. Should I take this medication throughout my pregnancy or only for parts?
7. Does this medication affect the baby? How?
8. What happens if I decide to stop taking this medication?
9. Can I continue this medication if I choose to breastfeed?
10. Will this medication help with postpartum depression?

Always look for a prescriber who is patient and caring enough to answer your questions clearly. If you ever need emergency assistance for your depression, pregnancy, or antidepressant side effects, call 9-1-1 or go to the nearest emergency room immediately.

Final Thoughts

Pregnant women struggling with depression should know that while there are ways to reduce depression without medication, many antidepressants are generally safe to take during pregnancy. It’s important to develop a treatment plan with their providers, including their OB/GYN, therapist, psychiatrist and other doctors. The risk of untreated depression can be much greater than the potential side effects associated with antidepressants.