Anxiety Medication During Pregnancy: Safety, Risks & Questions to Ask

Why Is Treatment for Anxiety Important During Pregnancy?

Anxiety during pregnancy can be distressing for the mother and can put her at higher risk of developing a postpartum disorder. It can also have effects on the unborn baby. Children of mothers who have anxiety while pregnant are at higher risk of low birth weight, emotional problems, hyperactivity, and certain health conditions.³ Fortunately, anxiety treatment is available to help pregnant women cope with their anxiety and reduce the negative effects on children.

Any decision about getting anxiety medication during pregnancy should be made with the help of a healthcare provider trained in this area. If you find out that you’re pregnant while taking anxiety medication, do not stop taking your medication without first speaking to your provider. Some medications are safe to take while pregnant, while others can cause adverse effects or antidepressant withdrawal symptoms. If you’d like to stop taking medication, speak with your doctor first about how to taper off of them safely.

If you choose not to take medication while pregnant, natural remedies for anxiety can also help manage your symptoms.

You may be able to get through your pregnancy without taking medication if you:^1,4,5

• Speak with a therapist regularly: Therapy can be helpful on its own or in combination with medication. In therapy, you can understand what causes your anxiety and learn tools to help you cope. An initial evaluation with a therapist will help you decide if you need therapy.
• Exercise: Physical activity is another healthy way to manage your anxiety. Be sure to get your healthcare provider’s approval before exercising while pregnant.
• Practice Yoga: Prenatal yoga is a form of physical activity that combines meditation. Yoga can ease anxious thoughts and also provides physical benefits.
• Meditation: Meditation is a practice where you sit quietly and focus your mind on an anchor, like your breath, an image, or an affirmation. Mindfulness and meditation practices can help manage anxiety and improve mood.
• Acupuncture for anxiety: Acupuncture is an alternative medicine where small needles are inserted into different points in the body. Studies show that it can help improve anxiety and depression in pregnant women.

Are Anxiety Medications Safe During Pregnancy?

Anxiety medications can be safe to take during pregnancy, but it depends on the specific medication.¹ Some medications are considered safe, while others are more risky. If you are considering anxiety medication during pregnancy, you should speak with your OBGYN or midwife, psychiatric prescriber, and any other members of your treatment team about the risks and benefits.

Antidepressants and benzodiazepines are two types of medications that are typically prescribed to treat anxiety disorders.⁶ Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant that increase serotonin in the brain. They are prescribed for long-term anxiety. Benzodiazepines are prescribed for short-term anxiety with caution because they can lead to dependence and addiction.

These medications reduce acute anxiety and panic attack symptoms. When it comes to pregnancy, both antidepressants and benzodiazepines may be safe, but they are associated with certain risks that you should be aware of before taking these medications.^7,8

Benzodiazepines and Pregnancy

Benzodiazepines during pregnancy are associated with certain complications for mothers and babies.^8,9 Though taking benzodiazepines may increase the risk of some complications, these risks are considered to be low and do not mean that a pregnant woman cannot take these medications. Both medications and untreated anxiety are associated with risks that must be considered.

Benzodiazepines that may be safe to take during pregnancy include*:⁹

• Alprazolam (Xanax)
• Clonazepam (Klonopin)
• Diazepam (Valium)
• Lorazepam (Ativan)

*These medications have a black box warning, the most serious kind of warnings from the FDA for abuse or misuse, risk of physical dependence, and risk of serious side effects, including death, when combined with an opioid.

Risks of Taking Benzodiazepines While Pregnant

Taking benzodiazepines during pregnancy is associated with the same side effects of Xanax and risks to both mother and baby, but they can be prescribed safely with close monitoring by a healthcare professional.⁹ Untreated anxiety disorders, however, can also be harmful to mothers and babies, so any decision should involve weighing the risks and benefits with a psychiatrist who specializes in this area.

Some common risks for women taking benzodiazepines during pregnancy include:¹⁰

• Cesarean section (C-section) delivery

Some common risks for babies who get benzodiazepines in utero include:^8,9

• Premature birth
• Low birth weight
• Floppy infant syndrome, a condition that involves weak muscle tone, lethargy, and feeding problems
• Withdrawal

Benzodiazepine Withdrawal Symptoms for Baby

Benzodiazepine withdrawal (i.e., Xanax withdrawal) can occur in babies of mothers who take these medications while pregnant.¹¹ Whether or not a baby experiences withdrawal and the severity of withdrawal depends on how often and how long the mother took medication, as well as the dose.

Symptoms of benzodiazepine withdrawal in babies can include restlessness, twitching, grimacing, inconsolable crying, and seizures. These symptoms can take up to a week and may persist for months.⁹ Mothers may be gradually tapered off of benzodiazepines toward the end of pregnancy to help avoid or ease withdrawal symptoms in the infant.

Antidepressants and Pregnancy

There are several different types of antidepressants used to treat anxiety.⁶ Selective serotonin reuptake inhibitors (SSRIs) are the most popular, but serotonin-norepinephrine reuptake inhibitors (SNRIs) vs. SSRIs, tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs) are also sometimes prescribed. When it comes to pregnancy, some antidepressants are considered safe, while others have been linked to birth defects and complications.⁹ Paroxetine (Paxil), for example, is an SSRI linked to fetal heart defects and is not prescribed during pregnancy.⁷

Antidepressants that may be safe to take during pregnancy include:⁹

• Sertraline (Zoloft)
• Fluoxetine (Prozac)
• Escitalopram (Lexapro)
• Citalopram (Celexa)
• Fluvoxamine (Luvox)

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

Risks of Taking Antidepressants While Pregnant

Taking antidepressants during pregnancy is associated with certain risks for mothers and babies.^12,13,14 It is important to note that these risks are generally small, except for paroxetine. Just like there are risks with taking medications, mothers with untreated anxiety disorders are at higher risk of certain complications, postpartum mental health disorders, and difficulty bonding with their infants. Therefore, the risks and benefits of medications must always be carefully taken into account when deciding how to treat anxiety.

Some common risks for women taking antidepressants during pregnancy include:^12,13

• Preeclampsia
• Miscarriage

Some common risks for babies who get antidepressants in utero include:^13,14

• Premature birth
• Low birth weight
• Persistent pulmonary hypertension (PPHN)
• Neonatal abstinence syndrome
• Congenital malformations (Paroxetine)

Antidepressant Withdrawal Symptoms for Baby

Infants exposed to SSRIs may develop neonatal abstinence syndrome (NAS) after birth.¹⁵ NAS is a withdrawal syndrome that affects around 30% of exposed infants. Symptoms of NAS include crying, restlessness, tremors, lethargy, weak sucking and crying, diarrhea, vomiting, feeding issues, temperature instability, breathing irregularities, and possibly seizures. These symptoms typically last a few days and should be carefully monitored and treated.

Other Factors to Consider Before Taking Anxiety Meds During Pregnancy

Many healthcare providers encourage pregnant women to consider therapy first before taking medication.¹ If you try therapy and don’t notice improvements, then you may consider medication. Cognitive behavioral therapy (CBT) is a helpful approach to reducing anxiety for pregnant women.¹⁶ CBT for anxiety can help you identify and change unhealthy thoughts and beliefs that contribute to your anxiety and learn ways to cope.

Having a good social support system is also associated with less anxiety, so connecting with loved ones or increasing your support system may be helpful.¹⁷ Postpartum Support International, a non-profit organization that promotes awareness and offers support for issues related to childbearing, offers free virtual support groups for pregnant women. You may also be able to find other local groups aimed at helping pregnant women connect with one another.

Questions to Ask Your Health Team About Taking Anxiety Medication While Pregnant

It’s normal to feel nervous about taking medication while pregnant. Don’t hesitate to ask your healthcare provider any questions you may have to help ease your concerns. Serious side effects are rare, but should not be ignored. If your health is at risk or you experience suicidal thoughts, call your doctor, 911, or the National Suicide Prevention Lifeline at 1-800-273-8255 right away.

Questions to ask your care team about taking anxiety meds while pregnant include:

1. What are the risks and benefits of this medication?
2. What is the lowest effective dose?
3. How do I know if my anxiety medication is working?
4. What should I do if I experience side effects?
5. Can I continue this medication after giving birth?
6. Is this medication safe for breastfeeding?
7. What should I do if I experience postpartum anxiety?
8. What else can I do to help manage my prenatal anxiety?
9. Is it safe to take Xanax while pregnant?

Final Thoughts

If you’re pregnant and experiencing mild anxiety, there may be ways to cope without medication, like seeing a therapist and connecting with a support system. You may benefit from therapy and medication if your anxiety is severe and interfering with your life. Some anxiety medications are safe to take while pregnant. Talk to your OBGYN, psychiatrist, or healthcare provider about your options and whether or not the medication is right for you.