Antidepressants: Safe during pregnancy?

Antidepressants are a primary treatment option for most types of depression. But there are benefits and risks to consider when taking antidepressants during pregnancy. Here’s what you need to know.

Why is treatment for depression during pregnancy important?

If you have untreated depression, you might not seek prenatal care or eat the healthy foods you and your baby need. Having major depression during pregnancy is associated with an increased risk of premature birth, low birth weight, decreased fetal growth and other problems for the baby. Unstable depression during pregnancy also increases the risk of postpartum depression and difficulty bonding with your baby.

Are antidepressants an option during pregnancy?

Yes. A decision to use antidepressants during pregnancy, in addition to counseling, is based on the balance between risks and benefits. The biggest concern is typically the risk of birth defects from exposure to antidepressants. Overall, the risk of birth defects and other problems for babies of mothers who take antidepressants during pregnancy is very low.

However, some antidepressants are associated with a higher risk of complications for your baby. Talking to your health care provider about your symptoms and medication options can help you make an informed decision.

If you use antidepressants during pregnancy, your health care provider will try to minimize your baby’s exposure to the medication. This can be done by prescribing a single medication at the lowest effective dose, particularly during the first trimester.

Keep in mind that psychotherapy also is an effective treatment for mild to moderate depression.

Which antidepressants are considered OK during pregnancy?

Generally, these antidepressants are an option during pregnancy:

• Certain selective serotonin reuptake inhibitors (SSRIs). SSRIs are generally considered an option during pregnancy, including citalopram (Celexa) and sertraline (Zoloft). Potential complications include maternal weight changes and premature birth.

  Most studies show that SSRIs aren’t associated with birth defects. However, paroxetine (Paxil) might be associated with a small increased risk of a fetal heart defect and is generally discouraged during pregnancy.
• Serotonin and norepinephrine reuptake inhibitors (SNRIs). SNRIs also are considered an option during pregnancy, including duloxetine (Cymbalta) and venlafaxine (Effexor XR).
• Bupropion (Forfivo XL, Wellbutrin SR). 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. Research suggests that taking bupropion during pregnancy might be associated with miscarriage or heart defects.
• Tricyclic antidepressants. This class of medications includes nortriptyline (Pamelor) and desipramine (Norpramin). 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. The tricyclic antidepressant clomipramine (Anafranil) might be associated with fetal birth defects, including heart defects.

Are there any other risks for the baby?

If you take antidepressants during the last trimester of pregnancy, your baby might have temporary signs and symptoms of quitting the drug — such as jitters, irritability, poor feeding and respiratory distress — for up to a month after birth. However, there’s no evidence that discontinuing or tapering dosages near the end of pregnancy reduces the risk of these symptoms for your newborn. In addition, changing your treatment might increase the risk of a relapse postpartum, especially for severe depression.

The connection between antidepressant use during pregnancy and the risk of autism and attention-deficit/hyperactivity disorder in offspring remains unclear. But most studies have shown that the risk is very small, and some studies have shown no risk at all. Further research is needed.

A new study also suggests a link between use of antidepressants during pregnancy, specifically venlafaxine and amitriptyline, and an increased risk of gestational diabetes. More research is needed.

Should I switch medications?

The decision to continue or change your antidepressant medication will be based on the stability of your mood disorder. Talk to your health care provider. Concerns about potential risks must be weighed against the possibility that a different drug could fail and cause a depression relapse.

What’s the bottom line?

If you have depression and are pregnant or thinking about getting pregnant, consult your health care provider. 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.