Antidepressants: Safe during pregnancy?

content provided by mayoclinic.com

Antidepressants: Safe during pregnancy?

Antidepressants are the first line of treatment for most types of depression. Antidepressants can help relieve your symptoms and keep you feeling your best — but there's more to the story when you're pregnant or thinking about getting pregnant. Here's what you need to know about antidepressants and pregnancy.

How does pregnancy affect depression?

Pregnancy hormones were once thought to protect women from depression, but researchers now say this isn't true. Although pregnancy doesn't make depression worse, pregnancy often triggers a range of emotions that can make it more difficult to cope with depression.

Is treatment important during pregnancy?

Yes. If you don't take proper care of depression during pregnancy, you may put your health — and your baby's health — at risk. If you're depressed, you may not have the energy to take good care of yourself. You may not seek optimal prenatal care or eat the healthy foods your baby needs to thrive. You may turn to smoking or drinking alcohol. The price of untreated depression may be high, including premature birth, low birth weight, developmental problems and an increased risk of postpartum depression.

Are antidepressants an option during pregnancy?

Overall, the risk of birth defects and other problems for babies of mothers who take antidepressants during pregnancy is low. Still, few medications have been proved safe without question during pregnancy and some types of antidepressants have been associated with health problems in babies.

What are the risks and recommendations for each type of antidepressant?

Here's an overview, arranged alphabetically by type of antidepressant:

Selective serotonin reuptake inhibitors (SSRIs)
Citalopram (Celexa)

Risks: Has been associated with a rare but serious newborn lung problem (persistent pulmonary hypertension of the newborn, or PPHN) when taken during the last half of pregnancy; has been associated with septal heart defects; has been associated with a birth defect that affects the brain and skull (anencephaly), a birth defect that affect sutures on the head (craniosynostosis) and a birth defect that affects the abdominal organs (omphalocele)

Recommendation: Consider as an option during pregnancy

Fluoxetine (Prozac, Sarafem)

Risks: Has been associated with PPHN when taken during the last half of pregnancy

Recommendation: Consider as an option during pregnancy

Paroxetine (Paxil)

Risks: Has been associated with fetal heart defects when taken during the first three months of pregnancy; has been associated with PPHN when taken during the last half of pregnancy; has been associated with anencephaly, craniosynostosis and omphalocele

Recommendation: Avoid during pregnancy

Sertraline (Zoloft)

Risks: Has been associated with PPHN when taken during the last half of pregnancy; has been associated with septal heart defects; has been associated with omphalocele

Recommendation: Consider as an option during pregnancy

Note: Persistent pulmonary hypertension of the newborn, anencephaly, craniosynostosis and omphalocele are rare conditions. Even if you take an SSRI during pregnancy, the overall risks remain extremely low.

Tricyclic antidepressants (TCAs)
Amitriptyline

Risks: Suggested risk of limb malformation in early studies, but not confirmed by newer studies

Recommendation: Consider as an option during pregnancy

Nortriptyline (Pamelor)

Risks: Suggested risk of limb malformation in early studies, but not confirmed by newer studies

Recommendation: Consider as an option during pregnancy

Monoamine oxidase inhibitors (MAOIs)
Phenelzine (Nardil)

Risks: May cause a severe increase in blood pressure that triggers a stroke

Recommendation: Avoid during pregnancy

Tranylcypromine (Parnate)

Risks: May cause a severe increase in blood pressure that triggers a stroke

Recommendation: Avoid during pregnancy

Other antidepressants
Bupropion (Wellbutrin)

Risks: No established risks during pregnancy

Recommendations: Consider as an option during pregnancy

Are there any other risks for the baby?

If you take antidepressants throughout pregnancy or during the last trimester, your baby may experience temporary discontinuation symptoms — such as jitters or irritability — at birth. Some health care providers may suggest tapering dosages until after birth to minimize newborn withdrawal symptoms, though it's unclear whether this method can reduce harmful effects. This strategy may also be unsafe for new mothers as they enter the postpartum period — a time of increased risk of mood and anxiety problems.

Some studies associate the use of antidepressants during pregnancy with preterm birth, but other studies don't support this link.

Should I switch medications?

The decision to continue or change your antidepressant medication is up to you and your health care provider. Concerns about potential risks must be weighed against the possibility that a drug substitution could fail and cause a depression relapse. Keep in mind that switching medications during pregnancy will mean that you're exposing your baby to an additional medication, which could increase the risk of side effects and congenital problems. In addition, use of more than one type of SSRI during the first trimester of pregnancy has been associated with an increased prevalence of septal heart defects.

What happens if I stop taking antidepressants during pregnancy?

If you stop taking antidepressants during pregnancy, you risk a depression relapse. A 2006 study showed that pregnant women who stopped taking antidepressants were five times more likely to experience a depression relapse than were pregnant women who continued taking the drugs.

In addition, stopping an SSRI abruptly may cause various signs and symptoms, including:

  • Nausea and vomiting
  • Chills
  • Fatigue
  • Insomnia
  • Anxiety
  • Irritability

What's the bottom line?

If you have depression and are pregnant or thinking about getting pregnant, consult your health care provider. Sometimes mild depression can be managed with psychotherapy, including counseling or other therapies. If your depression is severe or you have a recent history of depression, the risk of relapse may be greater than the risks associated with antidepressants.

Deciding how to treat your depression during pregnancy won't be easy. The risks and benefits of taking medication during pregnancy must be weighed carefully on a case-by-case basis. Work with your health care provider to make an informed choice that gives you — and your baby — the best chance for long-term health.

Last Updated: 2009-12-17
© 1998-2014 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.com," "Mayo Clinic Health Information," "Reliable information for a healthier life" and the triple-shield Mayo logo are trademarks of Mayo Foundation for Medical Education and Research.

Terms and conditions of use

 

Bookmark and Share   E-Mail Page   Printer Friendly Version