Antidepressants during pregnancy

Taking antidepressants during pregnancy may pose risks for your baby — but stopping may pose risks for you.
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.
Pregnancy hormones were once thought to protect women from depression, but researchers now say this isn’t true. In fact, an estimated 10 percent of women experience depression during pregnancy. Although pregnancy doesn’t make depression worse, pregnancy often triggers a range of emotions that can make it more difficult to cope with depression.
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. And the price may be high, including premature birth, low birth weight, developmental problems and an increased risk of postpartum depression.
Few medications have been proved safe without question during pregnancy. Research continues, however, and the latest studies on antidepressants and pregnancy offer some reassurance. Overall, the risk of birth defects and other problems for babies of mothers who take antidepressants during pregnancy is very low. Still, some types of antidepressants are safer than others.

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

Antidepressant name Risks Recommendations
                   Selective serotonin reuptake inhibitors (SSRIs)
Citalopram (Celexa) 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 Consider as an option during pregnancy
Fluoxetine (Prozac, Sarafem) Associated with PPHN when taken during the last half of pregnancy Consider as an option during pregnancy
Paroxetine (Paxil) Associated with fetal heart defects when taken during the first three months of pregnancy Avoid during pregnancy
Sertraline (Zoloft) Associated with PPHN when taken during the last half of pregnancy Consider as an option during pregnancy
                Tricyclic antidpressants
Amitriptyline Suggested risk of limb malformation in early studies, but not confirmed with newer studies Consider as an option during pregnancy
Nortriptyline (Pamelor) Suggested risk of limb malformation in early studies, but not confirmed with newer studies Consider as an option during pregnancy
               Monoamine oxidase inhibitors (MAOIs)
Phenelzine (Nardil) May cause a severe increase in blood pressure that triggers a stroke Avoid during pregnancy
Tranylcypromine (Parnate) May cause a severe increase in blood pressure that triggers a stroke Avoid during pregnancy
              Other antidepressants
Bupropion (Wellbutrin) No established risks during pregnancy Consider as an option during pregnancy

Note: Persistent pulmonary hypertension of the newborn is a rare condition. Even if you take an SSRI during pregnancy, the ultimate risk remains extremely low.

 If you take antidepressants throughout pregnancy or during the last trimester, your baby may experience temporary withdrawal symptoms — such as jitters or irritability — at birth.
A preliminary 2007 study associated the use of antidepressants during pregnancy with preterm birth. However, the evidence wasn’t strong enough to consider antidepressants a consistent risk for preterm birth. Generally, antidepressants aren’t considered a risk factor for preterm birth.
If you stop taking antidepressants during pregnancy, you risk a depression relapse. In fact, in a 2006 study, 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:

  • Headache
  • Nausea and vomiting
  • Chills
  • Dizziness
  • Fatigue
  • Insomnia
  • Irritability
  • Vivid dreams

If you have depression and are pregnant or thinking about getting pregnant, consult your doctor. Sometimes mild depression can be managed with support groups, 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.
It’s not an easy decision. As researchers continue to learn more about antidepressants, the risks and benefits of taking the drugs during pregnancy must be weighed carefully on a case-by-case basis. Work with your doctor to make an informed choice that gives you — and your baby — the best chance for long-term health.