Can You Take Antidepressants While Pregnant?

Mental health is important, especially during pregnancy. If you’ve tried making lifestyle adjustments but still have concerns about depression, you might consider discussing antidepressants with your mental health care provider. It’s natural to worry about starting a new medication while you’re pregnant. This article highlights the benefits and risks of taking antidepressants while pregnant, what types may be safer, and alternatives you may want to discuss with your physician.

Can you take antidepressants while pregnant?

Depression commonly affects about 20% of women during pregnancy and up to one year following birth. However, it is not recognized or diagnosed as often as it should be. Furthermore, some women stop taking their medications after becoming pregnant. If you’re currently taking antidepressants and are now pregnant, it’s normal that you may be concerned about medications affecting your baby.

If you are considering changing antidepressants, do not abruptly quit or make any other changes to your mental health regimen without consulting your physician. There are risks associated with using antidepressants while pregnant, but leaving mental health disorders untreated also carries risks for pregnant women.

A recent clinical trial showed that taking antidepressants while pregnant may generally be safe for the developing fetus’ brain health. A 2022 study looking at more than 145,000 pregnant women taking antidepressants showed that antidepressant use in pregnancy does not negatively impact the child’s brain development and future behavior.

Can you take antidepressants while trying to get pregnant?

There is no clear link between antidepressant use and fertility. More research is being done to clarify how antidepressants may impact the ability to conceive. If you are currently taking antidepressants and trying to conceive, talk to your doctor about a depression management plan for now and during pregnancy. If your current antidepressant is not the safest option for pregnancy, your healthcare provider may recommend switching to a safer alternative before you become pregnant.

What antidepressants can you take while pregnant?

All antidepressants carry some risks in pregnancy, but some medications may be safer options than others. Untreated depression also carries significant risks for you and your baby. It’s important to talk with your physician about which categories of antidepressants may be the best choices to manage your mental health while keeping your baby safe. Let’s take a closer look at the differences between different types of antidepressants that can be used while pregnant.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are used for multiple mood and anxiety disorders and have also been studied in pregnancy more than any other medications used for mental health. Studies on SSRIs and pregnancy, however, have led to inconsistent results due to trial restrictions. Some of the information available about SSRI use in pregnancy is conflicting, but this category of medication is considered the antidepressant of choice for pregnant women.

Examples of SSRIs include citalopram (Celexa), escitalopram (Lexapro), sertraline (Zoloft), paroxetine (Paxil), and fluoxetine (Prozac, Sarafem).

A 2022 review of 22 clinical analyses found that there were significant associations between using SSRIs during the first trimester of pregnancy and heart defects present from birth. However, the studies did not directly compare women with depression who took SSRIs versus women with depression who did not take any medications. The study concluded that the absolute risk of negative outcomes with SSRI use during pregnancy is lower than compared to women who had untreated depression during pregnancy.

In another small study that looked at 60 newborns who were exposed to SSRIs before birth, 30% of the newborns showed symptoms of neonatal abstinence syndrome or poor neonatal adaptation. Poor neonatal adaptation is a temporary group of symptoms that occur in newborns who have been exposed to drugs in the uterus. The symptoms associated with poor neonatal adaptation are restlessness, respiratory difficulties, vomiting, spasms, irritability, and crying.

Although all SSRIs are generally considered safe for use in pregnancy, paroxetine and fluoxetine have higher risks than the other SSRIs of negative outcomes such as heart defects at birth and low birth weight. If you are currently taking paroxetine or fluoxetine and become pregnant, you should talk with your doctor about whether continuing these medications is the safest choice for your situation.

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

SNRIs have not been studied in pregnancy as extensively as SSRIs, but they remain a common choice for treating depression in pregnant women.

Examples of SNRIs include duloxetine (Cymbalta) and venlafaxine.

Similarly to SSRIs, SNRI use in pregnancy carries the risk of the newborn developing neonatal abstinence syndrome. However, severe abstinence is found to be very rare.

Tricyclic antidepressants (TCAs)

TCAs are much older medications used for depression. They work much differently than SSRIs or SNRIs, so if those medications have not worked for you in the past, your physician may consider a TCA for you.

Nortriptyline (Pamelor) and desipramine (Norpramin) are examples of TCAs that are preferred for use in pregnancy.

They have not been found to lead to abnormalities in newborns, and they have been shown to have fewer heart and digestive side effects in the fetus.

Risks of taking antidepressants while pregnant

Antidepressant use in pregnancy may be associated with an increased risk of heart defects and neonatal abstinence syndrome in newborns, as well as premature birth, lower birth weight for the newborn, and increased blood pressure in the lungs of the baby when the medication is taken in late pregnancy.

If you are not already taking antidepressant medication and have a mild mental health disorder, your physician may explore non-medication options to manage your mental health. Antidepressant use in pregnant women is usually used for women with moderate to severe mental health needs.

Should you stop using antidepressants while pregnant?

If you are taking antidepressants and become pregnant, it is not recommended to stop your medication. Untreated depression can lead to serious health complications and risks for both you and your baby. Depending on your mental health condition and current medications, your physician may consider switching you to a safer type of antidepressant if needed and provide instructions on how to safely discontinue your current treatment and start the new medications.

Antidepressants can change the amounts and responses to brain chemicals, and stopping your medication abruptly can disrupt those chemical levels and hinder your progress or cause bodily harm. If you were previously taking antidepressants and already stopped them without notifying your physician, please reach out to your doctor and make an appointment to discuss the best approach to care for your mental health.

Importance of mental health during pregnancy

Antidepressant use during pregnancy is complex because of the associated risks; however, the risks of leaving depression untreated may be much greater. Mental health disorders like depression, if undamaged, can lead to an increased risk of preeclampsia, eclampsia, and depression that continues for the mother after childbirth.

Pregnant women with severe mental disorders are also at an increased risk of having premature childbirth or impaired fetal development. If you are pregnant and you experience depression symptoms, talk to your physician about the options available to manage your mental health.

Alternatives to antidepressants

Medical treatments for depression are not the only options available. You may want to talk with your physician about trying alternatives to antidepressants first, or you may want to ask about the importance of adding certain lifestyle changes to your medication regimen. However, sometimes, medication may be necessary, and other options are adjunctive. There are three alternatives you may want to discuss:

Therapy

Therapeutic sessions with a professional, whether in an individual or group setting, may help to relieve some stress during pregnancy. There are different types of therapy options available — from in-person sessions or virtual sessions to sessions that focus on present issues at hand instead of targeting the past. You may find that the coping methods taught during therapy help you navigate your thoughts, responses to challenges, and relationships.

Lifestyle changes

There are numerous changes you can incorporate into your everyday routine that may help to lift your mood. Being physically active, drinking more water, getting more sleep, and focusing on self-care may make an improvement in how you feel. You don’t have to incorporate everything all at once; you can choose to focus on a few and add them to your daily routine.

Even if you are taking medication to help with depression, you may find that establishing a self-care routine helps.

Support groups

Navigating a pregnancy can be stressful. Finding a community of people who can provide emotional support may help relieve some of the mental and emotional pressure of pregnancy. In addition, others in your support group may provide practical solutions to problems you may be facing.

Signs you may need help

Changes in emotions and anxiety are natural responses to daily challenges, but these emotions should come and go as situations change. If you are experiencing persistent feelings of sadness or worthlessness and thoughts about dying or suicide, seek help for depression immediately.

Untreated mental health disorders can be dangerous for pregnant women and also for the unborn fetus. Antidepressant use in pregnancy is controversial, but based on your situation, it may be safer for you to take an antidepressant than to go without treatment. Please reach out to your healthcare provider if you are pregnant or trying to become pregnant and want to make changes to your mental health treatment regimen.