Antidepressants: Safe during pregnancy?

Antidepressants are a key treatment option for most types of depression. But these medicines have benefits and risks during pregnancy. Here's what you need to know.

Why is treatment for depression during pregnancy important?

Without treatment for depression, you might not seek the health care you need during pregnancy. This is called prenatal care. You also might not eat the healthy foods you and your unborn baby need. Or you may have trouble caring for yourself and your family if depression becomes overwhelming.

Having depression during pregnancy raises risks for babies, including the following:

• Premature birth.
• Low birth weight.
• Less growth in the womb.
• Other problems after birth.

Untreated depression during pregnancy also raises the risk of postpartum depression and trouble bonding with your baby.

Are antidepressants an option during pregnancy?

Yes. A decision to use antidepressants during pregnancy is based on the balance between risks and benefits. Often, the biggest concern is the risk of birth defects from exposing an unborn baby to depression medicine in the womb. But overall, the risk of birth defects and other problems for babies of pregnant people who take antidepressants is very low.

Still, some antidepressants are linked with a higher risk of health problems for your baby. Talk with your health care team about your symptoms and your medicine choices. That information can help you make well-informed decisions.

If you use antidepressants during pregnancy, your health care team tries to minimize your baby's exposure to the medicine. This can be done by prescribing a single medicine at the lowest effective dose. It's particularly common to do that during the first trimester.

Keep in mind that talk therapy also can help treat depression during pregnancy. Ask your health care team to refer you to a therapist who is skilled at cognitive behavioral therapy. Regular exercise can ease depression too. Ask your health care professional what types of exercises are safe for you to do during pregnancy.

Which antidepressants are OK during pregnancy?

In general, these antidepressants are options during pregnancy:

• Certain selective serotonin reuptake inhibitors (SSRIs). SSRIs usually are an option during pregnancy. These include citalopram (Celexa), sertraline (Zoloft), escitalopram (Lexapro) and fluoxetine (Prozac). Risks include high blood pressure for the pregnant person and premature birth. These risks are small. Your health care team watches for them during your prenatal care.

  Most studies show that SSRIs aren't linked with birth defects. But an SSRI called paroxetine (Paxil) might slightly raise the risk of heart defects in babies when used during the first trimester. For that reason, most health care professionals do not recommend paroxetine during pregnancy.

• Serotonin and norepinephrine reuptake inhibitors (SNRIs). Some SNRIs can be treatment options during pregnancy. These include duloxetine (Cymbals) and venlafaxine (Effexor XR). These medicines can lead to high blood pressure in pregnancy. Your care team watches your blood pressure closely during prenatal visits.
• Bupropion (Forfivo XL, Wellbutrin SR). Most often, bupropion isn't a first treatment for depression during pregnancy. It might be an option for pregnant people who haven't gotten enough relief from other medicines. Research suggests that taking bupropion during pregnancy might be linked with a small risk of miscarriage or heart defects.
• Tricyclic antidepressants. This class of medicines includes nortriptyline (Pamelor) and amitriptyline. Most often, tricyclic antidepressants aren't a first or second treatment for depression during pregnancy. But they might be an option for pregnant people if other medicines haven't been effective. The tricyclic antidepressant clomipramine (Anafranil) might be linked with birth defects in babies, including heart problems.

Are there any other risks for the baby?

If you take antidepressants during the last trimester of pregnancy, your baby might have short-term symptoms of quitting the medicine. The symptoms could include:

• Jitters.
• Irritable behavior.
• Poor feeding.
• A breathing condition called respiratory distress.

These symptoms may last for up to two weeks after birth. But there's no proof that stopping antidepressants or slowly reducing the dose near the end of pregnancy lowers the risk of these symptoms. Also, stopping your treatment or slowly lowering the dose might raise the risk of depression coming back after you give birth. That's especially true for people who have serious depression.

The connection between antidepressant use during pregnancy and the risk of autism spectrum disorder in babies is not clear. But most studies have shown that the risk is very small. Some studies have shown no risk at all. More research is needed.

Some research also links use of antidepressants during pregnancy with a higher risk of diabetes during pregnancy. That condition is called gestational diabetes. The higher risk is specifically linked with the antidepressants venlafaxine and amitriptyline. More research is needed. Other studies suggest that use of SSRI antidepressants during pregnancy doesn't raise the risk of gestational diabetes.

Should I switch medicines?

The decision to continue or change your antidepressant depends on whether your depression is under control. Talk with a member of your health care team. Concerns about risks must be weighed against the chance that a different medicine might not work, which could cause your depression to come back.

What's the bottom line?