Are Antidepressants Safe During Pregnancy?

Depression in Pregnancy

Depression affects approximately 1 in 10 pregnant women, according to the American College of Obstetricians and Gynecologists. Feeling sad every now and then is normal and to be expected, but depression is different. Signs of depression include:

• Unrelenting feelings of sadness, guilt, hopelessness, or worthlessness
• Loss of interest in activities you once enjoyed
• Sleep changes (either sleeping too much or having trouble sleeping)
• Changes in appetite (either eating more than normal or experiencing loss of appetite)
• Feeling restless or slowed down

If these types of feelings are persistent or disruptive to your daily life, it could be a sign of depression. But it’s important to know that pregnancy itself isn’t the cause.

“Pregnancy is risk-neutral in terms of the development of depression,” explains Lauren M. Osborne, M.D., board-certified psychiatrist, director of the Center for Women’s Reproductive Mental Health, and associate professor at Johns Hopkins Medicine, in Baltimore. “A woman is not biologically more at risk of developing depression during pregnancy than she is at any other time of her life.”

However, research shows that if you have a previous history of anxiety or depression, you may have an increased risk of the same condition during pregnancy. If you’re diagnosed with depression—whether before or during pregnancy—it’s important to weigh the risks of taking an antidepressant medication along with the risks of not taking it.

Benefits of Antidepressants During Pregnancy

Taking antidepressants during pregnancy—particularly a class of drugs called selective serotonin reuptake inhibitors (SSRIs)—can benefit both the pregnant person and their baby. The biggest benefit of antidepressants during pregnancy is that they help improve symptoms of depression in the pregnant person. “They shorten the time it takes for people to feel better when suffering from a depressive episode,” says Lulu Zhao, M.D., a board certified ob-gyn at University Hospitals in Beachwood, Ohio.

Taking antidepressants during pregnancy can also help prevent a depressive episode. “Many women who have preexisting depression will go off medications for pregnancy without consulting a medical professional, and their relapse rate is about 65% to 70%,” explains Osborne. If you were prescribed an antidepressant before you became pregnant, discuss with your doctor about whether or not you should continue to take it before making any changes.

Left untreated, depression can make it harder for you to take care of yourself when you’re pregnant, so things like eating healthfully, getting adequate sleep, and attending prenatal checkups become far more difficult. It’s also thought that treating depression while you’re expecting—whether with antidepressants or psychotherapy—could help prevent postpartum depression after the baby is born. This is important because, sadly, suicide accounts for 20% of postpartum deaths.

You can find a therapist who specializes in perinatal mental health at the Postpartum Support International (PSI) provider directory.

Treating depression with antidepressants during pregnancy, may also help:

• Reduce the risk of preterm birth. Depression may increase the risk of preterm birth, and a study published in 2015 suggests that treating depression with SSRIs may help reduce that risk.
• Lower the risk of cesarean section. The same study found that pregnant mothers who took SSRIs to treat depression were less likely to deliver via C-section than those with mental health issues who chose not to be treated.
• Normalize fetal growth. Left untreated, depression can lead to decreased fetal growth.
• Keep your child mentally healthy, too. Perinatal depression has been associated with poor child development and psychological outcomes.

Risks of Taking Antidepressants During Pregnancy

Overall, antidepressants—specifically SSRIs—are generally considered compatible with pregnancy. “They have years of safety data behind them when it comes to pregnancy and lactation,” Zhao says. However, research has still identified small risks of taking antidepressants during pregnancy, such as:

• Preterm birth. “Both antidepressants and depression itself are associated with preterm birth,” Osborne says. “But it's just a matter of a few days’ difference.”
• Low birth weight. The same may also be true for low birth weight. “SSRIs are associated with lower birth weight, but it should be noted that mothers with untreated depression are also at risk for lower birth weight,” Zhao says. “Therefore, it’s unclear whether it is the SSRI causing the problem or just having depression itself.”
• Persistent pulmonary hypertension (PPHN). Research suggests that using antidepressants during pregnancy (particularly late in pregnancy) may increase the risk of PPHN, which is a “failure of the newborn lungs to inflate the way they’re supposed to [after birth],” Osborne says. But bear in mind that this risk is also very small.
• Poor neonatal adaptation. Research suggests that newborns’ exposure to SSRIs may be associated with poor neonatal adaptation, a behavioral syndrome that can lead to fussiness, restlessness, irritability, crying, and difficulty feeding or breathing in the first two weeks after birth. “So a pediatrician is going to say, ‘Is this an infection? Is something else going on? I may need to run some extra tests. I may need to put the baby in the special nursery.’ That can be alarming [to a parent],” explains Osborne.

Many of the risks of taking antidepressants during pregnancy are relatively small. To weigh them, it’s best to consult your doctor about whether or not to treat your depression during that time. “For most women who have at least moderate to severe symptoms, the balance of risks is going to come down in favor of treating [the depression],” says Osborne

Which Antidepressants Are Okay to Take During Pregnancy?

While the way in which antidepressants work is not entirely understood, it’s thought that they help increase the production of chemicals in the brain linked to mood and emotion. There are many types of antidepressants available. However, some have been more thoroughly studied for use in pregnancy than others. They include:

• Selective serotonin reuptake inhibitors (SSRIs). The most commonly prescribed antidepressant, many SSRIs are thought to be compatible for use in pregnancy, including citalopram, fluoxetine, and sertraline. (These medications tend to go by their brand names, so check to make sure you know which one you’ve been prescribed.) “SSRIs have been better studied [in pregnancy] than any other class of medications,” Osborne says. “They are by far the most common class of antidepressants that have the lowest side effect burden, so they will be prescribed much more [in pregnancy] than other antidepressants.” However, not all SSRIs are created equal. “I would always rather use an older [SSRI] with more evidence than a newer drug that has less,” adds Osborne.

• Serotonin-norepinephrine reuptake inhibitors (SNRIs). Some SNRIs (sometimes called selective serotonin-norepinephrine reuptake inhibitors, or SSNRIs), including duloxetine and venlafaxine, can also be used for treating depression, though their safety hasn’t been as thoroughly studied in pregnancy as that of SSRIs. Talk to your doctor if you’re taking an SNRI to discuss whether you should stick with it or switch to another antidepressant during pregnancy.

• Tricyclic antidepressants. They aren’t as commonly prescribed today, but as Osborne says, “We have a lot of data for [tricyclic antidepressants], and they are compatible with pregnancy.” It’s worth noting that these options, such as nortriptyline, are typically only prescribed in pregnancy if you haven’t responded to other antidepressants.

• Other options. Medications like bupropion can also be used in pregnancy.

If you have milder depressive symptoms, talk to your doctor about whether psychotherapy may be enough to address the issue. Other steps you can take to manage your mood include:

• Staying active
• Practicing yoga
• Meditating
• Opening up to a friend or family member
• Joining a support group

If you do decide to take an antidepressant while pregnant, know that that’s okay. “People would never choose not to treat diabetes or a heart condition in pregnancy,” Osborne says. “I think women need to give themselves permission to view a mental illness as a real illness, and not beat themselves up for needing treatment for something that isn't their fault and can be treated successfully.”

Talking to Your Doctor

If you’re experiencing signs of depression, it’s important to talk about it. “It’s not normal to feel chronically depressed, hopeless, or anxious,” Zhao says. You don’t need to accept and live with your symptoms. Together, you and your doctor can discuss your options and come up with the right treatment plan for you.

“Your doctor may be the expert in medications and other treatment options, but only you know what you’re comfortable with and your past history with depression,” Zhao says. You’re the decision-maker when it comes to your own body.

It’s helpful to know, however, that not all doctors will feel comfortable treating depression with antidepressants during pregnancy. “And some do give bad advice, such as stopping your antidepressants just because you’re pregnant, or telling you that depressive symptoms are normal,” adds Zhao. “Please trust your gut—if you don’t feel like yourself, you need further evaluation by an experienced professional.”

Your physician may very well be happy that you do seek a second opinion. “Most [doctors] will be eager to refer you to a specialist because they themselves are not comfortable,” Osborne says.

“Anybody who can get to a reproductive psychiatrist should do so,” she adds. This is a type of specialist with vast knowledge of the nuances of treating mental health issues during pregnancy. If your doctor can’t refer you to one, you can search the PSI Provider Directory to find a specialist near you.

Meanwhile, educating yourself about your options and weighing the benefits and risks will empower you to work with your doctor to make the right decision for you and your baby.

You May Also Like:

• How to Manage Anxiety During Pregnancy
• Is Meditation the Secret to Pregnancy Stress Relief?
• The “Baby Blues” vs. Postpartum Depression: Understanding Postnatal Emotions