Antidepressants During Pregnancy: What’s Safe?

Antidepressants During Pregnancy

Women already being treated for depression may wonder whether they need to stop taking their medication when they become pregnant. It’s a decision that is best made on an individual basis, after learning the facts, and consulting with a healthcare professional.

It’s a decision that requires some thought, because according to the American Congress of Obstetricians and Gynecologists (ACOG), both depression symptoms and the use of antidepressants during pregnancy have been associated with risks to newborns. Studies have explored the possible health risks of taking antidepressants during pregnancy but also the negative consequences of not treating an expectant mother’s depression. That’s why an individual approach is important.

The Benefits of Taking Antidepressants While Pregnant

The National Center for Health Statistics estimates that antidepressants are the third most commonly prescribed drug taken by Americans. Suddenly stopping treatment can lead to withdrawal and a return of previous symptoms. Not treating depression may also encourage unhealthy maternal behavior, such as drinking and smoking, which can lead to low birth weight, premature birth and health complications for the fetus. Women suffering from depression have higher levels of cortisol, which can directly affect the fetus and may have the ability to shape development. A study in Finland found lower risks of premature births and cesarean sections in women treated for depression than in those who were not treated. Not treating depression may also contribute to postpartum depression and affect a mother’s ability to bond with her new infant.

The Risks Studies Have Examined

Several studies have explored whether the maternal use of antidepressants during pregnancy promote temporary symptoms such as irritability, as well as long-term health problems that include lung problems, autism, and heart defects. So far many studies focusing on long-term results have been inconclusive.

One study did find evidence that the maternal use of antidepressants results in a greater than normal incidence of irritability and jitteriness in newborns, as well as some short term breathing problems.

Another  study demonstrated a slightly higher risk in long-term breathing problems, but concluded the risk was small. The study published in the Journal of the American Medical Association (JAMA) suggests that children born to mothers taking antidepressants such as citalopram, fluoxetine and sertraline during the second half of pregnancy may have a higher risk of a newborn lung problem known as persistent pulmonary hypertension (PPHN).

Studies identifying autism spectrum disorder (ASD) in children whose mother took antidepressants during pregnancy have seen varying results. So far, the number of studies finding no direct connection outnumbers those that suggest it does. One 2016 study published by JAMA Pediatrics demonstrated a  dramatic 87% increase in diagnosis  in children born to mothers who took antidepressants. However, the risk for ASD in the general population is about one percent. When mothers took antidepressants the incidence increased to two percent. Study authors noted that women who suffer from psychiatric illnesses such as depression already have a statistically greater risk of having children with ASD. Another study published in the New England Journal of Medicine studied 600,000 births in Denmark and did not detect any association.

Cardiac birth defects were also a concern but so far the link has not been substantiated. A National Institutes of Health Study followed more than two million births and found that there was no increase in cardiac birth defects in infants whose mothers took antidepressants while expecting.

Preferred Antidepressants During Pregnancy

Some antidepressant medication is considered safer than others. How do they shape up?

Considered preferable during pregnancy:

Selective serotonin reuptake inhibitors or SSRIs are a preferred treatment option during pregnancy. These include citalopram (Celexa), fluoxetine (Prozac) and sertraline (Zoloft).

SNROs or serotonin and norepinephrine reuptake inhibitors are also preferred. These include duloxetine (Cymbalta) and venlafaxine (Effexor XR).

Less preferable options:

Bupropion (Wellbutrin) is not a preferred treatment unless patients are not responding to other therapy. Bupropion is used to treat depression and help people quit smoking.

Tricyclic antidepressants, such as amitriptyline and nortriptyline (Pamelor), are also generally only prescribed if other treatment has not been effective.

Medication not generally prescribed:

The SSRI Paxil or paroxetine is not usually prescribed during pregnancy. Concern was raised that Paxil increased the rate of fetal heart defects, but a study published in the Official Publication of the College of Family Physicians of Canada found that the evidence was inconclusive.

Monoamine oxidase inhibitors (MAOIs), such as phenelzine (Nardil) and tranylcypromine (Parnate), may have an adverse effect on fetal growth.

Weighing Risks and Benefits

It is important for expectant mothers to discuss the risks and benefits of each treatment option with a healthcare professional. Weighing both is the best way to arrive at an individualized plan that works best for both mother and baby.

Joan MacDonald
Joan Vos MacDonald has written about health and fitness for newspapers, magazines and websites. She is a member of the National Association of Science Writers and the author of two books on health-related topics, "Tobacco and Nicotine Dangers," for young adults, and "High Fit Home," a design book about fitness and architecture. She lives in upstate New York near her children and grandchildren.

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