Note: The Pregistry website includes expert reports on more than 2000 medications, 300 diseases, and 150 common exposures during pregnancy and lactation. For the topic Depression, go here. For the topic Tricyclic Antidepressants, go here. These expert reports are free of charge and can be saved and shared.
The use of antidepressants during pregnancy has been controversial for a long time. Although some studies have found an elevated risk for pregnancy complications and birth defects, others have not. On the other hand, untreated depression is not controversial. It is dangerous for a pregnancy. You can read about the benefits and risks of antidepressants in pregnancy here.
Depression during pregnancy is not uncommon, so it is not surprising that 7 to 13 percent of women take an antidepressant during pregnancy. Untreated depression can lead poor prenatal health, premature birth, low birthweight babies, and poor fetal growth.
Although studies on the risks of taking antidepressants during pregnancy have been inconsistent, three major concerns have been identified. They are an increased risk for preterm birth, heart defects, and breathing problems for newborns, called neonatal respiratory distress.
Now, a new study from researchers at the University of California San Diego Department of Pediatrics* has taken a fresh look at antidepressant risks during pregnancy based on patterns of use. They looked at the dose of the antidepressant along with the length of time the medication was used in pregnancy to learn how those factors affect risks for preterm birth, cardiac malformation, or neonatal respiratory distress.
This was a large study involving over 1,500 pregnancies. The findings of the study are published in the journal Pediatrics. Women taking antidepressants were compared to a large group of women not taking antidepressants, the control group. They divided antidepressant use into five patterns of use to see how each pattern affected the risk of adverse neonatal outcomes.
These were the key findings for each pattern of use compared to the control group:
- Group one was low dose antidepressant use with reduction of use during the first trimester. This pattern was not linked to any increased risks.
- Group two was low dose use that continued through pregnancy. This pattern was linked to a 36 percent increased risk of neonatal respiratory distress.
- Group three was moderate dose use with reduced use during the first trimester. This pattern was linked to a 23 percent increased risk of respiratory distress.
- Group four was moderate dose continued through pregnancy. This pattern was linked to a 67 percent increased risk of respiratory distress and 31 percent increased risk of preterm birth.
- Group five was high dose use throughout pregnancy. This pattern was linked to a more than double risk for respiratory distress and a 78 percent increase in risk for preterm birth.
- The risk of cardiac malformations was the same for all the antidepressant groups as the control group, about one percent, there was no evidence of an increased risk.
The type of antidepressant used did not change the risks. Brands of antidepressants included Zoloft, Celexa, Prozac, Lexapro, and Wellbutrin.
Women taking an antidepressant during pregnancy should not stop their current treatment. Although the researchers do not feel that their study changes the basic belief that the risk of untreated depression outweighs the risk of using an antidepressant during pregnancy, they do think it raises new concerns.
They urge doctors treating depression during pregnancy to use the lowest dose that is still effective. They also say that women who may need a moderate to high dose of an antidepressant should be made aware of the increased risks of newborn respiratory distress and preterm birth when weighing the risks and benefits with their doctors.
*Prenatal Antidepressant Use and Risk of Adverse Neonatal Outcomes.
Bandoli G, Chambers CD, Wells A, Palmsten K. Pediatrics. 2020 Jul;146(1):e20192493.