Thinking about pregnancy or being pregnant can be an exciting time. It can also be a stressful time, and considering medications for existing or new mental health conditions can be challenging. Below is some information to help you in your discussion with your physician.
Myths of antidepressant use during pregnancy
All antidepressants are unsafe during pregnancy.
While antidepressant medications cross the placental barrier and may reach the fetus, the National Institute of Mental Health states that antidepressants, especially SSRIs, are considered to be safe during pregnancy. However, risk varies by medication and at what point during pregnancy the medication is taken (see below).
Stopping antidepressants during pregnancy is good for my fetus.
Suddenly stopping an antidepressant may have serious consequences for you and your fetus including relapse of depression and unwanted side effects. Additionally, untreated depression during pregnancy may lead to poor birth outcomes. Always consult your physician before stopping or switching medications.
The medical literature of antidepressant use during pregnancy is conclusive.
Given conflicting evidence over links between antidepressant use and certain birth defects, the FDA advises no changes to the current treatment of depression during pregnancy. Antidepressants remain a primary option based on a balance between risks and benefits. The effects of antidepressants on birth outcomes and child development remain under study.
Mental health medications considered OK during pregnancy
- SSRIs including sertraline, citalopram, and escitalopram
- SNRIs such as venlafaxine are the second most frequently prescribed antidepressant
- Bupropion (Wellbutrin) is not considered a first line treatment but may be an option for women who haven’t responded to other medications
- Tricyclic antidepressants are not generally considered first or second line treatment
Mental health medications to avoid during pregnancy
- Paroxetine (SSRI) may be associated with a small increase in fetal heart defects
- Mood stabilizers such as benzodiazepines and lithium have been shown to cause “floppy baby syndrome” and other infant problems
- Antipsychotics can lead to birth defects
- Monoamine oxidase inhibitors (MAOIs) are discouraged during pregnancy and are associated with limiting fetal growth.
Approach to treatment
- Treatment choice should be individualized to each woman’s needs and circumstances and involves a thorough weighing of benefits and risks.
- Psychotherapy (ie. CBT) is a primary treatment option for depression among pregnant women and is often combined with medication.
- Using antidepressants at the lowest effective dose may minimize your baby’s exposure to the medication. Discuss treatment options with your doctor before tapering or changing medication.
- Tapering off antidepressants late in pregnancy may also minimize your baby’s exposure to the medication.
Postpartum depression and breastfeeding
- Women should be carefully monitored for postpartum depression, especially if medication was stopped during pregnancy.
- Medication exposure from breastfeeding is less than the exposure that occurs transplacentally. If you are nursing, discuss antidepressant use with your doctor.
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