There are so many myths and facts swirling around the idea of antidepressants during TTC and pregnancy. Let’s sort through them.
Are antidepressants safe when trying to conceive?
Yes. While some antidepressants can reduce sex drive, there is no evidence that any of the commonly used antidepressants have a negative effect on fertility. The main concern with taking antidepressants while trying to conceive is the effect they may have once you do get pregnant.
What about during pregnancy?
It’s important that you tend to your mental health during pregnancy, because research shows that untreated depression puts your unborn baby at more risk than the small amount of medication that crosses the placenta. Untreated depression in pregnancy is associated with an increased risk for preterm birth, low birth weight, and impaired fetal growth. It can also make it difficult for pregnant women to gain the appropriate amount of weight, schedule and attend prenatal appointments, and perform necessary self-care. Untreated depression during pregnancy also increases a woman’s risk of postpartum depression and the likelihood that she’ll have difficulty bonding with her baby.
For ethical reasons, there haven’t been randomized trials of antidepressants during pregnancy, but we have increasing amounts of information from registries and other types of studies. You and your healthcare provider know the most about your mental health history, and can make the right decision for you and your baby together.
How can antidepressants impact a pregnancy?
The most commonly prescribed class of antidepressant medications, Selective Serotonin Reuptake Inhibitors (SSRIs), are the most well-researched in pregnancy and are generally the safest first-line medication for depression. Studies have shown that most SSRIs do not put developing fetuses at any higher risk for birth defects.
However, while many SSRIs are fine to use during pregnancy, research suggests that some antidepressants may affect the fetus. Past studies associated exposure to Paxil in the first trimester to a slightly increased risk of heart defects, but other studies have not found that association. So if this medication is part of your treatment plan, your provider may work with you to explore other options during pregnancy. The class of antidepressants known as MAOIs (monoamine oxidase inhibitors) should also be avoided, as they can cause blood pressure issues during pregnancy.
If your depression is having a significant impact on your health and peace of mind, your baby is probably less likely to be affected by a safe antidepressant than they would be if you were depressed throughout pregnancy, so it’s important that you and your healthcare provider establish a treatment plan that will keep you happy and healthy throughout your pregnancy.
Which antidepressants are generally safe during pregnancy?
The following medications tend to be better options for those using antidepressants during pregnancy:
- Some selective serotonin reuptake inhibitors (SSRIs), like:
- Sertraline (Zoloft)
- Fluoxetine (Prozac)
- Escitalopram (Lexapro)
- Citalopram (Celexa)
- Serotonin and norepinephrine reuptake inhibitors (SNRIs)
- Tricyclic antidepressants
- Bupropion (Wellbutrin)
The bottom line
It’s great to talk to your healthcare provider and develop a plan for treating your depression while trying to conceive.
Most popular antidepressants are generally safe to take during pregnancy, but you should always speak with your healthcare provider before starting, or ending, an antidepressant regimen. Your mental and emotional health are just as important as your physical health during pregnancy.
- Mayo Clinic Staff. “Antidepressants: Safe during pregnancy?” Mayo Clinic. Mayo Clinic. February 28, 2018.
- MGH Center for Women’s Mental Health. “Psychiatric disorders during pregnancy.”