Evaluating medication options during pregnancy

Pregnant women want to do whatever they can to support the healthiest pregnancies and deliver the healthiest babies possible. Typically, this involves exercise, sticking to a healthy diet, and avoiding certain products, like medications that are known to be harmful to a gestating baby. These are great instincts, and there are certainly medications that need to be discontinued during pregnancy, but are antidepressants among them?

Often, no.

As is the case for so many aspects of healthcare, there is no one-size-fits-all approach to depression medication during pregnancy. The decision to continue or wean off of a medication during pregnancy should be the result of an open and honest conversation with one’s healthcare provider, discussing the risks, if any, not just of a medication, but also a person’s mental health situation.

Are some medications more or less safe than others?

Yes. Data suggest that some commonly used antidepressants, like most SSRIs, SNRIs, Wellbutrin, and tricyclic antidepressants may be safe to take during pregnancy.

There is some evidence that the SSRI paroxetine, which is sold under the brand name Paxil, may be associated with a slight increase in fetal heart defects, so healthcare providers generally discourage its use during pregnancy. Another group of antidepressants, known as MAOIs (notably including phenelzine and tranylcypromine), are typically not recommended during pregnancy because they are believed to discourage fetal growth.

There are some potential risks associated even with well-studied antidepressants, but often the risks associated with depression itself outweigh the risks of the medication.

What are the risks of depression during pregnancy?

Depression during pregnancy, known as antenatal depression, is quite common, and can have a major impact on a growing fetus, and a mother’s quality of life. Those struggling with depression might have a more difficult time exercising, sleeping well, and eating a nutritious diet, all of which can affect the progress of a gestating fetus. In addition to the immediate risks of antenatal depression, women who deal with it are more likely to experience postpartum depression after giving birth. Growing research suggests that the risks of stopping an effective antidepressant are far greater than any risks associated with taking the medication for the duration of a pregnancy.

The bottom line

Because of possible risks associated with both depression and depression medication during pregnancy, it’s important to have a conversation with your healthcare provider about taking your prescribed depression medications during pregnancy. Pregnant women want to create the best environment possible for their babies to develop and grow. For some women, that means weaning off of their antidepressants, but for others, that means staying on them throughout pregnancy. You’re the best advocate for both your own mental health and the health of your little one, so if you’re currently on antidepressants, or were before pregnancy, the conversation with your healthcare provider is one worth having.

Read more
  • Mayo Clinic Staff. “Antidepressants: safe during pregnancy?” Mayo Clinic. Mayo Clinic, February 28 2018. Retrieved July 2 2018. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/antidepressants/art-20046420.
  • Mayo Clinic Staff. “Depression during pregnancy: you’re not alone.” Mayo Clinic. Mayo Clinic, November 24 2016. Retrieved July 2 2018. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/depression-during-pregnancy/art-20237875.
  • Jennifer L. Payne, Samantha Meltzer-Brody. “Antidepressant use during pregnancy: current controversies and treatment strategies.” Clinical Obstetrics and Gynecology. 52(3): 469-482. September 2009. Retrieved July 2 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2749677/.
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