The question of whether taking antidepressants during the TTC period is safe isn’t actually about the act of conceiving – instead, it’s a question of whether taking antidepressants is safe in the very beginning of the first trimester of pregnancy. In the first few weeks of pregnancy, before pregnancy can be confirmed with a test, many women aren’t sure they’re pregnant, which is why some women who are actively trying to conceive will take the same precautions they would during pregnancy, because they might be pregnant without knowing it.
The answer to the question of whether antidepressants are safe during pregnancy is, “it depends,” both on the type of medication and on the person taking it. For many people, taking any number of a wide range of medications, the risk of untreated mental illness, and of stopping taking a prescribed mental health medication abruptly, is higher than the risk associated with the medication. For others, especially people taking certain other medications, this time before conception is a great time to talk to a doctor about the pros and cons of transitioning to different medication that may be safer during pregnancy.
In any case, it’s always important to talk to a doctor before changing or stopping taking any kind of medication. There are several medications that it’s safest to stop on a gradual timeline. It’s always a good idea to start to have a conversation about medication during pregnancy while you’re still trying to conceive. Your healthcare provider will be able to talk through the particulars of your health and medications, and whether it will be healthiest for you to continue your medication, taper off, or gradually shift to a different medication plan.
Selective serotonin reuptake inhibitors (SSRI) antidepressants
Serotonin is a neurotransmitter that helps regulate mood, social behavior, appetite and digestion, and libido, among other things. SSRIs are commonly prescribed for depression because they increase serotonin levels in the brain. Examples of SSRIs include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft).
If you’re currently on an antidepressant, now is a great time to start to talk to your healthcare provider about your medication plan in particular. Many SSRIs are considered to be generally safer during pregnancy than untreated depression.
Some people can benefit from antidepressants that are not SSRIs. Some non-SSRIs increase serotonin levels, while others do not. Two common types of these are serotonin-norepinephrine reuptake inhibitors (SNRIs), like duloxetine (Cymbalta) and venlafaxine (Effexor), or norepinephrine-dopamine reuptake inhibitors (NDRIs), like bupropion (Wellbutrin).
Many SNRIs and NDRIs are generally considered to be a safe option during early pregnancy, but it’s always a good idea to talk to your healthcare provider about the safety of your medication routine during pregnancy.
Depending on your diagnosis and the nature of your illness, sometimes other medications may be helpful. Some examples of medications that can be used this way are mood stabilizers and antipsychotic medication. Anti-anxiety medications might be prescribed, but these aren’t usually used long-term. A healthcare provider will be able to talk through the risks and benefits of other medications as they relate to pregnancy and TTC.
- Mayo Clinic Staff. “Antidepressants: Safe during pregnancy?” Mayo Clinic. Mayo Clinic. February 28 2018. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/antidepressants/art-20046420.
- Mayo Clinic Staff. “Antidepressants: Selecting one that’s right for you.” MayoClinic. Mayo Foundation for Medical Education and Research, November 25 2014. https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046273.