Antidepressants and pregnancy: safe or not?

Are antidepressants safe during pregnancy? The answer is, “it depends,” both on the type of medication and on the person taking it. The risk of untreated mental illness, and of stopping taking a prescribed mental health medication abruptly, is usually higher than any risk associated with the medication. Some medications are safer than others, so the time before conception is a great time to talk to a healthcare provider about potentially transitioning to different medication that may be safer during pregnancy.

In any case, it’s always important to talk to a healthcare provider before stopping any medication.

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).

SSRIs are the most-studied class of medications in pregnancy, and most SSRIs are considered to be a safe option during pregnancy, including Celexa, Prozac, and Zoloft. Paxil has been associated with a very small increased risk of birth defects in some studies, so this is used with caution in the first three months of pregnancy.

If you’re on an antidepressant now, it’s a great time to talk to your healthcare provider about the safety of your medication in particular during pregnancy.

Non-SSRI antidepressants

SSRIs won’t work for some people, who will then need to try different medications. 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 are considered to be a safe option during early pregnancy. There has been some concern that they may be associated with a small increased risk of postpartum hemorrhage when taken in the third trimester. However, the finding isn’t consistent across studies, and the increased risk in the studies that did find it is very slight.

Other medications

It’s not uncommon for a provider to combine medications or even add a medication to balance out the effects of an antidepressant. 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.

Read more
  • Mayo Clinic Staff. “Antidepressants: Safe during pregnancy?” Mayo Clinic. Mayo Clinic. February 28 2018.
  • Mayo Clinic Staff. “Antidepressants: Selecting one that’s right for you.” MayoClinic. Mayo Foundation for Medical Education and Research, November 25 2014.
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