If you are pregnant — or are thinking about getting pregnant — you may wonder if it’s safe to take an antidepressant. The short answer is yes. The longer answer is that there are benefits and risks to taking antidepressants while pregnant that must be weighed against the risks of untreated depression and anxiety in pregnancy.
The benefits and risks of medications depend on the type of medication, the dose, and the severity of the depression.
Women and other birthing parents* who are on antidepressants and thinking of planning a family or who are already pregnant should talk to their doctors. Based on this discussion, they may decide to:
- Try therapy and other non-medication options if their symptoms are mild.
- Stay on the same antidepressant medication on the same dose with potential for dose increases.
What Are the Benefits of Taking Antidepressants in Pregnancy?
There are many benefits of taking antidepressants in pregnancy. For one, it’s easier to enjoy your pregnancy if you’re not depressed. Women who stop taking antidepressants during their pregnancy are six times more likely to experience depression than women who continue them. Studies suggest that restarting an antidepressant medication during pregnancy after stopping carries a risk of the medication not being as effective.
Depression in pregnancy increases the risk of having preterm birth, miscarriage, and a low birthweight baby. One analysis of many studies found depression upped the risk for preterm birth by 46% and low birth weight by 90%.
Thankfully, there are many effective depression treatments that can target this risk area.
By treating depression, antidepressants can reduce these risks to the fetus. Both for the health of the mom and the baby, doctors usually don’t recommend stopping an antidepressant when pregnant especially if it is effective in treating your depression.
What Are the Risks of Taking Antidepressants in Pregnancy?
Just like depression, antidepressants can also increase the risk of some poor birth outcomes. These include low birth weight and preterm birth.
The increased risk is small and depends on the dose. One major study found a low dose (10mg to 20mg) of fluoxetine did not increase the risk of preterm birth.
While previous studies have found a link between antidepressant use and miscarriage, more recent research has disproved this link.
Some studies have found that antidepressants also increase the risk of birth defects, including heart issues. The evidence here is mixed, with other studies not finding a link.
In studies that do find an increased risk, the overall risk of a birth defect remains small. For example, one review found that the risk of having a baby with a heart defect was 1% for women who took paroxetine. That’s not much different than the 0.7% risk for the general population.
What Antidepressants Are Safer to Take in Pregnancy?
There is no list of safe antidepressants during pregnancy. That’s because there isn’t enough research to prove any antidepressant is risk free. That would require following babies over many years and measuring all outcomes. Additionally, studies about risks in in pregnancy are difficult, as the “gold standard” study design of randomized controlled trials (giving one group of individuals the medication and the other group a sugar pill to compare) is not considered ethical in pregnancy.
Plus, a drug may be safe at low levels, but not at high levels.
However, doctors prefer certain lower-risk antidepressant drugs in pregnancy. For example, a large U.S. study did not find increased risk of birth defects with sertraline use. But the study did find a slightly higher risk with paroxetine and fluoxetine.
Because the overall risk remains low, however, most guidelines don’t recommend women switch medications during pregnancy. This is because switching to another drug can add stress during pregnancy and the medication you switch to may not be as effective for your depression. This would then expose your baby to two medications and untreated depression.
For women who are newly diagnosed with depression in pregnancy, your doctor may recommend a medication and typically start with whatever medication has been effective for you in the past.
What About Antidepressants When Breastfeeding?
Breastfeeding and taking antidepressants is generally safe, no matter the medication. That’s because much less medication passes to the baby through breastmilk, compared to through the placenta.
To find out about any risks during pregnancy or breastfeeding with any specific medication, talk to your doctor.
Remember that the decision to choose one drug over another is individual, and there is no one-size-fits-all approach. What matters is that you’re healthy and happy — for you and for your baby.
*Not all birthing parents identify as women or mothers. At UPMC Magee we interchangeably use the terms mother and birthing parent. We have a long history supporting women and have a commitment to the LGBTQIA+ community. Transmasculine birthing parents are welcome at Magee.
Sources
Dr. Bérard et al. The risk of major cardiac malformations associated with paroxetine use during the first trimester of pregnancy: a systematic review and meta analysis. British Journal of Clinical Pharmacology. Link
Centers for Disease Control and Prevention. Key findings—A closer look at the link between specific SSRIs and birth defects. Link
Centers for Disease Control and Prevention. Preterm birth. Link
Raina Delisle. What the research actually says about taking antidepressants during pregnancy. Today's Parent. Link
Dr. Molenaar et al. Guidelines on treatment of perinatal depression with antidepressants: An international review. Australian and New Zealand Journal of Psychiatry. Link
Dr. Kimberly Yonkers et al. The management of during pregnancy: A report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. Link
Corey Laskey. Antidepressant use in the breastfeeding patient. U.S. Pharmacist. Link