Taking Antidepressants During Pregnancy

Taking Antidepressants During Pregnancy Depression Treatment Medication Print Taking Antidepressants During Pregnancy Mothers Mental Health and Medication Safety By Nancy Schimelpfening Nancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary. Nancy has a lifetime of experience with depression, experiencing firsthand how devastating this illness can be. Learn about our editorial policy Nancy Schimelpfening Updated on February 06, 2020 Depression Overview Types Symptoms Causes & Risk Factors Diagnosis Treatment Coping ADA & Your Rights Depression in Kids Wavebreakmedia / Getty Images In This Article Table of Contents Expand Pregnancy & Depression Antidepressant Safety Types of Antidepressants Natural Treatments Risks of  Untreated  Depression View All Deciding whether to start or continue taking an  antidepressant  if you become pregnant can  be a difficult decision.  Expectant parents often worry that certain exposures during pregnancy will cause birth defects.  Prospective parents may wonder if medications will negatively affect their attempts to conceive.     Studies  have indicated that many  medicationsâ€"including  antidepressantsâ€"may  affect  a  developing fetus. However, research has also  demonstrated that  maternal depression  can  negatively impact fetal development. These effects  may even have lasting  consequences that stretch into childhood and beyond. Deciding whether to take antidepressants during pregnancy is not a decision you need to make alone. Armed with the facts  about each type of antidepressant,  you can discuss the pros and cons of  your  choice with your doctor and mental health care provider.   Pregnancy and Depression In 2019, the  Centers for Disease Control and Prevention  (CDC)  published a report on the rate of depression in women giving birth in a hospital between 2000â€"2015.  According to data,  the rate of depression in 2015 was  seven times higher  than it had been in 2000.??     Previous  research published in 2007  had indicated that  the rate of depression among pregnant women was  between 12% and 15%.?? The rate of depression in U.S. women overall  is around 10%, according to the CDC.  ?? According to  a 2012 report  from the  CDC,  depression in pregnancy often goes  undiagnosed.  Of  all  people who are diagnosed with depression  (whether they are pregnant or not),  only about half receive treatment.  Approximately 39% of pregnant people are prescribed medication to treat depression.     Pregnancy causes a cascade of physiological and psychological changes that may increase a person’s risk of depression. This risk may even  extend after the birth of a  child  and contribute  to symptoms of  postpartum depression.     Pregnancy and Antidepressants     The biological  stress of  pregnancy, such as shifting hormones,  can  also  change  how the  brain and body  respond to antidepressants.?? These changes can impact everything from  how the medications are metabolized and absorbed, to how they are eliminated.??  The ramifications may affect both the pregnant parent and the developing fetus.   Pregnancy may affect how well an antidepressant works or the side effects it causes.  Even if someone does not wish to stop taking  an  antidepressant  while  they are pregnant, they may need to adjust the dose.   Antidepressants can  cross the placenta and enter the amniotic fluid. The medications also pass into breastmilk, meaning exposure can continue after a baby is born  through breastfeeding.     Many studies have suggested that antidepressants can impact fetal development, but the evidence has not been conclusive.  Research on the effects of antidepressants in pregnancy is limited largely due to  ethical restrictions.??     People who are pregnant,  fetuses,  and newborns  cannot be directly subjected to the  type of testing or  experimentation  that would be necessary to  provide more definitive proof of the medication’s effects.   Based on what researchers do understand about the mechanisms of both pregnancy and pharmaceutical treatments for depression, it’s likely that many factors determine what, if any, effect antidepressants have.   Types of Antidepressants Each class  of  antidepressant medication carries  its own set of  risks.  Everyone  who is taking an antidepressant needs to be informed of  and understand these  risks. If you  are pregnant  or planning to conceive,  it’s important to discuss your individual risk factors with your doctor. The  FDA categorizes and labels all drugs  based on research  about their safety, including how safe they are to take during pregnancy.?? Your doctor  may  choose to  prescribe a drug  that the FDA  has not categorized as being completely safe to take during pregnancy  if  the benefits of the medication for you outweigh the risk.     Selective Serotonin Reuptake Inhibitors (SSRIs) Selective serotonin reuptake inhibitors (SSRIs)  are one of the most commonly prescribed classes of antidepressant medications.  Popular  SSRIs include:   Prozac (fluoxetine)  Zoloft (sertraline)  Luvox (fluvoxamine)  Paxil (paroxetine)Celexa (citalopram)Lexapro  (escitalopram)   The Most Common Antidepressants SSRIs  are among the newer classes of antidepressants available. Consequently, there is more research about their safety. However,  SSRIs are not without risk.     The research on SSRIs  in pregnancy  has been largely mixed.?? Some studies have linked specific medications  to an increased risk of miscarriage  and birth defects,  but subsequent studies failed to confirm these findings.     For example,  a  2007 study  indicated that taking  Paxil in the first trimester of pregnancy  might be linked to a higher  risk of  congenital  heart  abnormalities.?? However, later studies showed that  heart defects  were  found just as often  in  babies whose mothers had not taken antidepressants.??     In addition to maternal and fetal health, researchers have also evaluated whether taking an antidepressant during pregnancy affects newborn health. Poor neonatal adaptation  (PNA)  or  neonatal adaptation syndrome  is a recognized and treatable condition  that occurs  in  approximately 10% to 30% of  newborns who were exposed to  SSRIs or SNRIs in utero.   When they  are no longer being exposed to low levels of the antidepressant,  newborns  may  develop  respiratory  and/or neurological  problems  like those  seen in babies  withdrawing from exposure to illicit drugs and alcohol.   However, unlike the consequences of conditions like fetal alcohol syndrome, babies with poor neonatal adaptation usually respond well to treatment and get better on their own within a week after birth.  Research has suggested that other factors, such as whether infants were breast or formula-fed after birth, may also  influence the risk for PNA.??   Researchers aren’t sure why some newborns develop the syndrome while others do not. It likely depends on many individual factors (such as drug metabolism) specific to both the infant and the mother.     Overview of Selective Serotonin Reuptake Inhibitors Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) Serotonin-norepinephrine reuptake inhibitors (SNRIs)  block the reuptake of both serotonin and another neurotransmitter called norepinephrine. Common SNRIs include:   Cymbalta (duloxetine)  Pristiq (desvenlafaxine)  Effexor and Effexor XR  (venlafaxine/venlafaxine XR)   While some research has claimed an association between SSRIs and SNRIs and preterm birth, other studies have not supported these claims.     The risk of rare conditions, such as  persistent pulmonary hypertension, may be increased in newborns who were exposed to antidepressants in the womb, but the research is  not conclusive.??  The  overall  risk of a baby developing  the  form of high blood pressure  is  incredibly small (less than 1%).??     How SNRIs, SSRIs, and SNDRIs Differ in Treating Depression Tricyclic Antidepressants (TCAs) Tricyclic antidepressants  (TCAs)  are the oldest class of antidepressants. TCAs work by blocking neurotransmitters and other  receptors in the brain. Although TCAs have been  in use for a  long time, they  arent prescribed as often today. These medications tend to have more side effects than newer antidepressants. The most commonly prescribed TCAs include:   Elavil (amitriptyline)    Tofranil (imipramine)    Pamelor (nortriptyline)    Anafranil (clomipramine)     Elavil is one commonly prescribed TCA and may also be given to people who get migraines. As with the other TCAs, research on using Elavil during pregnancy is limited. The small number of studies has not definitively linked the medication to specific  outcomes for people who are  pregnant  or fetuses exposed to the drug in the womb.   Several  studies have  evaluated large numbers of  pregnant women taking  TCAs or other  antidepressants  and  proposed a link between taking the medications early in pregnancy and certain congenital malformations. However, the authors note that their research did not  account for  other factors that could  affect fetal  development,  like smoking cigarettes and using alcohol.     Overview of Tricyclic Antidepressants Monoamine Oxidase Inhibitors (MAOIs) Monoamine oxidase inhibitors (MAOIs)  work by  breaking  down  neurotransmitters  like dopamine and serotonin. Like TCAs, antidepressants in the MAOI class tend to have a lot of side effects and  can interact with food, drinks, and other drugs. Popular MAOIs include:   Nardil  (phenelzine)  Emsam  (selegiline)  Marplan  (isocarboxazid)  Parnate  (tranylcypromine)   There has not been much research on MAOIs and pregnancy, partly because this class of antidepressants is not prescribed as often as newer antidepressants. A  2017 case report  published in the journal  Reproductive Toxicology  noted fetal malformations  in the two pregnancies of a  woman taking high doses of MAOIs.?? Both pregnancies resulted in fetal abnormalities, one of which was severe enough to result in stillbirth. The second infant was born with severe physical and neurological disabilities. The authors of the paper  speculated that the high dose of MAOIs contributed to outcomes of the pregnancies, but  it  was not clear if (or how) the medications caused the  specific malformations. Additional factors may have contributed, such as the other medications the woman had taken during her pregnancy and the parents ages (both were over 40). The family also declined to undergo  testing  to investigate a genetic cause for birth defects.     Research on the potential risk of  Nardil  (one of the more commonly prescribed MAOIs) on a developing fetus is limited.  The  FDA  label  states that health care providers  need to  weigh the potential risks of  Nardil  against the benefits when prescribing the  medication  for people who are pregnant.  This recommendation is consistent with the other MAOI antidepressants as well as medications in other classes.     Overview of Monoamine Oxidase Inhibitors Atypical Antidepressants   There are a few other medications that  can be prescribed  â€œoff-label”  to treat depression.  Since they don’t neatly fit into one of the other categories, these  drugs are referred to as  atypical antidepressants/antipsychotics.     While they are in the same category, the  medications  work in different ways  and  are often  used to treat  mental health  conditions other than  depression, such as bipolar disorder, schizophrenia, and attention-deficient hyperactivity disorder (ADHD).  Some of the medications  may also be  prescribed to treat  chronic pain and irritable bowel syndrome  (both of which can  co-occur with depression).   Medications prescribed as atypical antidepressants include:   Wellbutrin (bupropion)  Abilify (Aripiprazole)  Seroquel  (quetiapine)  Zyprexa (olanzapine)    Latuda (lurasidone)  Risperdal (risperidone)  Remeron  (mirtazapine)  Oleptro  (trazodone)     The drugs within this class may be classified into subcategories based on how they work. For example, Wellbutrin is also classified as a norepinephrine and dopamine reuptake inhibitor (NDRI).   Risperdal, Seroquel, Latuda, and Zyprexa are considered atypical antipsychotics. These drugs were developed to have fewer side effects than older antipsychotics and work by altering the levels of dopamine in the brain, which can help control symptoms such as hallucinations and paranoia in people with schizophrenia. Due to the effect on dopamine and other neurotransmitters, atypical antipsychotics may also be helpful for people with severe depression who have not responded to other medications. Researchers are also investigating other medications used to treat depression. For example, the CDC has led many studies on the effect of prescription and over-the-counter medications on pregnancy and fetal development as part of its  Treating for Two  initiative. Most classes of  antidepressants were evaluated  in the research, including popular atypical antidepressants, such as Wellbutrin.??  A  2010 study  indicated that taking Wellbutrin during  early  pregnancy was associated with an increased risk of fetal heart defects.?? However, researchers noted that the overall risk  for those defects  was small and concluded that more research was needed to establish Wellbutrin as a potential cause. Another popular atypical antidepressant, Abilify, has also been the subject of research. A  2018 review of the literature  concluded that if  someone is  taking Abilify before  they  become pregnant  (and the  drug has effectively managed their symptoms), health care providers should weigh the potential risks of continuing it against the risks of discontinuation.??     As with other drugs in this class, research about the potential risk of miscarriage, preterm birth, neonatal withdrawal symptoms, birth defects, and the potential for developmental delays  is  limited and, in some cases, nonexistent.     Natural Treatments for Depression   There  are also non-prescription or alternative treatments for depression,  such as St. John’s wort.  Research hasnt established a significant difference in the risk of specific effects on the developing fetus (such as congenital malformations) when taking St. Johns wort during pregnancy compared to antidepressants. However, anyone planning to use St. Johns wort needs to be aware of potential interactions. For example, taking St. Johns wort with medications, supplements, or foods containing 5-hydroxytryptophan  (5-HTP), L-tryptophan, or  SAMe, can increase your risk for developing serotonin syndrome. As with medications, ask your doctor about taking a nutritional supplement or herbal remedy if you are pregnant or breastfeeding. Resources for Research For information on specific medications or alternative treatments, the Mother-to-Baby  exposure database, maintained by the Organization of Teratology Information Specialists (OTIS), can be a helpful resource. The fact sheets created by the non-profit summarize  the available  research on the use of  prescription  medications and herbal supplements  during pregnancy.   The Risk of  Untreated  Depression   While you will want to consider the risks associated with taking an antidepressant if you are pregnant, its important to remember that untreated depression also carries risks. Discontinuing an antidepressant puts you at risk for a relapse of your  depression symptoms.?? The risk may be greater when you are pregnant and right after you give birth.     Do not discontinue your antidepressant without talking to your doctor or mental health care provider.  Unless they direct you to, do not abruptly stop taking your medication. Withdrawing from antidepressants can cause side effects and pregnancy may intensify these symptoms. The Importance of Treating Prenatal Depression Pregnancy was once  believed  to  provide some protection against depression due to shifting hormones, but research has not supported this theory.?? In fact, the opposite may be true: Some research has shown that depression in either parent can affect the  health of a child.??     Many studies have demonstrated that  maternal stress during pregnancy  can negatively affect fetal development and may influence the later behavior and emotional well-being of the child.??   The physical and emotional stressors of pregnancy can contribute to or worsen feelings of depression.  The symptoms of depression can affect how well a person can take care of their needs. This  includes  everything from practicing overall self-care to pregnancy-specific care  such as prenatal appointments.     People with depression  may  also be more likely to use  substances  to cope with their symptoms. The risks  associated with  drinking  alcohol  and using  illicit  drugs during  pregnancy are well-established. Substance use during pregnancy can  have  serious long-term consequences for parents and children.     Eating well, getting enough sleep, staying physically active,  and avoiding drugs and alcohol  benefit everyones well-being, but  these considerations are  especially  important for expectant  parents.  The demands of pregnancy are felt in the mind as well as the body, so a healthy pregnancy requires taking care of your physical and mental health.     A Word  From  Verywell   Taking antidepressants  during pregnancy  and letting depression go untreated both present potential risks  to mothers and infants.  If you are  trying to decide whether to stop taking your antidepressant during pregnancy, talk to your doctor or therapist. They can help you look at the most recent and relevant research, as well as consider your individual risk factors. This information will prepare you to make an informed decision. If you decide to stop taking your antidepressant  medication while you are pregnant, you need to have a solid support system in place and strategies to help you  cope with depression  symptoms. An Overview of Perinatal Depression