Every year approximately 10 to 15% of reproductive-aged women in the US are prescribed antidepressants. The doctor may prescribe pregnancy-safe antidepressants based on the individual’s treatment history, past medications, pregnancy condition, the severity of depression, and the most up-to-date information on reproductive safety. Untreated depression may contribute to adverse pregnancy outcomes, affecting maternal well-being and leading to complications (1). This post discusses the safe use of antidepressants during pregnancy and the risks associated with them.
Why Is Treatment Of Depression During Pregnancy Important?
Maternal depression is a major risk factor for adverse effects in both the mother and fetus. Depression during pregnancy is associated with:
Increased risks of preeclampsia, fetal distress, preterm birth, low birth weight, and postpartum depression. Unhealthy maternal behavior such as maternal tobacco smoking, excess caffeine consumption, poor nutrition, and inadequate exercise. Cognitive and behavioral problems of the child with growth.
Effective treatment can decrease these risks. Abruptly stopping antidepressant treatment in pregnancy in women with a previous history of depression may cause a relapse of symptoms in approximately 60-70% of women. Additionally, perinatal depression may also increase the risk of maternal suicide (2) (3).
Are Antidepressants Safe During Pregnancy?
Studies suggest that antidepressants of the class, selective serotonin reuptake inhibitors (SSRIs), have not been found to cause major malformations with the exception of paroxetine, sold as Paxil. Some other antidepressants, such as selective norepinephrine reuptake inhibitors (SNRIs) and dopamine reuptake inhibitors, may also be used. Some antidepressant medications have been associated with congenital malformations. Therefore, discuss the risks and benefits of antidepressants extensively with your psychiatrist. It can help you identify a safe and effective option during pregnancy (4) (5).
Which Antidepressants Are Commonly Prescribed During Pregnancy?
Sertraline (an SSRI) did not show confirmed links with birth defects in a study conducted by the Centers for Disease Control and Prevention (CDC). Sertraline (Zoloft) is prescribed most often to pregnant women with depression (6). Other antidepressants prescribed during pregnancy may include (7):
Citalopram (Celexa) Escitalopram (Lexapro) Fluoxetine (Prozac) Bupropion (Wellbutrin)
The above-mentioned drugs are enlisted in pregnancy category C (Animal reproduction studies have shown potential adverse effects on the fetus, and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of a drug in pregnant women despite potential risks) as per the US Food and Drug Administration (FDA) (8).
Can Antidepressants Cause Miscarriage?
Some studies have shown an increased risk of spontaneous abortions (miscarriages) with antidepressant exposure in early pregnancy. However, these studies did not include the contribution of the underlying psychiatric illness and other factors such as poor nutrition, smoking, and substance abuse (9).
What Are The Other Potential Risks Of Using Antidepressants During Pregnancy?
Doctors need to balance the potential risks of medications with that of the untreated disorder during pregnancy. Antidepressant exposure late in the third trimester of pregnancy may cause neonatal complications requiring prolonged hospitalization, respiratory support, and tube feeding. Potential risks of prenatal exposure to antidepressants include (6) (8):
1. Fluoxetine has been linked to:
Cardiac malformation (heart defect) with obstructed right ventricular outflow tract Craniosynostosis (a birth defect in which the bones in a baby’s skull join together too early)
2. Paroxetine may be associated with:
Anencephaly (baby is born without parts of the brain and skull) Atrial septal defects (a type of heart defect) Heart defects with obstructed right ventricular outflow tract Gastroschisis (structural anomaly of the abdominal wall) Omphalocele (a birth defect of the abdominal wall)
3. Other conditions linked to SSRIs are:
Persistent pulmonary hypertension (PPHN) in the newborn (failure of the lungs to breathe outside the womb). Neonatal withdrawal symptoms such as seizures, temperature instability, feeding difficulty, gastrointestinal problems, tremor, increased or decreased muscle tone, jitteriness, irritability, and constant crying. These conditions may also be caused by SNRIs. Antidepressant exposure late in the third trimester may cause neonatal complications requiring prolonged hospitalization, respiratory support, and tube feeding.
