Pregnancy and Antidepressants

Deciding to continue or stop using antidepressants during pregnancy is one of the hardest decisions a woman must make. Untreated depression can have harmful effects on both the mother and the baby. But, taking antidepressants while pregnant may increase the risk of problems for the baby.

When making the decision, it’s important to consider your health, the health of your unborn child, and the well-being of your family, including your other children. It’s also important to not make the decision before discussing it with your doctors. That includes the ob-gyn and the psychiatrist. Together, you can weigh the pros and cons of continuing or stopping your medication and make the right decision for you.

Depression and Pregnancy

Many women battle depression and need antidepressants to manage their symptoms. In the past, it was thought that pregnancy protected against depression. But scientists now realize this is not the case. More and more women are taking antidepressants while pregnant to keep their symptoms in check. One study found that between 1998 and 2005, nearly one out of every 20 women reported using an antidepressant three months before becoming pregnant or during the pregnancy.

There are questions about the safety of taking antidepressants when you are pregnant. But research is showing that many antidepressants, especially the selective serotonin reuptake inhibitors (SSRIs) and older medications, are generally safe. Birth defects and other problems are possible. But the risk is very low.

Pregnancy and Antidepressants: What the Experts Say

Both psychiatric experts and ob-gyn experts agree that if you have mild depression and have been symptom-free for at least six months, you may be able to stop using antidepressants under a doctor’s supervision before getting pregnant or while you are pregnant. Psychotherapy, along with lifestyle measures, may be all that you need to manage your depression. You may be able to get through your pregnancy without antidepressants if you:

  • Talk with a therapist on a regular basis
  • Exercise more
  • Spend time outside
  • Practice yoga and meditation
  • Minimize your stress

But, the experts point out, it will be better for both you and your baby to stay on antidepressants while pregnant if any of the following is true:

  • You have a history of severe or recurrent depression
  • You have a history of other mental illnesses, such as bipolar disorder
  • You have ever been suicidal

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Pregnancy and Antidepressants: Understanding the Risks

Few, if any, medications are considered absolutely safe during pregnancy. Research findings on the effects of antidepressants on the growing baby are mixed and inconclusive. One study may find a particular antidepressant causes one type of risk. Another one, though, may find that it doesn’t. Also, the risks to the baby may be different depending on the type of antidepressant and when in the pregnancy it is taken. Regardless, most risks found by researchers have been low.

Reported risks for the baby include:

  • Persistent pulmonary hypertension in the newborn (PPHN), a serious condition of the blood vessels of the lungs.
  • Miscarriage.
  • Heart defects.
  • Birth defects, including anencephaly (affecting the spinal cord and brain), craniosynostosis (affecting the skull), omphalocele (affecting the abdominal organs), and limb malformation.
  • Preterm birth (being born before 37 weeks gestation).
  • Low birth weight (being born less than 5 pounds, 8 ounces).

In addition, at least one study showed that babies exposed to antidepressants in the womb experienced withdrawal symptoms, such as:

Some required a short stay (one to four days) in the neonatal intensive care unit. None of these symptoms caused any long-term harm to the baby.

The long-term impact of antidepressant exposure on development and behavior is still unclear. But, studies have not found a significant difference in IQ, behavior, mood, attention, or activity level in children who were exposed to antidepressants in the womb.

Pregnancy and Untreated Depression

Left untreated, depression can have far reaching effects on both your and your baby’s health. Women who are depressed are less likely to take proper care of themselves. For instance, they may not eat a healthy diet or may skip doctors’ appointments. Plus, women who are depressed may be more likely to take part in risky behaviors, such as drinking alcohol, smoking, or taking drugs during pregnancy. All of these actions can lead to potentially serious health problems for the baby, including miscarriage, preterm birth, and low birth weight.

Untreated depression can also take a toll on family dynamics. That includes your relationship with your spouse and other children. If you have older kids, they need you to care for them. For some pregnant women, regardless of their mental state, it can take all the energy they have to care for themselves. Add depression to the mix, and the suffering can become intolerable for everyone. If depression is preventing you from caring for your family, you may need to stay on your antidepressants during this vulnerable time.

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Antidepressants and Pregnancy: Keeping Risks in Perspective

It‘s important to keep the risks associated with antidepressant use in pregnancy in perspective. All pregnant women have an average 3% risk of having a baby with any type of birth defect in most cases. When researchers say antidepressants may increase the risk of certain birth defects, they are talking about just a slight increase. For example, one study showed that antidepressants increased the risk that the baby would be born with PPHN by 1%. So, even if you take an antidepressant during pregnancy, the overall risk of your baby having a problem is still very low. Other studies showed different levels of risk associated with antidepressants and PPHN, and 1% is on the high end. So the risk may be even lower.

Pregnancy and Antidepressants: Medication Options

Some antidepressants are considered safer for pregnant women than others. Antidepressants that are considered safer include:

But if you are pregnant and taking an antidepressant that is not on this list, do not worry. Even the more controversial ones, including paroxetine (Paxil), have relatively low risk. Changing medications mid-pregnancy poses its own set of problems. Talk to your doctor and see what he or she thinks would be best for you.

If you are not pregnant but planning on becoming pregnant, it may be worth trying a different medication if you are concerned about the safety of your current antidepressant. Again, talk to your doctor to see if this is a good option for you.

Pregnancy and Antidepressants: What to Do?

No matter how small the risk, no mother wants to unnecessarily expose her baby to medicine. Making the decision to take or stop taking antidepressants in pregnancy is not easy. There is no right answer. You must look at your own set of circumstances and make the decision based on the risks and benefits unique to you. If you and your doctor think you may be able to stop your medication during pregnancy, it is certainly worth a try. But, never stop taking your medication without talking to your doctor first. Most antidepressants require weaning to safely stop the drug. If you need to stay on an antidepressant while you are pregnant, don't panic. Remember, the risks associated with most of the antidepressants in pregnancy are extremely low. Untreated depression could pose a greater risk.

Whatever you finally decide to do, do not second-guess yourself. Once you make the decision, accept it and move on. Trust yourself and your doctors. Like you, your doctors want the very best possible outcome -- a healthy mom and baby.

WebMD Medical Reference Reviewed by Trina Pagano, MD on October 04, 2014

Sources

SOURCES:

Chambers, C. The New England Journal of Medicine, Feb. 9, 2006; vol 354: pp 579-587.

Nakhai-Pour, R. Canadian Medical Association Journal, July 2010; vol 182: pp 1031-1037.

Louik, C. The New England Journal of Medicine, June 28, 2007; vol 356: pp 2732-2734.

Alwan, S. The New England Journal of Medicine, June 28, 2007; vol 356: pp 2684-2692.

News release, American College of Obstetricians and Gynecologists.

Massachusetts General Hospital: "Psychiatric Disorders During Pregnancy."

CDC: "Use of Medications in Pregnant Women."

National Institute of Mental Health: "Which groups have special needs when taking psychiatric medications?"

March of Dimes: "Your Premature Baby."

National Institute of Mental Health: "Women and Depression."

Mayo Clinic: "Antidepressants: Safe during pregnancy?"

Lori Wolfe, president, Organization of Teratology Information Specialists (OTIS).

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