Health & Pregnancy

You may be taking medicine for depression and are wondering if you should stop because you are pregnant or planning to become pregnant. Or maybe you just found out that you have depression and are wondering if you should start taking medicine, even though you are pregnant. Consider the following when making your decision:

• Certain types of antidepressants are less likely to harm your baby than others. More research is needed before doctors can say for sure that any antidepressant is completely safe for the baby.
• If you don't treat your depression, it could harm your baby. People who are depressed can have a hard time caring for themselves. And after your baby is born, you may be more likely to suffer from postpartum depression, which can cause serious problems for both you and your newborn.
• The decision about whether to take antidepressants while you are pregnant depends a lot on how bad your symptoms are. Talk to your doctor, and compare the risks of taking the medicine with the risks of living with your symptoms.
• If you were taking medicine for depression before you got pregnant, stopping now could cause your symptoms to come back. Also, quitting antidepressants suddenly can cause you to feel like you have the flu. Talk to your doctor first.

What is depression?

Depression is an illness that makes you feel sad and hopeless for much of the time. It is different from normal feelings of sadness or low energy. It can have a very big effect on your life, your work, your health, and the people you care about. Many pregnant women struggle with depression.

What are the risks of taking antidepressants while you are pregnant?

There are several types of antidepressant medicine. Some types are less likely to harm your baby than others. More research is needed before doctors can say for sure that any antidepressant is completely safe for the baby.

For pregnant women, doctors may choose SSRIs (selective serotonin reuptake inhibitors), such as Zoloft or Prozac, or tricyclic antidepressants.

But more research is needed. One recent study found that babies whose mothers took SSRIs during the second half of their pregnancies were more likely to have a rare but serious breathing problem.¹

The U.S. Food and Drug Administration (FDA) has sent out a warning on the drug Paxil (paroxetine), an SSRI. Taking Paxil during the first 12 weeks of pregnancy may increase a woman's chance of having a baby with a birth defect. But for some women who have already been taking Paxil, the benefits of continuing may be greater than the potential risk to the baby. Talk to your doctor if you are taking Paxil and are thinking about getting pregnant.

You may have side effects from SSRIs or tricyclics, but they usually go away within the first few weeks. Common side effects include stomach upset, loss of appetite, diarrhea, feeling anxious or on edge, sleep problems, drowsiness, loss of sexual desire, and headaches.

If you were taking antidepressants at the end of your pregnancy, your newborn may need to stay in the hospital for a few extra days. This is so that doctors can watch for signs of drug withdrawal. These signs sound scary, but they are usually mild and go away in a few days. They include mild breathing problems, crying more than is usual, having trouble feeding, or in rare cases having seizures. If you are worried about this, talk to your doctor about gradually stopping your medicine a week or two before your due date.

What are the risks of NOT taking antidepressants?

When depression is not treated during pregnancy, it can harm both mother and child. People who are depressed may not eat well or get enough sleep. They are more likely to smoke and drink. They may think about killing themselves. Pregnant women who are depressed are less likely to go to the doctor as often as they should. A depressed woman is more likely to deliver early and to have a baby that weighs less than it should.²

Women who have depression during pregnancy and don't treat it are also more likely to have postpartum depression after the birth. Postpartum depression makes it hard to care for and bond with your baby. Babies of depressed mothers may be slower in some areas.³

Never stop taking an antidepressant suddenly. If you have been taking medicine to treat depression and find out you are pregnant, talk to your doctor. If you decide to stop taking the medicine, you will need to lower your dose slowly, with your doctor's help.

What other treatment is available?

Counseling is an important part of treatment for depression. If you have only mild depression, counseling alone may be enough to help you feel better.

Light therapy, which involves sitting in front of a special light box for about 30 minutes every day, can help people with seasonal affective disorder, also called the "winter blues." Recent studies suggest that light therapy may help with depression too.⁴

If you need more information, see the topic Depression or Postpartum Depression.

Your choices are:

• Take medicine for your depression.
• Try other treatment for your depression first.

The decision about whether to take antidepressants during pregnancy takes into account your personal feelings and the medical facts.

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about taking antidepressants while pregnant. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use antidepressants during your pregnancy.

Check the box below that represents your overall impression about your decision.

• Depression
• Postpartum Depression
• Pregnancy

Organizations

• Depression
• Postpartum Depression
• Pregnancy

Citations

1. Chambers CD, et al. (2006). Selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. New England Journal of Medicine, 354(6): 579–587.

2. Gentile S (2005). The safety of newer antidepressants in pregnancy and breastfeeding. Drug Safety, 28(2): 137–152.

3. Newport DJ, et al. (2002). The treatment of postpartum depression: Minimizing infant exposure. Journal of Clinical Psychiatry, 63(Suppl 7): 31–44.

4. Tuunainen A, et al. (2004). Light therapy for non-seasonal depression. Cochrane Database of Systematic Reviews (2). Oxford: Update Software.