June 12, 2015 -- If you're pregnant (or are trying to be) and you have depression, you might wonder if it's safe to take medicine to boost your mood. Will antidepressants harm your baby? Spend a day online and the ping-pong reports of their safety during pregnancy could make your head spin.
The issue has long been a topic of debate. Some studies suggest antidepressants are dangerous for babies in the womb. Others say the risks are extremely small, and that untreated depression poses a bigger threat to both the baby and mom.
Also, "there's an idea that antidepressants are a luxury medicine, and women should be pulling up their socks and getting through their pregnancy without taking them," says Jennifer Payne, MD, director of the Women's Mood Disorders Center at Johns Hopkins. "But what most people do not understand is the risk of untreated depression to both the mother and baby is substantial."
More Pregnant Women Using Antidepressants
Depression affects millions of pregnant women. It's due in part to changes in the mood-boosting chemicals in the brain. Commonly used antidepressants can help balance these chemicals.
"Roughly about 1 in 10 women [takes] an antidepressant during pregnancy," says Krista Huybrechts, PhD, an assistant professor of medicine at Brigham and Women's Hospital. She's written research on the topic, including a recent report.
Use of such meds by pregnant women has skyrocketed in the last two decades. One type, called selective serotonin reuptake inhibitors (SSRIs), now ranks among the top 20 drugs prescribed during pregnancy. In 1998, no antidepressants made that list, according to a recent commentary in the Journal of Nervous and Mental Disease. Despite the wide use, there is limited data on the drugs' dangers, because pregnant women are typically excluded from safety trials.
"It's an ethical dilemma," says Siobhan Dolan, MD, an OB/GYN and medical advisor to the March of Dimes. "We understand why we exclude pregnant women from medication trials, but we don't have data to counsel them. So are we really helping them?"
How to Read Studies on the Topic
Before you look at the potential dangers of antidepressants during pregnancy, it's important to understand how to interpret the information in research on the subject. Negative news always tends to spread more swiftly, particularly on social media.
Also, "women who take antidepressants are different than women who don't. They have other risk factors that can lead to problems during pregnancy. So is it the mental illness or the actual medication that causes the risks?" Dolan says.
Reported Dangers to the Baby
Among the most publicized risks of taking an antidepressant during pregnancy is persistent pulmonary hypertension of the newborn (PPHN). It's a life-threatening condition in which a baby has high blood pressure in the lungs, causing severe breathing problems.
Scientists first linked it to the use of SSRIs in 2006, prompting the FDA to issue a warning about it. Five years and five conflicting studies later, the FDA revised its statement, saying "it is premature to reach any conclusion about a possible link between SSRI use in pregnancy and PPHN." Since then, a handful of reviews, including one in June, have further reassured pregnant women that the risk is "statistically insignificant."
"Our study by no means says that antidepressant use is safe during pregnancy. It is just that, for this outcome, we do not find an increased risk of PPHN," says Huybrechts, who co-authored the study.
Another concern for moms-to-be taking these meds is the chance of heart defects in the baby. The FDA warned in 2005 that paroxetine (Paxil) could lead to holes and other structure problems in a newborn's heart. But a study published last year didn't confirm the risk.
About 3 in 10 babies born to moms who have taken SSRI have a temporary condition called poor neonatal adaption syndrome. Symptoms include:
- Low blood sugar
- Poor muscle tone
- Weak cry
Still, in at least one study, researchers say they don’t believe it causes long-lasting effects in a child.
Reasons to Take an Antidepressant When Pregnant
Lots of research shows that depression during pregnancy can be bad for the health of mom and baby. If you have a mental illness and become pregnant, it's considered a high-risk pregnancy.
Pregnant moms who are depressed are:
- Less likely to get proper prenatal care
- Less likely to eat healthfully
- More likely to smoke and drink alcohol
Depression during pregnancy also raises your chances of conditions that can lead to infant death and illness, including:
- High blood pressure and organ damage during pregnancy (preeclampsia)
- High blood sugar during pregnancy (gestational diabetes)
- Baby being born too soon (preterm birth)
- Baby weighing less than 5 pounds, 8 ounces at birth (low birth weight)
Which Antidepressants Are Safest During Pregnancy?
There is no clear-cut answer. Using any medicine while you're expecting can be risky. "We tend to use older antidepressants, like Prozac or Zoloft, because they've been around for a long time and if there's going to be an issue we would have seen it," Payne says.
If you're pregnant and depressed, make extra time to weigh the risks and benefits of medication with your doctor.
"It's not a black and white issue. There's a lot to consider," Dolan says. "Risk and benefits. Timing in pregnancy. Optimal medical management. Maybe you're on two or three antidepressants. Can you get down to one? A woman and her doctor need to personalize treatment. There's not a one-size-fits all answer. "
If you've been taking medicine for depression and become pregnant, don't stop taking it until you get your doctor's OK. About 90% of women who quit their meds often see their depression come back during the last 3 months of pregnancy. If a particular medicine has worked for you, experts in this article encourage you to stick with it and get regular tests to check the baby's growth and heart rate.
"The best antidepressant to use during pregnancy is the one that keeps the moms well," Payne says.