Treating Depression Before, During, and After Pregnancy

If you have major depressive disorder (MDD), you may wonder if it’ll affect your plans for a family. Will you have to stop taking your antidepressant? What are the risks to your baby if you don’t? Can you take antidepressants while breastfeeding?

Whether you’ve dealt with depression for a long time or recently been diagnosed, here’s what you need to know.

Why Treatment Is Important

If you don’t treat your MDD, you could relapse. That’s when your symptoms come back. When you’re depressed, you’re less likely to eat well and get the care you and your baby need. You’re also more likely to use drugs.

The risk of depression after your baby is born -- postpartum depression -- is higher. This can affect your ability to bond with your baby.

“We know that babies who are born to moms who are depressed, stressed, or anxious in pregnancy are born with increased levels of cortisol, the stress hormone, which makes the babies themselves extra reactive,” says Lauren Osborne, MD, associate professor of psychiatry, gynecology, and obstetrics at the Johns Hopkins University School of Medicine. “This sets them up for their own psychological problems going into childhood.”

Your treatment options depend on:

  • The severity of your depression
  • What treatment you’re on now
  • How you’ve responded to other medications
  • Whether you’re pregnant, planning to get pregnant, or breastfeeding

You may be able to get through pregnancy without an antidepressant if your MDD is mild and you’ve responded well in the past to:

  • Psychotherapy
  • Support groups
  • Prenatal yoga

If you need an antidepressant later, you can always try one that’s lower risk.

Electroconvulsive therapy (ECT) may be an option for severe MDD that doesn’t respond to medication. ECT sends electrical currents to your brain that may affect neurons and certain chemicals. It’s considered safe for both you and your baby.

Medication Risks

Generally, the chances of birth defects or other issues from taking antidepressants during pregnancy are low. But some medications have more evidence of safety for than others.

Continued

Before Pregnancy

If you have MDD, make a treatment plan with your obstetrician (OB) before you get pregnant if possible. This gives you and your doctor time to talk about what treatments might be best before, during, and after pregnancy. And if you need to switch medications, this gives you time to make changes.

The two classes with the most evidence of safety for pregnancy are selective serotonin reuptake inhibitor (SSRIs) and tricyclic antidepressants (TCAs). TCAs are older antidepressants that can cause several side effects whether you're pregnant or not. So your doctor probably won’t prescribe it first. For most people, Osborne recommends a well-studied SSRI, like citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), or sertraline (Zoloft).

If you’re taking a serotonin-norepinephrine reuptake inhibitor (SNRI) like duloxetine (Cymbalta) or venlafaxine (Effexor) because SSRIs haven’t worked for you, it’s probably fine.

“I’m not inclined to make a switch because I know this works and something else won’t,” Osborne says. “We have some reasonable evidence on SNRIs as well.”

Osborne says there’s not enough research on the safety of newer antidepressants like vortioxetine (Trintellix) in pregnancy. They haven’t been around long enough. In this case, she’d recommend switching to something with more evidence of safety.

During Pregnancy

If you’re already on an antidepressant, you probably shouldn’t switch to another one, no matter what you’re taking. This helps limit your baby’s exposure. Most importantly, don’t feel bad about taking an antidepressant while you’re pregnant.

“I think there’s a real tendency in this country, because of the stigma against mental illness, for a lot of people, including a lot of physicians, to assume that an antidepressant is an optional treatment,” Osborne says. “They say, ‘You can take that medication if you really need it,’ which makes the mom feel terrible and like she doesn’t really need it.”

After Pregnancy

Trying to manage symptoms of depression while caring for your newborn can make an already challenging time worse. So it’s important to keep taking your medication. Call your doctor if you notice your symptoms getting worse.

Antidepressants can enter breast milk, but it’s a very small amount -- less than 10% of whatever dose you’re taking.

“There’s never a situation in which I’m going to say, ‘I want you to take this medication and you can’t breastfeed because you’re taking it,’ because antidepressants just don’t have that level of risk,” Osborne says.

WebMD Feature Reviewed by Hansa D. Bhargava, MD on February 01, 2021

Sources

SOURCES:

Lauren Osborne, MD, associate professor of psychiatry and gynecology and obstetrics, Johns Hopkins University School of Medicine, Baltimore.

Mayo Clinic: “Antidepressants: Safe during pregnancy?”

Medscape: “What is the role of electroconvulsive therapy (ECT) in the treatment of pregnant women?”

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