Managing symptoms of depression while pregnant is possible, and sometimes it may include taking prescription drugs.
If you‘re expecting a child, it‘s natural to wonder if antidepressant use during pregnancy may put you or the baby in jeopardy.
Every case is different, and only a health professional can determine the safest way to approach your symptoms. However, in many instances, taking antidepressants when pregnant is an effective and safe treatment.
It can be for many people.
Selective serotonin reuptake inhibitors (SSRIs) are among the most common types of antidepressants used to treat depression.
However, study findings also supported previous research that suggested some developmental issues for a fetus are associated with the use of certain SSRI drugs during pregnancy.
Specifically, taking fluoxetine (Prozac and Sarafem) and paroxetine (Paxil and Pexeva) may increase the chances of fetal developmental issues.
The study found no link between fetal issues and the use of sertraline (Zoloft).
Additional safety considerations
Congenital disorders from medication use in pregnancy is one consideration when evaluating safety.
According to Dr. Susan Hatters-Friedman, a doctor in Cleveland, Ohio, the decision to use antidepressants during pregnancy comes down to overall assessment.
“When we are thinking about any medication during pregnancy, we are weighing the risks and benefits to both mom and fetus, and conceptualizing mom and baby as a unit,“ she explains.
In other words, a health professional will assess your personal medical history and the course of your pregnancy to determine what the best course of treatment may be.
Pregnancy complications are always possible but may depend on your unique circumstances and history. More often, they involve considerations beyond medication types and dosages.
Other factors that may need to be taken into account include:
- environment during pregnancy
- support systems
- personal safety
- socioeconomic challenges
“No pregnancy — with or without medications — is unfortunately guaranteed to have a perfect outcome,” cautions Hatters-Friedman.
The potential side effects of antidepressant use do not necessarily change based on your pregnancy status.
Common side effects of antidepressants include:
- nausea or indigestion
- changes in appetite
- sleep disturbance
- reduced sex drive
- dry mouth
- heart rhythm changes
- serotonin syndrome
- suicidal thoughts
When you’re pregnant, the list of side effects may also include what could affect your baby.
- premature birth
- low birth weight
- delayed fetal growth
- neonatal adaptation syndrome
- persistent pulmonary hypertension
Working with a health professional can help limit the chances you‘ll experience these or other side effects.
They can review what has worked for you in the past, as well as the safety profiles of available medications.
“The goal is therapy with one medication where possible (rather than a combination) and to treat with the lowest effective dose to minimize unnecessary exposure,” says Hatters-Friedman.
In other words, a health professional may look at your specific case and determine the frequency, combination, and dosage you need.
According to the CDC
“Sertraline and citalopram/escitalopram are generally regarded as the safest antidepressants in pregnancy based on years of available data,“ Hatters-Friedman explains.
However, safety is determined by the availability of data, she pointed out. The longer a medication has been available in the market, and the more widely it’s been used, the more information providers have to base decisions on.
Both Zoloft and Lexapro are considered safer antidepressants during pregnancy because the evidence does not point to a link to congenital disorders or miscarriages.
Because of the volume of data available on Zoloft and its proven safety record, it remains the go-to of many healthcare professionals.
“Zoloft (sertraline) is usually the first choice of reproductive psychiatrists,“ says Hatters-Friedman. “Lexapro (escitalopram) is a close second.“
Most of the safety data available on antidepressant use during pregnancy is focused on SSRIs and serotonin-norepinephrine reuptake inhibitors (SNRIs).
SNRI use during pregnancy is understudied compared with SSRI use, but SNRIs appear to have similar safety margins to SSRIs, according to review data.
SSRIs and SNRIs that are not recommended for use during pregnancy include:
- fluoxetine (Prozac, Sarafem)
- paroxetine (Paxil, Pexeva)
- venlafaxine (Effexor)
These medications have been linked to possible congenital disorders, such as respiratory problems.
Other types of antidepressants, such as tricyclics, tetracyclics, and monoamine oxidase inhibitors (MAOIs) are older and rarely used during pregnancy due to a naturally higher chance of side effects.
Untreated depression during pregnancy could affect how you feel and behave, and this, in turn, may affect your child.
“When we are discussing antidepressant medications with pregnant women, we need to think about the risks of untreated depression in pregnancy — as well as any risks of meds,” explains Hatters-Friedman. “People underestimate the risk of not treating depression.”
Living with depression may also lead you to have a challenging time taking care of yourself. You might miss prenatal appointments, skip the needed physical activity, change your eating habits, or let your sleep schedule slide.
In some cases, untreated depression might affect your mood in such a way that you may engage in behaviors that put your safety at risk. For example, using alcohol or contemplating self-harm.
Medication is just one part of the recipe for effective treatment of depression, however.
Prescription medications can help ease the severity of symptoms, but psychotherapy — like cognitive behavioral therapy (CBT) — can help you address the underlying causes of depression.
These links could be the first step:
- Psych Central‘s “How to Find Mental Health Support” page
- American Psychiatric Association‘s Find a Psychiatrist tool
- American Psychological Association‘s Psychologist Locator tool
- Asian Mental Health Collective’s therapist directory
- Association of Black Psychologists‘ Find a Therapist tool
- National Alliance on Mental Illness Helplines and Support Tools
National Institute of Mental Health’s Helpline and Support information
- National Queer and Trans Therapists of Color Network
- Inclusive Therapists
Even if you can‘t afford therapy or don‘t have the means to seek out the help of a mental health professional, consider contacting a support group or crisis line.
These resources can help:
- Call a crisis hotline, such as the National Suicide Prevention Lifeline at 800-273-8255.
- Text HOME to the Crisis Text Line at 741741.
- Call or text the Postpartum Support International HelpLine at 800-944-4773 (#1 Español, #2 English).
- The Trevor Project, for young people in the LGBTQIA+ community. Call 866-488-7386, text START to 678-678, or chat online 24/7.
- For the Veterans Crisis Line, call 800-273-8255, text 838-255, or chat online 24/7.
- If you don’t live in the United States, Befrienders Worldwide (an international crisis helpline network) can help you find a local helpline in your country.
It‘s natural to wonder if taking antidepressants during pregnancy will affect the safety of your baby. However, treatment for depression is always highly recommended.
Antidepressants like escitalopram (Lexapro) and sertraline (Zoloft) are considered safe to use during pregnancy. Along with talk therapy, medication can help you effectively manage your depression symptoms.
Consider having this conversation with your health team to find support strategies for your specific needs.