Antidepressants in Pregnancy: Risks and Frequent Worries

Are antidepressants safe in pregnancy? Learn about the potential effects on both mother and baby's well-being.

Antidepressants in Pregnancy

Mood disorders, such as depression, are not uncommon during pregnancy. It's estimated that more than 10% of pregnant women experience depression, and approximately 2-3% of pregnant women use antidepressants during pregnancy. The question of whether to treat depression with antidepressants during pregnancy can be a difficult one to answer, as antidepressants may have detrimental effects on the developing baby.

Studies show that medically treated depression during pregnancy can lead to issues like premature birth, low birth weight, and other newborn complications. Some antidepressants may also cause withdrawal symptoms in the child after birth.

Not treating depression can also be harmful and have similar adverse effects on the child, resulting in decreased fetal growth and low birth weight. Depression can also impact the mother's health and increase the risk of conditions like preeclampsia and eclampsia. Additionally, it can lead to postpartum depression, which can severely affect the mother-child relationship. 

Being Pregnant and Depressed

Pregnancy can be a time of great joy, but also one of unprecedented challenges, both physically and emotionally. While emotional difficulties may be expected, some women go on to develop clinical depression during pregnancy. Those with previous depressive episodes are especially at risk.

Symptoms

A portion of the classical symptoms of depression, such as lack of energy, irritability, and sleep difficulties may occur in pregnancy due to bodily changes, without them being an indication of depression. You may still want to discuss these symptoms with your healthcare provider in case they prove to be persistent or overwhelming.

However, if you are experiencing apathy, frequent sadness, low mood, hopelessness, or self-destructive thoughts, then these are significant signs that warrant urgent medical attention. Not being able to properly care for yourself or lacking the motivation to get out of bed may be more practical signs of depression. You can take our short depression quiz, which is based on the ICD-10 diagnostic criteria for depression.

In case you have been experiencing some of the previous signs and symptoms, most of the day, nearly every day, for at least 2 weeks, you may be experiencing depression and should contact your healthcare provider for a more precise evaluation. 

Why Treatment is Necessary

Untreated depression during pregnancy can impact both the mother's and baby's well-being. Thus, addressing depression is very important for bonding and caregiving. The goal is to find a balanced approach that ensures the well-being of both mother and baby. Depression during pregnancy can frequently be managed through therapy or lifestyle adjustments, but in more severe cases, medications may be needed. 

What Antidepressants Are Safe in Pregnancy? 

The US Food & Drug Agency (FDA) categorizes medications for their safety in pregnancy. Currently, most antidepressants are either classified in the C or D category. There are no antidepressants classified in the A or B category. In other words, all antidepressants have animal studies that have shown a risk of use, although the C category indicates that the benefits from the antidepressant may outweigh the risks. 

It's important to remember that most women who are treated with antidepressants during pregnancy have healthy babies. Even so, the decision to medically treat depression can only be made in close collaboration with your psychiatrist. 

Antidepressant	Brand Name	Drug Class	FDA Category
Citalopram	Celexa	SSRI	C
Escitalopram	Lexapro	SSRI	C
Fluoxetine	Prozac	SSRI	C
Paroxetine	Paxil	SSRI	D
Sertraline	Zoloft	SSRI	C
Duloxetine	Cymbalta	SNRI	C
Venlafaxine	Effexor	SNRI	C
Bupropion	Wellbutrin	Atypical	C
Mirtazapine	Remeron	Atypical	C
Trazodone	Desyrel	Atypical	C
Amitriptyline	Elavil	TCA	C
Clomipramine	Anafranil	TCA	C
Imipramine	Tofranil	TCA	C
Nortriptyline	Pamelor	TCA	D

Source: Interventions to Prevent Perinatal Depression | Table: WhatMedicine.Org

SSRIs & SNRIs

Amongst the selective serotonin reuptake inhibitors (SSRIs), both Sertraline and Escitalopram are generally considered options for treatment. Possible concerns include changes in the mother's weight and the baby being born too early. Most research suggests that SSRIs do not seem to cause birth defects, except Paroxetine, which may have a slightly higher chance of causing a heart defect in the baby. Serotonin and noradrenaline reuptake inhibitors (SNRIs), such as Venlafaxine and Duloxetine are also considered options, with similar risks to the fetus as SSRIs.

Atypical Antidepressants

As for atypical antidepressants, research suggests that taking Bupropion during pregnancy might be associated with heart defects when used during the first trimester. Despite this, it may be an option for treatment-resistant depression in pregnancy. 

There has been little research done on Mirtazapine and its use in pregnancy. However, a systematic review from 2016  stated that there haven't been any reports of a higher risk of significant birth defects linked to Mirtazapine use during pregnancy. While one study did suggest a slightly higher occurrence of respiratory issues and low blood glucose, there was no causal relationship between the two. No other significant adverse effects on neonates were reported.

Tricyclic Antidepressants in Pregnancy

Tricyclic antidepressants (TCAs), which include Nortriptyline and Amitriptyline, are not typically the first or even second choice for treatment, as they are less tolerable and known for their wide range of side effects. Nonetheless, they could be considered for women who haven't had success with other medications. Note that the tricyclic antidepressant Clomipramine may be linked to fetal birth defects, including heart problems.

Frequent Worries

Pregnancy represents a unique experience, and soon-to-be mothers often have various concerns, especially regarding issues like depression and the use of antidepressants.

Who Should I Talk To if I'm Depressed? 

Depending on your country and local healthcare system, your options may vary. The primary healthcare contact during pregnancy is often your midwife. However, if you're experiencing persistent symptoms of depression for more than 2 weeks, then it is suggested that you contact either your gynecologist or primary care physician. If needed, they can refer you to a psychiatrist who may discuss the best medical options with you.

Does Antidepressants During Pregnancy Prevent Postpartum Depression?

We don't know for certain. There have only been two smaller studies done in this area. Unfortunately, it was not possible to draw any clear conclusions about the effectiveness of antidepressants for the prevention of postpartum depression. However, antidepressants can help to treat postpartum depression once it is diagnosed.

Can Antidepressants Cause Autism?

There have been several scientific studies linking the use of antidepressants in pregnancy to a slightly higher risk of autism in the child. However, there is recent research questioning the causality between the two. Additional research is likely necessary to understand the relationship better.

Cover image by Freepik

Author: J. Martin, M.D.
Last update: March 1, 2024

Disclaimer: The information provided is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider, such as a physician, before starting any new treatment or making changes to your existing treatment plan. Individual responses to treatment may vary, and a healthcare professional can provide personalized guidance based on your specific needs and circumstances. If you are experiencing severe or persistent symptoms of disease or mental illness, seek immediate medical attention.