continued:

Antidepressants: Safe during pregnancy?

Which antidepressants should be avoided during pregnancy?

The SSRI paroxetine (Paxil) is generally discouraged during pregnancy. Paroxetine has been associated with fetal heart defects when taken during the first three months of pregnancy.

In addition, monoamine oxidase inhibitors (MAOIs) — including phenelzine and tranylcypromine (Parnate) — are generally discouraged during pregnancy. MAOIs can limit fetal growth and aggravate maternal high blood pressure.

Are there any other risks for the baby?

If you take antidepressants throughout pregnancy or during the last trimester, your baby might experience temporary discontinuation symptoms — such as jitters or irritability — at birth. Tapering dosages near the end of pregnancy isn't generally recommended. It's not thought to minimize newborn withdrawal symptoms, and it might pose additional challenges for you as you enter the postpartum period — a time of increased risk of mood and anxiety problems.

Should I switch medications?

The decision to continue or change your antidepressant medication is up to you and your health care provider. Concerns about potential risks must be weighed against the possibility that a drug substitution could fail and cause a depression relapse. Keep in mind that switching medications during pregnancy will mean that you're exposing your baby to an additional medication, which could increase the risk of side effects and congenital problems.

What happens if I stop taking antidepressants during pregnancy?

If you stop taking antidepressants during pregnancy, you risk a depression relapse. In addition, stopping an SSRI abruptly might cause various signs and symptoms, including:

  • Nausea and vomiting
  • Chills
  • Fatigue
  • Anxiety
  • Irritability

What's the bottom line?

If you have depression and are pregnant or thinking about getting pregnant, consult your health care provider. Sometimes mild depression can be managed with psychotherapy, including counseling or other therapies. If your depression is severe or you have a recent history of depression, the risk of relapse might be greater than the risks associated with antidepressants.

Deciding how to treat depression during pregnancy isn't easy. The risks and benefits of taking medication during pregnancy must be weighed carefully on a case-by-case basis. Work with your health care provider to make an informed choice that gives you — and your baby — the best chance for long-term health.

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References
  1. Misri S, et al. Depression in pregnant women: Management. http://www.uptodate.com/index.html. Accessed Oct. 17, 2011.
  2. Misri S, et al. Depression in pregnant women: Clinical features and consequences. http://www.uptodate.com/index.html. Accessed Oct. 17, 2011.
  3. Briggs GG, et al. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. 9th ed. Philadelphia, Pa.: Wolters Kluwer Health Lippincott Williams & Wilkins; 2011:291.
  4. Malm H, et al. Selective serotonin reuptake inhibitors and risk for major congenital anomalies. Obstetrics and Gynecology. 2011;118:111.
  5. American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins - Obstetrics. ACOG Practice Bulletin No. 92: Use of psychiatric medications during pregnancy and lactation. Obstetrics & Gynecology. 2008;111:1001.
  6. Galbally M, et al. A review of the use of psychotropic medication in pregnancy. Current Opinion in Obstetrics & Gynecology. In press. Accessed Oct. 17, 2011.
  7. Dell D, et al. Mood and anxiety disorders. Clinical Updates in Women's Health Care. 2008;7:1.
DN00007 Jan. 10, 2012

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