Using Antidepressants in Pregnancy

If you take antidepressants and are thinking about continuing to use them while you are pregnant, there are several factors you should consider. If your depression is significant, it can affect your life in very negative ways. Counseling often can improve depression, and we recommend no matter what your decision about using antidepressants that you contact a local counselor if you do not already have one.

There are several medications that we prescribe for patients while they are pregnant, but you should know that all medications have certain risks to the pregnancy. Also, the decision to use or not use the medication is yours based on the recommendations of your obstetrician and your mental health professional as well.

  • For the initial treatment of mild-to-moderate symptoms of anxiety disorders and depression, we suggest cognitive behavioral or interpersonal psychotherapy.
  • Maintaining a normal mood throughout your pregnancy and preventing postpartum recurrence of depression are the most important goals of treatment. Untreated, or undertreated, maternal depression poses significant risks to both you and your baby. These risks often outweigh the risks associated with taking medications.
  • The overall risk of birth defects as the result of your taking SSRI drugs such as Prozac, Paxil, and Zoloft appears to be low. Several studies have, however, reported an association between exposure to these medications and cardiovascular defects. These findings remain controversial and are waiting to be confirmed by other studies.
  • SSRIs, as well as other antidepressants, have been also been associated with a risk of pregnancy complications such as miscarriage, stillbirth, preterm birth, shorter gestation, and low birth weight, as well as an increased risk of breathing problems in the newborn. Any increased risk is probably small and needs to be considered in the context of the potentially greater risk to you and your child that may result from not treating your depression.
  • SSRIs can also affect the baby immediately after birth because of a withdrawal effect on the newborn. This could lead to irritability and difficulty with feeding and temperature regulation. The long-term effects on your baby aren’t entirely known.
  • Although Prozac is the best studied drug in pregnancy and the SSRI with the largest amount of long-term follow-up data of infants who were exposed, it has a long half-life. This mean it can build up in your baby’s system. In addition, the transfer rate of Prozac through breastfeeding is higher than for other SSRIs. As a result, we suggest avoiding Prozac as a first-line antidepressant in pregnancy.
  • We suggest using Wellbutrin if you have attention deficit disorder, have not responded to other medications, or want help to stop smoking.

If you are taking antidepressants and become pregnant, talk to your doctor about the right approach for managing your depression for you and your baby.

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