Antidepressants: Are they safe during pregnancy?

Antidepressants are the first line of treatment for most types of depression. Antidepressants can help relieve your symptoms — and keep you feeling your best. But there's more to the story when you're pregnant or thinking about conceiving. Here's what you need to know about antidepressants and pregnancy.

How does pregnancy affect depression?
Pregnancy hormones were once thought to protect women from depression, but researchers now say this isn't true. In fact, up to 10 percent of women experience depression during pregnancy. Although pregnancy doesn't make depression worse, pregnancy often triggers a range of emotions that can make it more difficult to cope with depression.

Are antidepressants an option during pregnancy?
Few medications have been proved unequivocally safe during pregnancy. Although certain antidepressants have not been linked with an increased risk of birth defects or impaired development — including fluoxetine (Prozac, Sarafem, others), sertraline (Zoloft) and bupropion (Wellbutrin) — the latest studies aren't necessarily reassuring. As researchers continue to learn more about antidepressants, the risks and benefits of taking the drugs during pregnancy must be weighed carefully on a case-by-case basis.

Are some types of antidepressants safer than others?
So far, bupropion (Wellbutrin) has not been associated with risks to a developing baby. But researchers have identified various risks with other types of antidepressants. For example:
Paxil. Paroxetine (Paxil) — a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI) — has been linked to fetal heart defects when it's taken during the first three months of pregnancy. The American College of Obstetricians and Gynecologists recommends avoiding Paxil during pregnancy, if possible.

Other selective serotonin reuptake inhibitors. Taking other SSRIs — including citalopram (Celexa), fluoxetine (Prozac) and sertraline (Zoloft) — in the last half of pregnancy increases the risk of a rare but serious lung problem known as persistent pulmonary hypertension of the newborn. This condition occurs when a newborn's circulation system doesn't adapt to breathing outside the womb. For some women, however, the benefits of continuing these drugs may outweigh the risks.

Tricyclic antidepressants
These older antidepressants — including amitriptyline and nortriptyline (Aventyl, Pamelor) — are generally discouraged during pregnancy in favor of newer, more effective medications. Potential risks of tricyclic antidepressants to a baby may include damage to the central nervous system, physical deformities or developmental delays.

Are there any other risks for the baby?
If you take an SSRI antidepressant throughout pregnancy or during the last trimester, your baby may experience temporary withdrawal symptoms at birth — including tremors, gastrointestinal problems, sleep disturbances and high-pitched cries.

What happens if a woman stops taking antidepressants during pregnancy?
If you stop taking antidepressants during pregnancy, you risk a depression relapse. In fact, pregnant women who stop taking antidepressants are five times more likely to experience a depression relapse than are pregnant women who continue taking the drugs. Stopping an SSRI abruptly may cause various signs and symptoms, including:
Headache
Nausea and vomiting
Chills
Dizziness
Fatigue
Insomnia
Irritability
Vivid dreams

What's the bottom line?
If you have depression and are trying to conceive or are pregnant, consult your doctor. Sometimes mild depression can be managed with support groups, counseling or other therapies. If your depression is severe or you have a recent history of depression, the risk of relapse may be greater than the risks associated with antidepressants.

It's not an easy decision. Work with your doctor to make an informed choice that gives you — and your baby — the best chance for long-term health.