Paxil and Pregnancy: Is it Safe?

If you’re taking Paxil® (or its generic form, paroxetine) to care for your mental health, you might wonder whether it’s safe to continue using it while pregnant. It’s an understandable worry to have, given that this medication could potentially cause harm to your unborn baby. However, there’s also the question of your mental health to consider.

In many cases, the risks of Paxil and pregnancy have to be weighed carefully. On the one hand, there are some substantial dangers associated with the use of paroxetine (or its brand name Paxil) during pregnancy. But on the other hand, antidepressants are a crucial part of many people’s lives, and often an absolute necessity for quality of life and function at work and at home. 

Let’s look at the potential risks of using Paxil while pregnant and how to determine whether it makes sense to explore an alternative during pregnancy.

Let’s get straight to the point: If you’re wondering whether you can keep taking Paxil while pregnant, the answer is that you shouldn’t — unless a healthcare provider believes its benefits outweigh its associated risks. 

Paxil is a selective-serotonin reuptake inhibitor, or SSRI: an antidepressant medication that works to affect your brain chemistry to help better regulate your mood. Other SSRI antidepressants that you may be familiar with include citalopram (Celexa®), fluoxetine (Prozac®), and sertraline (Zoloft®).

Paxil, manufactured by GlaxoSmithKline, is the brand name for the drug paroxetine. The medication is typically prescribed for the treatment of mental health conditions like: 

• Major depressive disorder (MDD)

• Anxiety disorders, including generalized anxiety disorder (GAD), panic disorder, social anxiety disorder, and obsessive-compulsive disorder (OCD) 

• Post-traumatic stress disorder (PTSD)

SSRIs are known to be relatively safe and generally have mild side effects, and this goes for the side effects of paroxetine as well. It isn’t addictive, and most people see benefits from taking it. 

But things change when you’re pregnant. Although harm can’t be ruled out, most SSRI antidepressants have not been shown to cause congenital malformations in humans, and in many cases, doctors recommend that pregnant women with severe or recurrent depression continue to take their SSRI. Paxil, however, is different. 

Paxil is what is known as a Category D pregnancy medication, which carries with it specific warnings from the Food and Drug Administration (FDA). 

Pregnancy risk categories range from A to X. Category A medications are generally considered safe, with studies in humans showing no risk to the fetus.

As you continue down the letter scale, however, the risk increases. 

Category B shows no risk, but these medications have only been tested on animals. And Category C shows increased risks in animals, but they haven’t been thoroughly tested in humans. This is usually where medical professionals tend to start hesitating with prescriptions.

At Category D, studies of pregnant women have demonstrated risk to the fetus. Those are human tests, the risks are confirmed to exist and, in most cases, a healthcare provider will be hesitant to prescribe them unless they are absolutely necessary. 

Paxil is known to cause heart defects in newborns. Taking it while pregnant creates a substantially increased risk of congenital malformations of the heart.

Evidence suggests congenital malformations — and, specifically, cardiovascular malformations and future heart issue risks — are more prevalent in fetuses exposed to Paxil in early pregnancy, specifically in the first trimester.

For example, a 2016 review of 23 studies found that, compared to no exposure to paroxetine (the generic of Paxil), use of paroxetine during the first trimester was associated with a higher risk of any major congenital malformation and major cardiac malformation.

Additionally, a 2024 umbrella review of 21 meta-analyses recorded the following risk associated with use of antidepressants, SSRIs, and paroxetine during pregnancy: 

• A higher risk of preterm birth in pregnant people taking an antidepressant for any mental health disorder during any trimester of pregnancy

• A higher risk of having an infant with a low birth weight for pregnant people using an SSRI during any trimester of pregnancy

• An increased risk of a baby having major congenital or cardiac malformations for pregnant people taking paroxetine during their first trimester

There are also potential risks of pulmonary hypertension in newborns who are exposed to antidepressants like paroxetine during the third trimester. However, some recent studies have suggested that the absolute risk of this complication is rather low. 

In some rare circumstances, neonatal complications have arisen from paroxetine exposure. Complications can result in prolonged hospitalizations, tube feeding, and respiratory support.

The question of whether you should or shouldn’t continue taking Paxil during pregnancy isn’t quite as straightforward as it may seem. This is due to the dangers of untreated depression. The reality is that your own mental health and stability can have significant implications for the health of your infant, too.

The risk of cardiovascular defects and risk for birth defects are definitely two of the factors that you should consider before taking Paxil while pregnant. But if your mental health is dangerously unreliable without medication, your healthcare provider may still advise you to continue taking Paxil.

Typically, however, that’s not going to be the case. It is more likely that your healthcare provider will help you find another way to treat your depression during this time, up to and including prescribing a different medication. 

They may also recommend things like therapy or lifestyle changes, such as adjusting your diet or prioritizing exercise for your mental health. 

In particular, cognitive behavioral therapy has been proven effective in treating major depression. This type of therapy can teach someone with a depressive disorder how to control and overcome negative thought patterns.

If medication is a necessity, other options may provide the benefits you need without the significant risks associated with Paxil.

And keep in mind that if your healthcare provider recommends discontinuation of Paxil during your pregnancy, you may be able to start using it again postpartum, even if you’re breastfeeding. This is because paroxetine is found at low levels in breastmilk, making it one of the preferred antidepressants for nursing mothers. 

When it comes to Paxil and pregnancy though, we can’t really make any definitive recommendations. That’s because your unique circumstances necessitate a tailored treatment plan.

Instead, the only recommendation we’ll make is this: Talk to your healthcare provider. 

Pregnant? Hoping to become pregnant? On Paxil? Considering taking Paxil? You have a lot of decisions to make. And if you’re dealing with serious depression, things can get complicated fast.

So far, you’re doing the right thing: Educating yourself about the risks of Paxil during pregnancy as well as the importance of mental health care during this time. 

Knowing the risks of adverse pregnancy outcomes as a result of SSRIs use during pregnancy can cause feelings of guilt if you’re someone who needs them, and it can feel overwhelming to figure out what to do next. Luckily there’s one clear and obvious right answer: Speak to a healthcare provider.

A healthcare professional can answer your questions, address your concerns, and offer guidance so that you can make the best decisions going forward. 

If you’re not sure where to find that help, hers offers online therapy and other mental health resources for you to check out. We can connect you with a mental health professional quickly and conveniently on our platform to get the info you need. 

Whether you work with us or another provider, take that first step and get answers today. Motherhood is supposed to be a great time in your life — don’t let worries about mental health or medication risks take that away from you.