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Pregnancy can both be one of the most amazing and memorable experiences of a woman’s life, and one of the most anxious. And if you struggle with depression, that anxiety can come ten-fold. One of the biggest sources of fear for someone with mental health issues like depression might be mental health medication itself. So, just what is the safest antidepressant in pregnancy?
Whether your pregnancy is new, nearing its end or still hypothetical, you’ve probably seen evidence suggesting that antidepressants can be hazardous to the health of a fetus. And yet, not taking that necessary medication can be hazardous to a fetus too, especially if you’re not able to take care of yourself without it.
So what do you do? What’s the right medication for your needs?
Unfortunately, the answer to this question is complicated, in part because there are many unanswered questions about what’s safe and what isn’t.
To unpack the risks and known dangers of antidepressants while pregnant, we need to look at what antidepressant drugs as a treatment option can actually do to the little passenger in your womb.
Let’s start there.
First and foremost, we just need to state this: there’s a lot of complicated information out there about perinatal depression and antidepressants during pregnancy. The medications matter, the trimester of pregnancy matters and the severity of your depression symptoms matter.
For even the most prepared pregnant woman, it’s a lot of work to keep up with all your risk factors.
The gist of what you need to know is that many antidepressants have been associated with an increased risk of adverse effects on embryo and fetus development, though things can get murky once you wade into the specifics of individual antidepressant medications.
It’s also somewhat unclear how these medications can increase the risk of certain malformations and birth defects, though the studies have been fairly conclusive on certain medications.
In other words, we can say that there are some clear risks and we can say what those individual risks are, but it’s yet unclear why those risks exist, and even recent systematic reviews of existing data call for more research rather than attempting to draw conclusions.
The best way to get the latest information is to talk with a healthcare professional. But we’ll get to that in a moment. For now, let’s look at what experts agree on about the risks of using antidepressants while pregnant.
You probably understand the potential side effects of antidepressants for yourself already (if not, our guide to antidepressants is a great place to refresh your memory). But when it comes to the risks posed to embryos and fetuses, things are a little different.
Studies have shown that certain antidepressants can cause a variety of issues before birth. Some studies indicate that antidepressant use can lead to increased risks of low birth weight, ADHD later in life and neurodevelopmental issues.
Other studies have found associations between antidepressants and premature birth. There are also studies suggesting a link between antidepressants and congenital malformations and birth defects related to some psychiatric medications.
In many ways, the world of depression and anxiety medications as a pregnant mother can seem like a minefield. So what types of medication are at least a bit safer? Well, here’s how it breaks down.
First and foremost, the best way to figure out what medications are safe for your use is to talk with a healthcare professional.
A lot of factors should be considered when determining the course of action for an expectant mother with depression, including her susceptibility to side effects, her support needs and the risks posed by the medications to embryo or fetus.
That said, here’s what we know today:
Both the selective serotonin-reuptake inhibitor (or SSRI) and the serotonin-norepinephrine reuptake inhibitor (or SNRI) have been associated with an increased risk of heart defects and low birth weight in babies.
And it’s fair to say that the severity of risk for these medications is only perceived as lesser than others because, well, there aren’t a substantial number of studies on prenatal exposure to these types of antidepressants during pregnancy to begin with.
TCAs aren’t generally regarded as the best choice of medication for depression these days regardless of whether or not you’re pregnant.
They’re generally used when SSRIs and other medications aren’t working, because they often carry more significant side effects.
As for the risk to developing infants, some studies have associated TCAs with higher potential for heart defects.
There’s some debate about whether they might be safer later in a pregnancy than SSRIs, but it’s generally not a great idea to abruptly switch medications — particularly if you’re expecting.
The lowest ranking antidepressants — monoamine oxidase inhibitors — shouldn’t even be on a list of the safest options, except for the fact that we need to warn you of the risks.
These OG antidepressant medications are generally known now to have the most significant side effects, but they also pose serious risks to an embryo or fetus.
MAOIs can cause permanent or long-lasting impairment of serotonin function in children born to mothers that use these medications during pregnancy.
So, are antidepressants safe drugs during pregnancy? Put simply, no.
Arguably, nothing is really “safe,” of course, but even when used as directed, numerous antidepressants can drastically increase the potential risk of things like low birth weight, neurodevelopmental issues and other problems from day zero and, potentially, much later in life.
And yet, that doesn’t mean you should immediately dump your pills down the toilet and go cold turkey — in fact, that’s probably the worst thing you can do.
Instead, you should consider making smart, informed decisions with the guidance and support of your healthcare professional.
To learn about a specific antidepressant, read our blog on Cymbalta and pregnancy.
You likely have some valid concerns if you’re worried about the risks associated with antidepressants in pregnancy.
How you balance those concerns against untreated depression or other depressive disorders and other psychiatric disorders is ultimately up to you, but as far as we’re concerned, there’s a clear “right” choice of what to do next.
Some people might discontinue medication for the treatment of depression and endure the potential withdrawal symptoms, some might switch to another medication and some others might continue to take that original medication throughout their pregnancy rather than risk perinatal depression.
Ultimately, they could all be making the right decision for their own needs, but the best way to arrive at the right decision for your needs is to talk to a healthcare professional.
Reading is good — reading about things you don’t understand is good, too. But ultimately, talking to a professional is the best way to get clear feedback based on your unique needs, and make an informed choice.
Where you go to get that information is up to you. We offer support both through our online therapy resources and our mental health support offerings.
Whether you choose to work with us or another provider, though, make the choice to include someone in your decision making process today.
It could make everyone’s lives better, and that’s even more important when you’re making decisions for two.
Kristin Hall is a board-certified Family Nurse Practitioner with decades of experience in clinical practice and leadership.
She has an extensive background in Family Medicine as both a front-line healthcare provider and clinical leader through her work as a primary care provider, retail health clinician and as Principal Investigator with the NIH.
Certified through the American Nurses Credentialing Center, she brings her expertise in Family Medicine into your home by helping people improve their health and actively participate in their own healthcare.
Kristin is a St. Louis native and earned her master’s degree in Nursing from St. Louis University, and is also a member of the American Academy of Nurse Practitioners. You can find Kristin on LinkedIn for more information.
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