Antidepressants in Pregnancy- what are the risks?
Health and maternal well-being are vital during fertility therapy and a healthy pregnancy. At NRM, our goal is to achieve the best outcome possible for both and mom and baby. If you suffer from depression, anxiety, or another problem requiring SSRI use or other antidepressant medication, read here to learn more about the risks and benefits to your pregnancy– and to determine the best option for you.
Should I continue using my antidepressant medication during pregnancy?
Serotonin Reuptake Inhibitors (SSRIs) include medications such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft). The decision to continue the use of antidepressants in pregnancy requires weighing the adverse effects of antidepressants against the negative impact of untreated depression or anxiety on the pregnancy and outcomes. Often, the risks of maternal depression to the mother and the child outweigh the risks associated with antidepressants.
What are the risks of untreated maternal depression?
Untreated depression during pregnancy may lead to poor birth outcomes, including impaired fetal growth and preterm birth, as well as poor pregnancy outcomes including failure to pursue appropriate prenatal care, substance abuse, failure to recognize labor, and increased risk of suicide. Within days of delivery, between 40-80% of women may experience “post-partum blues”, a transient condition characterized by sadness, tearfulness, irritability and anxiety. Women with a prior history of depression or anxiety are at increased risk for more severe symptoms of postpartum depression that may necessitate medical intervention.
Struggling with infertility may worsen emotional instability in women with pre-existing anxiety or depression (infertility preceding a pregnancy can cause emotional strain and instability even for those patients that have not had a diagnosis of depression or anxiety in the past.) Undergoing infertility therapy is often associated with anxiety and periods of disappointment. Further, during pregnancy, common complaints such as nausea, fatigue, loss of energy, low back pain, or other discomforts may be exacerbated by depression and affect a woman’s ability to function at home or at work. Severe or constant symptoms may therefore cause women to miss days of work or quit jobs altogether, leading to financial strain.
What are the risks of antidepressant medications?
SSRIs are category C medications according to the FDA, which means: “Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.” The potential risk associations with third-trimester use of SSRIs include: neonatal withdrawal syndrome (irritability, crying, eating or sleeping difficulties), neurodevelopmental effects, and Persistent Pulmonary Hypertension of the Newborn (a rare condition associated with respiratory distress and difficulty with oxygenation, which may be life-threatening; this risk is estimated at 3 per 1000 live births). There is little to no risk of teratogenicity (birth defects) with first-trimester exposure to SSRIs with the exception of a potential small absolute increased risk of congenital heart defects specifically with Paxil.
Tricyclic antidepressants (TCAs) are generally regarded as low risk; however, pregnancy complications such as preterm birth or low birth rate may be increased, and infants have a risk of transient neonatal withdrawal when TCAs are used in the third trimester. Wellbutrin (Buproprion) is generally considered low risk but may be associated with an increased risk of miscarriages. Effexor (Venlafaxine) is also generally regarded as low risk for congenital anomalies when used in the first trimester, but may be associated with a small increase in risk of miscarriage, preeclampsia, and neonatal withdrawal syndrome.
The doctors at NRM encourage you to further discuss your medication and your specific history with your antidepressant-prescribing doctor or primary care physician.