Are Antidepressants Safe During Pregnancy?

Antidepressant medications are among the most common and effective ways to treat depression. According to the American College of Obstetricians and Gynecologists (ACOG), 1 in 10 women experience depression during pregnancy.

“It’s crucial to feel good during pregnancy,” says medication specialist Diana Isaacs, PharmD, an endocrine clinical pharmacist. “When you do, you’re more likely to take better care of yourself, and that’s always the best thing for healthy fetal development.”

Dr. Isaacs explains how antidepressant medications may affect you and your pregnancy. But talk to your healthcare provider, too. They can help you decide whether taking antidepressants during pregnancy is right for you.

Importance of treating depression during pregnancy

Pregnancy affects everyone differently. For some, depression gets better during pregnancy. Others deal with worse symptoms. Depression can also develop during pregnancy (prenatal depression), seemingly out of nowhere.

Untreated depression during pregnancy can be dangerous for you and can impact healthy fetal development. It can increase your risk for postpartum depression. It may also lead to troubles like:

• Poor fetal growth
• Early labor
• Low birth weight
• Health complications after birth

“Unmanaged depression can also affect your lifestyle during pregnancy,” Dr. Isaacs notes. “It can keep you from taking care of yourself. You may not feel like attending your prenatal appointments, exercising or eating a healthy diet. All those factors affect you and the fetus.”

Should you stop medication when getting pregnant?

Whenever you take medication during pregnancy, it can enter the fetus’s bloodstream and possibly cause side effects. If you’re pregnant or think you may be pregnant, speak with your provider before starting or stopping any medication, including antidepressants.

Dr. Isaacs explains that it’s challenging to know for sure how a medication will affect fetal development. Experts don’t conduct high-level randomized clinical trials on pregnant women — it’s too risky. Instead, they collect data from people taking medication over time and observe whether there have been harmful effects.

From the limited data collected, most antidepressant medications appear to be safe.

“While we don’t have conclusive research about antidepressants during pregnancy, we do have more data about certain antidepressants than others,” Dr. Isaacs reports.

Safest antidepressants to take in pregnancy

The antidepressants that have the most data available during pregnancy are selective serotonin reuptake inhibitors (SSRIs), specifically sertraline (Zoloft®).

That’s because SSRIs have been around for a long time and are the most commonly prescribed medications for depression. That adds up to a lot of data about them.

“Antidepressants, especially most SSRIs, appear to be safe. For most people, the benefit of treating depression with an SSRI is worth the potential risk,” Dr. Isaacs states.

Antidepressants to avoid during pregnancy

There are a couple of antidepressant medications that may cause side effects, like:

• Paroxetine. This SSRI is the least favorable option for pregnant women. Some studies suggest that paroxetine may slightly increase the risk of heart defects in babies.
• Tricyclic antidepressants. Research finds that most medications in this older class of antidepressants may increase the risk of birth defects affecting a baby’s head and neck.

“In general, it’s a good idea for pregnant people to switch from these medications to a different antidepressant medication,” Dr. Isaacs suggests. “But today, these medications aren’t as commonly used, even for nonpregnant people.”

Can antidepressants cause gestational diabetes?

Research suggests that using some antidepressants during pregnancy may increase the risk of gestational diabetes (GD). But SSRIs aren’t associated with any increased risk.

Dr. Isaacs says it’s likely that unmanaged depression, as opposed to medication, may present a higher risk of developing diabetes during pregnancy.

“We can try to manage a lot of things to help prevent gestational diabetes, such as diet, weight gain and physical activity,” she reinforces. “Unmanaged depression can affect all three of those risk factors. So, taking an antidepressant may potentially help lower the risk of GD.”

Alternatives to antidepressants during pregnancy

If hormonal changes during pregnancy improve your depression symptoms, you may be able to stop your medicine. But always discuss with your provider before stopping medications at any time.

If you don’t feel comfortable with antidepressants during pregnancy — or your provider doesn’t recommend them for you — there are non-medication options they may discuss with you, like:

• Lifestyle changes. Exercise, healthy eating, sleeping well and getting enough sunlight are all strategies that may improve depression symptoms for some people.
• Psychotherapy. “Talk therapy” can help you identify issues, develop solutions and manage depression symptoms.
• Electroconvulsive therapy (ECT). This treatment — which involves electrical brain stimulation — has been demonstrated to be safe and effective during pregnancy. Providers may recommend ECT for severe mental health disorders, including things like thoughts of self-harm or harming the fetus.

“Lifestyle changes and other treatments can help some people avoid antidepressant medication,” Dr. Isaacs says. “But you may benefit most from medication — and that’s OK.”

Speak to your provider about antidepressants and pregnancy

Dr. Isaacs recommends talking with a healthcare provider to weigh the risks of untreated depression against the potential for risks associated with medication. “It’s an individual process best navigated through shared decision-making with the pregnant person and their healthcare team,” she advises.

If you’re trying to conceive, you can discuss a trial period off your antidepressant medication before you get pregnant to see how it affects you.

And some providers and pregnant women decide to taper off antidepression medication at the end of the second trimester. The idea is that the fetus could potentially experience withdrawal when they’re born. Dr. Isaacs adds that the risk of severe withdrawal symptoms is low. But it may be worth discussing as an option with your healthcare provider.

“Do what’s best for your mental health because that’s almost always best for the fetus,” she continues. “When you’re in a headspace to properly care for yourself during pregnancy, it’s often the safer choice for everyone.”

Help is a phone call away

Depression can be serious. But treatment is available. And you don’t have to muddle through it. You deserve to be the best version of yourself — for your well-being and for that of the developing fetus.

Talk with your provider about what you’re experiencing. And if you have any thoughts about harming yourself or the fetus, take immediate action. In the U.S., text or call the Suicide and Crisis Lifeline at 988. This national network of local crisis centers provides 24/7 free and confidential support to people in emotional distress.