It’s natural to worry about whether it’s safe to take antidepressants while pregnant — you don’t want to hurt your baby. The bottom line: the risks of harming your baby are small, compared to the risks associated with depression, both for you and your child.
It’s true that researchers have found more short-term breathing issues in newborns whose mothers used the commonly prescribed selective serotonin reuptake inhibitors, known as SSRIs — Prozac, Celexa, Paxil, Zoloft, and Lexapro are the familiar names. This data came from a large study of nearly 850,000 births in Finland. Their babies were more likely to spend time in the intensive care unit, but usually just for observation as their breathing settled down.
The same study also provided a case for using antidepressants. Depressed people have higher levels of stress hormones, which the baby will pick up. This study also found that women with depression who didn’t take medication had a higher chance of a preterm delivery or C-section.
You may have read scary stories that taking antidepressants could tip your child into autism. In a Canadian study of more than 145,000 infants, scientists did find a slightly higher number of babies with autism among mothers who took antidepressants during the second or third trimester. For every 200 mothers who took antidepressants while pregnant, there might be one additional children born with autism.
However, the research on this question has been mixed, and, overall, more studies say antidepressants aren’t linked to autism, says Alan Brown, MD, a professor of psychiatry and epidemiology at Columbia University Medical Center.
Some genes associated with depression are also associated with autism, so it’s still unclear whether the antidepressants themselves were at fault, notes Bryan King, program director of Seattle Children's Autism Center and a professor of psychiatry and behavioral sciences at the University of Washington.
Overall, the low risks found in these studies might actually encourage you to stick with your medication, King suggests.
What about birth defects? Again, any risks are small. In a July 2015 study researchers concluded that there was no link between birth defects and taking Zoloft, Celexa, and Lexapro. There was a small association between birth defects and taking Paxil or Prozac early in pregnancy.
An April 2015 study of 2.3 million infants born to mothers who used SSRIs or Effexor found no link to cardiac birth defects.
A November 2012 study evaluated children at three and seven years old who had been born to a mother in one of three scenarios: she took an antidepressant while pregnant, discontinued an antidepressant before pregnancy, or didn’t have depression. The researchers concluded that antidepressants weren’t a problem, and children of mothers with untreated depression had the most behavioral problems.
If you had postpartum depression in an earlier pregnancy, or your recent bouts with depression have been severe, skipping medication while pregnant is probably a very bad idea. Severely depressed women might smoke or drink alcohol, miss doctor’s appointments, and skip meals and sleep during their pregnancy. They will also be at great risk of postpartum depression.
If your depression is mild to moderate, you might consider a break from medication during pregnancy. Are you sure the antidepressant is helping? Have you tried getting more exercise, changes in diet, and stress-relieving activities like yoga and meditation? Are you in therapy? According to a review of treatments for major depression, a team led by Vanderbilt University’s Steven Hollon concluded that psychotherapy boosts a patient's chance of lasting improvement in depressive symptoms by 20 percent. In other research, Hollon has concluded that psychotherapy should be the first line of action against depression since its effects are more enduring. For those with severe depression, taking meds at the same time could slow recovery, he argues.
If you do decide to go off a medication, do so gradually, under the guidance of your doctor or psychiatrist, and invest energy in other ways to fight depression.
August 17, 2016
Christopher Nystuen, MD, MBA