Can I Take Antidepressants While Pregnant?

If you experience depression, anxiety or other mental health concerns, taking care of yourself is key, and sometimes that can mean getting treatment with antidepressants. But what if you’re pregnant or planning to become pregnant?

It’s totally understandable if you’re being extra aware (and maybe a little cautious) of what you’re consuming while pregnant, and medication is no exception. But taking care of your mental health is important whether it’s before, during or after pregnancy.

If you’re not sure about how antidepressants might affect you or your baby, read on to find out what medical doctors have to say about starting or continuing mental health medication during pregnancy.

Are Antidepressants Safe During Pregnancy?

When it comes to taking any kind of medication during pregnancy, explains Dr. Kristin Lasseter, reproductive psychiatrist at Clinic of Austin and co-host of the WomenWell online community, the important thing to understand is that, in some cases, the amount of medication that baby is exposed to in the womb actually has fewer risks for baby than exposure to the pregnant parent’s untreated illness.

Another thing to keep in mind is that, as medications are tested for use during pregnancy, rather than medications being deemed “safe,” what you’ll see instead is the potential risk level—for example, the lowest-risk medications (known as Category A drugs) will be labeled something like “failed to demonstrate a risk to the fetus” or “no evidence of risk.”

Risk Level of Antidepressants During Pregnancy

As far as severe birth defects, “evidence shows no increased risk of miscarriage, congenital malformations or neurodevelopmental effects later in life with use of antidepressants in pregnancy,” Dr. Lasseter says.

Studies on the most common antidepressants taken during pregnancy—SSRIs (selective serotonin reuptake inhibitors) like Prozac (fluoxetine), Zoloft (sertraline) and Paxil (paroxetine)—seem to show low risk overall. “Some data suggests that these medications may be associated with an increased risk of certain birth defects. However, the absolute risk seems to be low (approximately 1%),” says Dr. Nathan Fox, ob-gyn, creator of the Healthful Woman podcast and Babylist Health Advisory Board member. “Furthermore, it is difficult to know if the small increase seen in birth defects is related to the medication itself or due to other underlying risk factors in the women or increased surveillance in their babies for minor birth defects. For this reason, it is very important to balance the possible risk of these medications with the risk to maternal mental health of stopping them.”

What birth defects, exactly? “The most commonly seen issue is neonatal adaptation syndrome,” says Dr. Lasseter, “which is when a baby has a more difficult time adapting to life outside of the womb than normal.” While doctors and researchers don’t know whether the baby’s difficulty adapting has to do with withdrawal from the medication or from exposure to the SSRI in general, here’s what they do know about neonatal adaptation syndrome: one study found that it affects about one-third of babies exposed to SSRIs in the third trimester, and while it does show up within the first few hours after birth and can include symptoms like irritability, restlessness, respiratory distress and difficulty eating, cases are typically mild and disappear within two to three weeks (skin-to-skin contact has been shown to be effective at reducing symptoms).

Risk Level of Untreated Mental Health Concerns

But if you’ve been taking antidepressants for any period of time before getting pregnant, and going off that medication puts your mental health at risk, your doctor will usually recommend that you stay on your medication while pregnant, says Dr. Fox. It’s important to understand that stopping antidepressants can increase your risk of relapse of major depression or anxiety, which can carry their own risk to the pregnancy.

Untreated maternal mental health issues have been related to premature birth and low birth rate as well as child developmental issues like emotional and behavioral self-regulation, Dr. Lasseter says. The most important point: Taking care of baby starts with taking care of you, and that includes your mental health.

Stopping Antidepressants While Pregnant

If you decide you’d rather go medication-free during your pregnancy, you need to talk to your health care team before making any changes to your medication schedule. In fact, any changes in your medication should be made under the supervision of your psychiatrist, says Dr. Fox.

Why the supervision? “Pregnancy is a high-risk time for mental illness symptoms to appear or recur,” Dr. Lasseter says, citing a 2006 study that found that, “among the 201 women in the sample, 86 (43%) experienced a relapse of major depression during pregnancy. Among the 82 women who maintained their medication throughout their pregnancy, 21 (26%) relapsed compared with 44 (68%) of the 65 women who discontinued medication.”

The risk of relapse increases further during the postpartum period, Dr. Lasseter continues, with postpartum depression and postpartum anxiety often appearing if mental health concerns were present during pregnancy.

If you’re concerned about dosage, rest assured that your doctor will likely recommend that you stay on your current dosage as long as it’s working for you. “Research shows [the risks of antidepressants during pregnancy] are independent of the dose of the medication,” Dr. Lasseter says, and it’s safer to continue whatever dosage eliminates your symptoms than to reduce your dosage and experience symptoms as a result.

Other Options for Prenatal Mental Health Treatment

Whether you’re not on antidepressants at all or you’re taking antidepressants prior to getting pregnant and your healthcare team gives the okay for your pharmaceutical treatment to stop, there are other non-medicated options to care for your mental health during pregnancy (but keep in mind that you should still consult your healthcare provider before trying any of these treatments):

• Psychotherapy: Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT) are the two types of therapy with the most evidence for treating mental illness during pregnancy
• Increasing social support
• Mindfulness meditation
• Yoga
• Massage therapy
• Acupuncture
• Getting plenty of high-quality sleep
• Eating healthy foods

What about supplements, especially those that claim to be mood boosters? “While many people believe that ‘natural’ treatments like herbs and supplements are ‘safe’,” Dr. Lasseter says, “the reality is these substances are mostly experimental with very little research about their safety to the baby in pregnancy.”

So it’s recommended that they be avoided during pregnancy unless fully backed by quality research on the safety to developing fetuses and pregnant people, specifically.

Taking Antidepressants While Breastfeeding

If you’re planning to continue, start or restart treatment with antidepressants during the postpartum period, whether or not you nurse or pump is something to consider.

Dr. Lasseter tells us that exposure to antidepressants through breastmilk can result in mild side effects like drowsiness or irritability, but the medication “is secreted in very minimal amounts in breastmilk, [so] these side effects are typically rare and the majority of babies have no issues” when nursing or being bottle-fed pumped breastmilk.

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The Key Takeaway:

Taking care of your mental health is extremely important no matter what stage of pregnancy or postpartum you’re in. If your mental health is a concern, there’s no need to go without treatment while pregnant.

If you’re considering taking antidepressants during pregnancy, talk to your healthcare provider to see if it’s the right treatment option for you. But if you’d rather not take medication while you’re expecting a baby, there are other non-medication treatments you can also discuss with your provider.

No matter how you care for your mental health during pregnancy, reducing any symptoms of depression and anxiety will help both you and baby.