Some women also have changes in metabolism, which can impact how your body absorbs, distributes, breaks down, and eliminates antidepressant medications should you choose to take them. If you want to continue taking your antidepressant while pregnant, ask your doctor how you can reduce any risks. They may be able to adjust your dosage or start you on a different antidepressant. Antidepressants can be passed to your baby through your breast milk. However, the amount that is secreted into breast milk is less than that which crosses the placenta.
The following selective serotonin reuptake inhibitors SSRIs are some of the best-studied medications for use during breastfeeding:. According to multiple studies, the serum antidepressant levels in nursing infants are either low or undetectable, and there have been no reports of short-term adverse effects.
For these reasons, they are considered relatively safe for use during breastfeeding. It is important that women remain on whichever SSRI is working during pregnancy postpartum while nursing. There is no indication for changing from one antidepressant to another in order to breastfeed safely. Monoamine oxidase inhibitors MAOIs , tricyclic antidepressants TCAs , and atypical antidepressants are also used, though less frequently.
Prior to , the Food and Drug Administration FDA categorized and labeled all drugs based on research about their safety, including how safe they are to take during pregnancy.
The new system provides information on pregnancy exposure, potential risk, and clinical considerations designed to help physicians use clinical judgment to make decisions that are better based on each person's needs. Selective serotonin reuptake inhibitors SSRIs are the most used class of antidepressants during pregnancy.
Some of the most common SSRIs prescribed to treat depression during pregnancy include:. Hundreds of studies have looked at SSRI exposure and congenital anomalies. Although findings have been mixed, the overall conclusion is that SSRIs are generally considered safe during pregnancy. But they are not without risk.
However, because some of the abnormalities are rare, the risks for anomalies still remain below that of the general population risk of 3 to 5 percent. Specifically, Paxil use during the first trimester was associated with several birth defects, including heart defects, problems with brain and skull formation anencephaly , and abdominal wall defects.
The study also confirmed links between Prozac use and two types of congenital anomalies: heart wall defects and irregular skull shape craniosynostosis. The same study found no evidence of an association between the use of SSRIs like Celexa, Zoloft, and Lexapro and birth defects, even though other studies have.
Controversy also exists regarding the association between SSRI use during pregnancy and the risk of persistent pulmonary hypertension of the newborn PPHN , a rare condition where the baby's lungs don't inflate well. But many researchers say the linkage is greatly exaggerated. This syndrome generally presents with symptoms such as jitteriness, irritability, feeding problems, and difficulty breathing. The average time of onset ranges between birth to 3 days of age and may last for up to 2 weeks.
It is important to note that PNAS has no negative outcomes or sequelae and most babies self resolve within days. Serotonin-norepinephrine reuptake inhibitors SNRIs block the reuptake of both serotonin and another neurotransmitter called norepinephrine.
Research shows that using Effexor during early pregnancy may be linked to several congenital anomalies, including heart defects, defects of the brain and spine, cleft lip, and cleft palate. However, the risk for these anomalies remains below that of the general population risk. Tricyclic antidepressants TCAs are the oldest class of antidepressants. They work by blocking neurotransmitters and other receptors in the brain. Though they can be effective as SSRIs in treating depression, they cause more adverse effects.
For this reason, they are not used as first-line treatment and are rarely prescribed for use during pregnancy. The most commonly prescribed TCAs for use during pregnancy include:. There is not enough research to determine whether TCA use during pregnancy has a negative effect on a developing fetus.
However, a study published in indicated that TCAs may be associated with an increased risk of digestive defects as well as eye, ear, face, and neck defects. Monoamine oxidase inhibitors MAOIs work by breaking down neurotransmitters like dopamine and serotonin. Because of the associated side effects and the increased risk of hypertensive crisis, MAOIs are not generally not recommended during pregnancy.
A case report published in the journal Reproductive Toxicology noted fetal malformations in the two pregnancies of a woman taking high doses of MAOIs. Both pregnancies resulted in fetal abnormalities, one of which was severe enough to result in stillbirth. The second infant was born with severe physical and neurological disabilities. The authors of the paper speculated that the high dose of MAOIs contributed to outcomes of the pregnancies, but it was not clear if or how the medications caused the specific malformations.
Additional factors may have contributed, such as the other medications taken during the pregnancy and the parents' ages both were over The family also declined to undergo testing to investigate a genetic cause for birth defects.
Research on the potential risk of Nardil one of the more commonly prescribed MAOIs on a developing fetus is limited.
The FDA label states that healthcare providers need to weigh the potential risks of Nardil against the benefits when prescribing the medication for people who are pregnant. This recommendation is consistent with the other MAOI antidepressants as well as medications in other classes.
Atypical antidepressants are antidepressants that don't fall under any of the other four classes of antidepressants. They're often prescribed when other antidepressants aren't working.
Common medications in this group include:. Like SSRIs, the atypical antidepressants tend to cause fewer side effects than other antidepressants. However, like other medications, there are potential risks when used during pregnancy. There are also non-prescription or alternative treatments for depression such as St. Rigorous, formal research does not exist regarding the risk of exposure to supplements like St. However, anyone planning to use St. John's wort needs to be aware of potential interactions.
For example, taking St. John's wort with medications, supplements, or foods containing 5-hydroxytryptophan 5-HTP , L-tryptophan, or SAMe, can increase your risk for developing serotonin syndrome.
As with medications, ask your doctor about taking a nutritional supplement or herbal remedy if you are pregnant or breastfeeding. For information on specific medications or alternative treatments, the Mother-to-Baby exposure database, maintained by the Organization of Teratology Information Specialists OTIS , can be a helpful resource.
She may also be more likely to abuse drugs and alcohol and to smoke. Adds Dr. Puryear: "Given the stigma toward mental illness , women are often more reluctant to take psychiatric medication while they are pregnant. Somehow they have the idea that they 'should' be able to manage without it in order to protect their baby, but no one has this expectation for any other serious medical illness; women take medication for many different illnesses, including hypertension, asthma, rheumatoid arthritis, and others.
Depression is no different. Save Pin FB More. Pregnant woman taking medication; what prescriptions are safe during pregnancy? Credit: Shutterstock. How severe is my illness? Women who have had four or more major depressive episodes before pregnancy or an episode within the last six months are most likely to relapse if they discontinue medication during pregnancy, according to a study published in Epidemiology. Have I gone off medication before and relapsed? Some women know they'll get sick if they wean off their medication.
Have I tried psychotherapy? Depression-focused psychotherapy can be very effective, research shows. Ask your doctor for recommendations, or find one via the American Psychological Association apa.
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