But getting pregnant may change things. The joy of seeing a positive pregnancy test result may be tinged with a nagging sense of worry if you rely on antidepressants. You may wonder whether you can continue taking your medication now that you’re pregnant, and you may have concerns about going without it for a period of nine months. Antidepressants can cause birth defects if you take them when you are expecting. Pregnant people who use antidepressants need to weigh out the risks and benefits of continuing their medication during pregnancy together with their healthcare provider. Antidepressants do pose some level of risk to an unborn baby, but being depressed while pregnant comes with some risks of its own, too. The decision of whether to continue taking medication, alter the type or dosage, or stop altogether depends on your individual situation.
What Are Antidepressants?
Antidepressants are medications that help to reduce depression symptoms. “Essentially, antidepressants are drugs that raise your happy hormones,” explains Kim Langdon, MD, an Ohio-based OBGYN with over 20 years of experience. Some people take antidepressants to help them navigate a traumatic life event, while others may take them over the long term to combat clinical depression.
Is It Safe to Take Antidepressants During Pregnancy?
All antidepressants come with some level of risk, and whether or not it’s wise to take them during pregnancy depends on a number of factors. There are different types of antidepressants as well as different doses. The risks to your unborn baby may be higher or lower depending on which type of antidepressant you take and the dose. All medications are assigned a “pregnancy category” to determine if they are safe for use in pregnancy. The categories are as follows:
Category A: Proven not to affect a human fetus in the first trimester.Category B: Animal studies indicate these drugs probably do not affect a fetus in the first trimester.Category C: Animal studies indicate that these drugs may cause birth defects.Category D: Proven to cause birth defects but in extreme cases, benefits may outweigh risks.Category X: Proven to cause birth defects and benefits would not outweigh risks.
Most antidepressants fall into category B or category C, though a few are category D or even category X. Tapering off and stopping the use of antidepressants may be the best choice during pregnancy. That being said, with more severe and debilitating depression, the benefits of taking antidepressants while pregnant may outweigh the risks. “The health of the mother is paramount in pregnancy, and that includes mental health,” emphasizes Katherine Palmerola, MD, an OBGYN and medical advisor with Stix. If you suffer from chronic depression, your depression may prevent you from taking proper care of yourself. “Pregnancy can be a vulnerable and stressful time for women, exacerbating mood disorders,” says Dr. Palmerola. “I encourage my patients [who rely on their antidepressant to function] to continue their category B/C medications, or if on a category D/X, switching to a safer alternative rather than stopping altogether.”
What If I Take Antidepressants Before Realizing I’m Pregnant?
If you find yourself pregnant and you are on antidepressants, it’s important to reach out to your healthcare provider right away. “Please speak with your psychiatrist and OBGYN immediately to confirm if the medication is safe for pregnancy, and if not, what medication to change to to ensure both you and baby are protected,” says Dr. Palmerola. If you plan to stop your antidepressants during pregnancy, make sure you speak to a healthcare provider before taking your own initiative. “If you want to stop them, consult your doctor because many of them need to be tapered,” notes Dr. Langdon.
Risks of Taking Antidepressants While Pregnant
Taking antidepressants comes with some risks, but depression also comes with risks. That’s why it’s so important to talk with your healthcare provider about whether you should continue your antidepressants during pregnancy. Taking antidepressants while pregnant increases your baby’s risk of being born with birth defects. Some medications, like fluoxetine and paroxetine, should be avoided completely because they have a higher chance of definitely causing birth defects. Other medications, like sertraline, have a lower risk (but they do have some risk). Here are some risks of taking antidepressants during pregnancy.
Abdominal Birth Defects
Babies exposed to antidepressants in utero may be at an increased risk of developing abdominal defects. This includes gastroschisis, where the intestines develop outside of the baby’s body, and omphalocele, where the organs stick out through the belly button in a transparent sack.
Cranial Birth Defects
Antidepressant use may increase your baby’s risk of developing deformities of the brain and skull. These birth defects include craniosynostosis, which causes a misshapen skull, and anencephaly which is when the baby is born with parts of the brain and skull missing.
Risks of Not Taking Antidepressants While Pregnant
If you suffer from debilitating depression, your healthcare provider may decide that antidepressants are worth the risks. “I always weigh the pros and cons of the medications with potential pregnancy risks with patients before trying to conceive, and come up with a plan for pregnancy,” notes Dr. Palmerola. Here are some risks of leaving depression untreated while pregnant.
Low Birth Weight and Preterm Birth
Research has linked maternal depression with preterm birth and intrauterine growth restriction. Both of these risks may lead to low birth weight. Low birthweight babies, who are born weighing less than five pounds, eight ounces, are at an increased risk of developing issues like breathing problems and jaundice.
Suicide Risk
Depression is an illness that may have devastating results if not treated. Pregnancy may worsen mental health problems in people who already suffer from depression, and antidepressants may be necessary to avoid the risk of harming oneself.
When Can I Resume Taking Antidepressants?
It’s fine to start taking your antidepressants once you have given birth. In fact, those who suffer from depression are at a higher risk for postpartum depression (PPD). Getting back on your medication may help you avoid this. If you are breastfeeding, any potential risks are even smaller than when you are pregnant. Again, whether you should take antidepressants while breastfeeding depends on the type of medication and the severity of your depression. Sertraline, paroxetine, nortriptyline, and imipramine have been shown to be the safest antidepressants to take while breastfeeding.
Pregnancy Safe Alternatives
Life with depression can be hard. Getting off your antidepressants for the duration of your pregnancy may be easier with these alternatives.
Aerobic Exercise
Getting your body moving regularly can help combat depression symptoms. Physical exercise has many added benefits during pregnancy as well. Safe kinds of pregnancy exercise include swimming, running, or indoor cycling.
Omega-3 Fatty Acids
Eating a diet rich in omega-3 fatty acids like salmon, avocado, and flaxseeds may help with depression. Researchers presume that the anti-inflammatory properties of these foods play a role, as do their ability to travel through the cell membrane and potentially affect mood-regulating molecules in the brain.
Talk Therapy
Talk therapy has benefits no matter what your situation is. If you suffer from depression linked to a traumatic life event, talking with a licensed psychologist may help a lot. You may already go to therapy. If you stop your antidepressants during pregnancy, it’s even more important to continue going. You may also want to consider seeking out a therapist who specializes in prenatal or postpartum mental health. “Therapy as an adjunct to medication is often very effective, with the opportunity to address pregnancy-specific concerns or changes to your mood,” explains Dr. Palmerola.
A Word From Verywell
Taking antidepressants may cause birth defects, so it’s important to talk over your prescription with a healthcare provider when you become pregnant. If you plan on getting pregnant soon, it would be wise to have this discussion before attempting to conceive. Your doctor may help you taper off of your medication when you get pregnant or when you begin trying to conceive. If you suffer from severe depression that interferes with your ability to function, continuing to take antidepressants may be the safest choice for you and your baby.
