When it comes to pregnancy and raising a child, the world is full of loud and contradictory opinions. Many women may feel pressured to take a stance or make a decision right away.
However, some decisions are harder to make than others, like which medications to continue during pregnancy. For many women with major depressive disorder (MDD), deciding whether to stop using antidepressants during pregnancy can be especially difficult.
This article will explore the potential benefits and risks of using antidepressants during pregnancy. Read on to learn about the safest antidepressants for expectant mothers. You'll also discover non-medical options for managing MDD during pregnancy.
Major depressive disorder and pregnancy
Major depressive disorder (MDD) is more commonly known as depression. MDD is one of the most common mental health disorders in the United States. Women are nearly twice as likely as men to experience depression in their lifetime.
Common symptoms of major depressive disorder may include:
- A persistently low mood
- Lowered interest in activities that were once enjoyable
- Frequent feelings of guilt or hopelessness
- A lack of energy
- Difficulty focusing
- Changes in appetite
- Difficulty falling or staying asleep
- Thoughts of suicide
Approximately 70% of women will have one or more symptoms of major depressive disorder while pregnant. Additionally, 45% of women who’ve had MDD in the past continue to experience MDD during their pregnancy. Experiencing MDD during pregnancy increases the risk of developing postpartum depression and anxiety.
Untreated MDD can lower a person’s quality of life. It can also make it hard to carry out day-to-day tasks. Antidepressants are the most common treatment option for depression. The second most common treatment option is psychotherapy (talk therapy).
Can you take antidepressants while pregnant?
Yes, it is possible to continue taking certain types of antidepressants while pregnant. When deciding on medication use during pregnancy, it's important to weigh the potential risks and benefits.
Some types of antidepressants are safer than others during pregnancy. Still, no antidepressant is entirely risk-free. Your obstetrical healthcare provider can help you determine a safe pregnancy and medication plan.
What are the safest antidepressants during pregnancy?
Sertraline (Zoloft) appears to have the lowest risk on a developing fetus during pregnancy. Sertraline is a selective serotonin reuptake inhibitor (SSRI), one of the most common types of antidepressants.
SSRIs are the most studied type of antidepressant. Additional SSRIs that may be safe to continue during pregnancy include citalopram (Celexa), escitalopram (Lexapro) and fluoxetine (Prozac).
Other common types of antidepressants include norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs) and bupropion. SNRIs are the second most commonly used antidepressants during pregnancy. Overall, SNRIs, TCAs and bupropion have been less studied in pregnancy. Some may not be recommended due to potential risks.
Always consult healthcare providers before making medication changes during pregnancy. Your healthcare provider can also help you understand your medication options. They can explain the risks and benefits of using antidepressants during pregnancy. In some cases, doctors may prescribe a lower dose of your medication during pregnancy.
In general, if a woman’s depression is well controlled on a medication that has a good safety profile, healthcare providers are unlikely to recommend stopping or changing the medication during pregnancy.
Potential risks and side effects of antidepressant use during pregnancy
There may be risks associated with using antidepressants during pregnancy. However, studies often show mixed results. The possible risk depends on the type of antidepressant and at what stage the baby is exposed to the medication.
Potential risks to the baby from using antidepressants during pregnancy may include:
- Persistent pulmonary hypertension
- Preterm birth
- Heart defects
- Low birth weight
- Poor neonatal adaptation syndrome
It's important to know the risks of using different antidepressants during pregnancy. Many women take antidepressants. They may worry that using them during pregnancy could cause birth defects, malformations and other health problems.
The use of certain SSRIs and TCAs during the first trimester does not increase the risk of birth defects or miscarriage. However, TCAs may increase the risk of preterm birth, low birth weight, and neonatal issues when taken during late pregnancy.
Late-term exposure to SSRIs and SNRIs in the uterus may significantly increase the risk of poor neonatal adaptation syndrome (PNAS) in infants. PNAS is a short-term condition that happens when a baby is withdrawing from the medication.
Symptoms may include jitteriness, respiratory distress and difficulties feeding. Additionally, infants may struggle to regulate their body temperature. In most cases, PNAS symptoms are mild and resolve within two weeks after birth.
No neurodevelopmental impact
Antidepressant use while pregnant has raised concerns about neurodevelopmental disorders (NDS) such as autism and attention deficit hyperactivity disorder (ADHD). However, a 2022 by JAMA Internal Medicine found that using antidepressants during pregnancy did not increase the risk of a child developing a neurodevelopmental disorder.
Neurodevelopmental disorders affect brain development. They impact a child’s behavior, memory or learning. Other common NDs include speech impairments, learning disabilities or coordination issues.
Pregnancy and untreated depression
People often discuss the risks and side effects of taking antidepressants during pregnancy. However, it's important to note that untreated maternal depression also has risks.
Depression is one of the most common pregnancy complications. Approximately 68% of women who stop taking antidepressants during pregnancy experience a depression relapse. A depression relapse is when symptoms come back after a period of having minimal to no MDD symptoms.
Untreated depression in pregnant individuals has been associated with a higher risk of:
- Premature/preterm birth
- Low birth weight
- Fetal growth restriction (when a baby isn’t growing at the expected rate)
- Postpartum depression
- Negative impact on the baby’s cognitive, motor, and language development
- Increased risk of preeclampsia (a type of high blood pressure that affects some pregnant individuals)
- Increased risk of eclampsia (seizures that may affect pregnant individuals with preeclampsia)
Additionally, some pregnant women with untreated depression may struggle to get the prenatal care they need. Untreated depression can lead to low energy and low mood. These symptoms can make it challenging to follow health recommendations.
Managing depression during pregnancy without using antidepressants
It is possible to manage certain types of mental illnesses without the use of antidepressants. But, the effectiveness of non-medical treatments for mental health can vary. It depends on the type and severity of the disorder.
Non-medical treatments that may help manage depression during pregnancy:
- Psychotherapy (talk therapy/ counseling)
- Daily exercise
- A healthy and balanced diet rich in omega-3 fatty acids and folate
- Bright light therapy
- Prenatal vitamins containing between 400-600 mcg of folic acid (upon doctor approval)
- Receiving social support and feeling connected to your loved ones
How Sesame can help
If you're navigating pregnancy and mental health challenges, Sesame can connect you to top-rated, licensed healthcare providers who can help. Book an online doctor visit today to receive expert medical advice, personalized treatment plans, and prescriptions when needed, all from the comfort of your home.
Providers on Sesame can help you understand the safest antidepressant options and explore non-medical treatments for managing depression during pregnancy. Take the first step towards a healthier pregnancy and peace of mind by booking an online OB-GYN appointment with a specialist near you today.
