What are the safe antidepressants for pregnant women?

From the Guidelines

Selective serotonin reuptake inhibitors (SSRIs) are generally considered the safest antidepressants for pregnant women when treatment is necessary, with sertraline (Zoloft) and citalopram (Celexa) being often recommended as first-line options due to their established safety profiles and minimal association with birth defects. The use of antidepressants during pregnancy should be carefully considered, weighing the benefits of treating depression against potential risks, as untreated depression poses significant risks to both mother and baby, including poor prenatal care, preterm birth, low birth weight, and postpartum depression 1.

Some key points to consider when prescribing SSRIs during pregnancy include:

• Typical starting doses are lower during pregnancy: sertraline 25-50mg daily, citalopram 10-20mg daily, gradually increasing if needed
• Treatment should continue throughout pregnancy and for at least 6-12 months postpartum to prevent relapse
• Some SSRIs may be associated with a small increased risk of persistent pulmonary hypertension in newborns, and babies may experience temporary withdrawal symptoms after birth
• The American Psychiatric Association and the American College of Obstetricians and Gynecologists recommend that women and their doctors work together to consider severity of current symptoms, previous mental health history, and patient treatment preferences when making decisions about antidepressant use during pregnancy 1

It's also important to note that the risk of neonatal drug withdrawal should be considered when using SSRIs during pregnancy, and that infants are at risk for manifesting clinical signs of drug toxicity or withdrawal over the first week of life 1. However, the benefits of treating depression with SSRIs during pregnancy often outweigh the risks, and sertraline and citalopram are considered relatively safe options. Ultimately, the decision to use antidepressants during pregnancy should be made in consultation with both an obstetrician and psychiatrist, taking into account the individual patient's needs and circumstances.

From the FDA Drug Label

When treating a pregnant woman with sertraline, the physician should carefully consider both the potential risks of taking an SSRI, along with the established benefits of treating depression with an antidepressant. The decision can only be made on a case by case basis Data from epidemiological studies of pregnant women exposed to bupropion in the first trimester have not identified an increased risk of congenital malformations overall

The safe antidepressants for pregnant women are not explicitly stated in the provided drug labels. However, the labels suggest that:

• Sertraline may be used during pregnancy only if the potential benefit justifies the potential risk to the fetus 2.
• Bupropion exposure during the first trimester has not been associated with an increased risk of congenital malformations overall 3. It is essential to weigh the potential risks and benefits of each medication on a case-by-case basis. Key considerations include:
• The potential risks of taking an SSRI or other antidepressant during pregnancy
• The established benefits of treating depression with an antidepressant
• The individual patient's medical history and circumstances No conclusion can be drawn about the safety of other antidepressants during pregnancy based on the provided information.

From the Research

Safe Antidepressants in Pregnancy

The safety of antidepressants during pregnancy is a topic of ongoing research and debate. According to the available evidence, some antidepressants are considered safer than others.

• Selective serotonin reuptake inhibitors (SSRIs) are generally considered to be relatively safe during pregnancy, although the risk of major congenital malformations and other adverse effects should be taken into account 4.
• Sertraline is often recommended as a safer option compared to other SSRIs such as paroxetine and fluoxetine, which have been associated with a higher risk of congenital heart defects and other adverse effects 4, 5.
• Tricyclic antidepressants are also considered to be relatively safe, although they may cause perinatal withdrawal symptoms and difficulties in neonatal adaptation 6.
• Antipsychotic drugs are generally considered safe for the developing fetus, but may cause perinatal withdrawal symptoms and difficulties in neonatal adaptation 6.

Factors to Consider

When considering the use of antidepressants during pregnancy, several factors should be taken into account, including:

• The severity of the depressive symptoms and their impact on the mother and fetus 7, 8.
• The potential risks and benefits of treatment with antidepressants versus the risks of untreated depression 7, 8.
• The pharmacokinetics of the antidepressant and its potential effects on the fetus 5.
• The need for close monitoring and follow-up during pregnancy and after delivery 4, 6.

Specific Antidepressants

Some specific antidepressants that are considered safe in pregnancy include:

• Sertraline 4, 5.
• Fluoxetine, although its use should be approached with caution due to the potential risk of congenital heart defects 4, 5.
• Paroxetine, although its use is generally discouraged due to the potential risk of major congenital malformations and other adverse effects 4, 5.
• Tricyclic antidepressants, such as imipramine and nortriptyline, which are considered relatively safe although they may cause perinatal withdrawal symptoms and difficulties in neonatal adaptation 6.