What are safe medications for anxiety and depression during pregnancy?

From the Guidelines

Selective serotonin reuptake inhibitors (SSRIs) are generally considered safe for use during pregnancy, with sertraline (Zoloft) and fluoxetine (Prozac) having the most safety data. When considering medication for anxiety and depression during pregnancy, it's essential to weigh the risks and benefits. According to the most recent study 1, non-pharmacologic treatments like cognitive-behavioral therapy (CBT) can be effective, but medication may be necessary for some women. The American Psychiatric Association and the American College of Obstetricians and Gynecologists recommend that women and their doctors consider the severity of current symptoms, previous mental health history, and patient treatment preferences when making decisions about antidepressant use during pregnancy 1. Some key points to consider when prescribing medication for anxiety and depression during pregnancy include:

• Sertraline (Zoloft) at 50-200 mg daily and fluoxetine (Prozac) at 20-60 mg daily are reasonable choices
• Citalopram (Celexa) at 20-40 mg daily and escitalopram (Lexapro) at 10-20 mg daily can also be used
• Buspirone (BuSpar) at 15-60 mg daily divided into multiple doses can be used for anxiety
• Lorazepam (Ativan) at 0.5-1 mg as needed may be used for short periods, but benzodiazepines should generally be avoided, especially in the first trimester
• Treatment should continue throughout pregnancy and for at least 6-12 months after delivery to prevent relapse, as suggested by the 2012 study 1. It's crucial to make medication decisions in consultation with both an obstetrician and mental health provider, as individual circumstances may affect recommendations.

From the FDA Drug Label

These doses correspond to approximately 4 times the maximum recommended human dose (MRHD) on a mg/m2 basis. There was no evidence of teratogenicity at any dose level. Bupropion hydrochloride extended-release tablets (XL) should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Sertraline hydrochloride should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus

Safe medications for anxiety and depression during pregnancy are not explicitly stated in the provided drug labels. However, the labels for sertraline 2 and bupropion 3 suggest that these medications can be used during pregnancy if the potential benefit justifies the potential risk to the fetus.

• Sertraline has no evidence of teratogenicity, but there are reports of complications in neonates exposed to the medication late in the third trimester.
• Bupropion has no increased risk of congenital malformations overall, but there are inconsistent findings regarding the risk of left ventricular outflow tract obstruction (LVOTO) and ventricular septal defect (VSD). It is essential to carefully weigh the potential risks and benefits of using these medications during pregnancy and to consult with a healthcare provider to make an informed decision.

From the Research

Safe Medications for Anxiety and Depression During Pregnancy

The following medications are considered relatively safe for use during pregnancy:

• Selective serotonin reuptake inhibitors (SSRIs) for depression and anxiety 4
• Antidepressants, such as SSRIs, can be used as an alternative for treating anxiety and insomnia 5
• Antipsychotic drugs can be substituted for mood stabilizers 5
• Lithium can be safely utilized in pregnancy with close monitoring 6
• Atypical antipsychotics have preliminary data that is reassuring in regards to major malformations, but larger numbers of participants are needed to provide more complete reproductive safety data 6

Medications to Avoid During Pregnancy

The following medications should be avoided during pregnancy:

• Valproate and carbamazepine due to the risk of major malformations 6
• Benzodiazepine drugs, used for anxiety or insomnia, have a small but significant risk of birth defects 5
• Lithium and anticonvulsant drugs (with the exception of lamotrigine) should generally be avoided during pregnancy 5

Considerations for Medication Use During Pregnancy

When considering medication use during pregnancy, the following factors should be taken into account:

• The risks of untreated depression and anxiety during pregnancy, including obstetric and neonatal complications, cognitive deficits, and low birth weight 7
• The potential risks and benefits of medication use during pregnancy, including the risk of birth defects and other adverse effects 4, 8, 5
• The importance of close monitoring and follow-up care during pregnancy and postpartum 7, 5, 6
• The need for evidence-based counseling and education for women and their healthcare providers 8