What is the safest anxiolytic medication to take during pregnancy?

From the Guidelines

The safest anxiolytic medication to take during pregnancy is generally considered to be selective serotonin reuptake inhibitors (SSRIs) such as sertraline (Zoloft) and citalopram (Celexa), due to their extensive safety data and minimal risks to the developing fetus. When considering anxiolytic medication during pregnancy, it's essential to weigh the benefits of treatment against potential fetal risks.

Key Considerations

• SSRIs like sertraline and citalopram are often considered first-line treatments for anxiety during pregnancy, typically starting at 25-50mg daily and gradually increasing if needed to a maximum of 200mg daily 1.
• Benzodiazepines, such as lorazepam, should be avoided when possible, especially in the first trimester, due to potential risks of cleft palate and in the third trimester due to neonatal withdrawal symptoms 1.
• Untreated severe anxiety can itself pose risks during pregnancy, including poor nutrition, inadequate prenatal care, and increased stress hormones affecting fetal development.
• Non-medication approaches like cognitive behavioral therapy, mindfulness, and pregnancy-safe exercise should be tried first or used alongside medication when appropriate.

Important Factors

• The American Psychiatric Association and the American College of Obstetricians and Gynecologists recommend considering severity of current symptoms, previous mental health history, and patient treatment preferences when making decisions about antidepressant use during pregnancy 1.
• Women with a history of severe suicide attempts or severe depression who have previously experienced symptom reduction with antidepressant treatment may respond to antidepressants better than psychotherapy.
• It's crucial to consult with both an obstetrician and psychiatrist before starting or continuing any medication during pregnancy to ensure the best possible outcome for both mother and fetus.

Medication Safety

• Research suggests that intrauterine antidepressant exposure does not substantially increase the risk for neurodevelopmental problems, such as ASD and ADHD 1.
• However, it's essential to monitor infants exposed to SSRIs during pregnancy for potential signs of drug toxicity or withdrawal over the first week of life 1.

From the FDA Drug Label

It is not known if clonazepam tablets can harm your unborn baby Tell your healthcare provider right away if you become pregnant while taking clonazepam tablets. You and your healthcare provider will decide if you should take clonazepam tablets while you are pregnant. Studies in pregnant animals have shown harmful effects of benzodiazepine medications (including the active ingredient in clonazepam tablets on the developing fetus Children born to mothers receiving benzodiazepine medications including clonazepam tablets late in pregnancy may be at some risk of experiencing breathing problems, feeding problems, hypothermia, and withdrawal symptoms.

Pregnancy Category C In embryo–fetal development studies in rats and rabbits, there was no evidence of teratogenicity following administration of up to 12.5 and 15 mg/kg/day, respectively (1.5 and 3.6 times, respectively, the MRHD of 80 mg on a mg/m2 basis) throughout organogenesis.

The safest anxiolytic medication to take during pregnancy is not explicitly stated in the provided drug labels.

• Clonazepam has shown harmful effects in pregnant animals, and its use in human pregnancy is not well understood 2.
• Fluoxetine has been shown to have no evidence of teratogenicity in embryo–fetal development studies, but it may pose a risk of persistent pulmonary hypertension of the newborn (PPHN) 3. It is essential to consult a healthcare provider to weigh the potential benefits and risks of each medication during pregnancy.

From the Research

Safest Anxiolytic Medication During Pregnancy

The safest anxiolytic medication to take during pregnancy is a topic of ongoing research and debate. According to the available evidence:

• Sertraline and citalopram are considered to be relatively safe options for treating anxiety and depression in pregnant women, with a lower risk of negative outcomes compared to other SSRIs 4.
• Paroxetine and fluoxetine have been associated with a higher risk of negative outcomes, including significant malformations and neonatal complications 4, 5.
• The use of benzodiazepines is generally not recommended during pregnancy due to the risk of birth defects, but they may be considered for short-term treatment in some cases 6, 7.
• SSRIs, including sertraline and citalopram, are considered to be first-line treatments for anxiety disorders during pregnancy, due to their efficacy and relatively favorable side effect profile 4, 6.

Key Considerations

When considering the use of anxiolytic medications during pregnancy:

• The risks and benefits of treatment must be carefully weighed, taking into account the potential risks of untreated maternal anxiety and depression 5, 7.
• Alternative treatments, such as cognitive behavioral therapy (CBT) and psychoeducation, may be considered for mild cases of anxiety 6.
• The use of any medication during pregnancy should be closely monitored and managed by a healthcare provider 4, 7.