From the Guidelines
For pregnant women with anxiety, selective serotonin reuptake inhibitors (SSRIs) like sertraline (Zoloft) are generally considered safer alternatives to lorazepam. When considering alternatives to lorazepam for treating anxiety in pregnant women, it's essential to weigh the potential risks and benefits of each option.
- Sertraline is typically started at 25-50 mg daily and can be gradually increased to 50-200 mg daily as needed, with extensive data showing minimal risk of birth defects or adverse pregnancy outcomes 1.
- Other relatively safe options include escitalopram (Lexapro) at 5-20 mg daily or fluoxetine (Prozac) at 10-40 mg daily.
- These medications may take 2-4 weeks to reach full effectiveness, so patience is important.
- Non-pharmacological approaches should also be considered first or as complementary treatments, including cognitive behavioral therapy, mindfulness practices, and regular moderate exercise.
- Any medication decision should involve careful discussion of individual risks and benefits with both a psychiatrist and obstetrician, as even these safer medications carry some potential risks that must be weighed against the significant risks of untreated maternal anxiety 1.
From the Research
Alternatives to Lorazepam for Treating Anxiety in Pregnant Women
- Lorazepam is a benzodiazepine, and its use during pregnancy has been associated with preterm delivery and low birth weight 2
- Non-pharmacological interventions, such as mindfulness therapy, cognitive-behavioral therapy, and education therapy, have been shown to be effective in reducing depressive and anxiety symptoms in pregnant women 3, 4
- Mindfulness therapy, in particular, has been found to be an effective non-pharmacological treatment for improving depressive and anxiety symptoms in pregnant women 3
- Selective Serotonin Re-uptake Inhibitors (SSRIs), such as sertraline and citalopram, may be considered as safer alternatives to lorazepam for treating anxiety in pregnant women, as they have been shown to have a more favorable safety profile compared to other SSRIs 5
Considerations for Treating Anxiety in Pregnant Women
- Pregnant women with elevated anxiety symptoms often report low willingness to use pharmacotherapy to treat anxiety symptoms during pregnancy, citing concerns about negative effects on the baby or themselves 6
- Clinicians should provide effective guidance and information about treatment options for anxiety disorders during pregnancy, taking into account the patient's perceptions of potential side-effects and long-term effects 6
- Alternative strategies for anxiety, such as non-pharmacological interventions, should be discussed and considered as part of the treatment plan 2