Is Viibryd (vortioxetine) safe to start or continue in a pregnant woman with depression, and should it be switched to a better‑studied SSRI such as sertraline or escitalopram?

Viibryd (Vilazodone) Use in Pregnancy

Switch from Viibryd to sertraline if the patient is pregnant or planning pregnancy, as sertraline is the first-line SSRI with the most robust safety data and minimal breast milk excretion. 1

Why Switch from Viibryd

• Viibryd (vilazodone) has essentially no human pregnancy safety data, making it inappropriate for use during pregnancy when better-studied alternatives exist 2
• Vortioxetine (a newer antidepressant similar to Viibryd in terms of limited pregnancy data) showed concerning findings in a 2025 rat study, including reduced fetal brain dimensions, cortical thinning, disrupted neurotransmitter levels, and elevated apoptotic markers at clinically relevant doses 3
• A 2024 Japanese case report of vortioxetine exposure during pregnancy documented neonatal respiratory distress requiring support and poor muscle tone immediately after birth, though the infant ultimately recovered 4
• The 2005 safety review explicitly states that newer antidepressants with incomplete safety data "should not be used as first-line agents in the pharmacological treatment of depression in pregnancy" 2

Why Sertraline is Preferred

• Sertraline is recommended as first-line therapy by the American Academy of Pediatrics due to minimal excretion in breast milk and low infant-to-maternal plasma concentration ratios 1
• Large population-based studies have demonstrated no increased risk of cardiac malformations with first-trimester sertraline use 1
• Sertraline provides the infant with less than 10% of the maternal daily dose through breast milk and can be safely continued during breastfeeding 1
• Multiple reviews have not identified adverse neurodevelopmental outcomes among infants born to women treated with SSRIs (including sertraline) during pregnancy 1

General SSRI Safety Context

• Converging evidence from observational studies suggests that maternal antidepressant use during pregnancy either has no influence on offspring risk of autism spectrum disorder and ADHD, or the influence is small and not clinically significant 5
• The associations observed between prenatal antidepressant exposure and neurodevelopmental problems are largely due to confounding factors (maternal psychiatric illness, environmental factors, genetic factors) rather than medication effects 5, 6
• Research to date suggests that antidepressant use during pregnancy is relatively safe, particularly for long-term neurodevelopmental outcomes 5

Risks of Untreated Depression

• Untreated depression during pregnancy carries significant documented risks including premature birth, decreased breastfeeding initiation, and harm to the mother-infant relationship 1, 6
• Women who discontinue antidepressants during pregnancy show significantly increased relapse risk of major depression 7
• Maternal depression negatively impacts the emotional development of children, and severe depression may lead to suicide attempts 2

How to Switch Medications

• Transition directly from Viibryd to sertraline without a washout period to prevent depressive relapse 7
• Monitor the patient for withdrawal symptoms during the transition and for adequate depression control after the switch 7
• Start sertraline at 25-50 mg daily and slowly titrate upward while monitoring for efficacy 1
• Use the lowest effective dose throughout pregnancy 1

Neonatal Monitoring After Birth

• Third-trimester SSRI use may lead to neonatal adaptation syndrome in approximately 30% of exposures, with symptoms including irritability, jitteriness, tremors, feeding difficulty, and respiratory distress 1, 7
• These symptoms typically appear within hours to days after birth and usually resolve within 1-2 weeks 1
• Arrange for early follow-up after initial hospital discharge and monitor infants for signs of drug toxicity or withdrawal over the first week of life 1
• In severely affected infants with persistent symptoms, a short-term course of chlorpromazine has provided measurable relief 1

Additional Considerations

• Avoid paroxetine specifically, which has FDA pregnancy category D classification due to cardiac malformation concerns 1, 8
• Late pregnancy SSRI exposure has a possible association with Persistent Pulmonary Hypertension of the Newborn (PPHN), with a number needed to harm of 286-351 1, 7
• Do not discontinue treatment altogether due to fear of medication risks, as untreated maternal depression carries substantial documented risks to both mother and infant 1