Antidepressants: Safe during pregnancy?

Taking medications during pregnancy can have risks and benefits. Get the facts about antidepressant use during pregnancy.

By Mayo Clinic Staff

Antidepressants are a primary treatment option for most types of depression. But there are benefits and risks to consider when taking antidepressants during pregnancy. Here's what you need to know.

Why is treatment for depression during pregnancy important?

If you have untreated depression, you might not seek optimal prenatal care or eat the healthy foods you and your baby need. Experiencing major depression during pregnancy is associated with an increased risk of premature birth, low birth weight, decreased fetal growth or other problems for the baby. Unstable depression during pregnancy also increases the risk of postpartum depression, early termination of breast-feeding and difficulty bonding with your baby.

Are antidepressants an option during pregnancy?

A decision to use antidepressants during pregnancy is based on the balance between risks and benefits. Overall, the risk of birth defects and other problems for babies of mothers who take antidepressants during pregnancy is very low. Still, few medications have been proved safe during pregnancy and certain types of antidepressants have been associated with a higher risk of complications for babies.

If you use antidepressants during pregnancy, your health care provider will try to minimize your baby's exposure to the medication. This can be done by prescribing a single medication (monotherapy) at the lowest effective dose, particularly during the first trimester.

Which antidepressants are considered OK during pregnancy?

Generally, these antidepressants are an option during pregnancy:

  • Certain selective serotonin reuptake inhibitors (SSRIs). SSRIs are generally considered an option during pregnancy, including citalopram (Celexa), fluoxetine (Prozac) and sertraline (Zoloft). Potential complications include an increased risk of heavy bleeding after giving birth (postpartum hemorrhage), premature birth and low birth weight. Most studies show that SSRIs aren't associated with birth defects. However, paroxetine (Paxil) appears to be associated with a small increased risk of a fetal heart defect.
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs). SNRIs also are considered an option during pregnancy, including duloxetine (Cymbalta) and venlafaxine (Effexor XR). However, research suggests that taking SNRIs at the end of pregnancy is associated with postpartum hemorrhage.
  • Bupropion (Wellbutrin). This medication is used for both depression and smoking cessation. Although bupropion isn't generally considered a first line treatment for depression during pregnancy, it might be an option for women who haven't responded to other medications. Research suggests taking bupropion during pregnancy might be associated with heart defects.
  • Tricyclic antidepressants. This class of medications includes nortriptyline (Pamelor). Although tricyclic antidepressants aren't generally considered a first line or second line treatment, they might be an option for women who haven't responded to other medications. The tricyclic antidepressant clomipramine might be associated with fetal birth defects, including heart defects. Use of these medications during the second or third trimester might also be linked with postpartum hemorrhage.

Which antidepressants should be avoided during pregnancy?

The SSRI paroxetine (Paxil) is generally discouraged during pregnancy. Some research suggests that paroxetine might be associated with a small increase in fetal heart defects.

In addition, monoamine oxidase inhibitors (MAOIs) — including phenelzine (Nardil) and tranylcypromine (Parnate) — are generally discouraged during pregnancy. MAOIs might limit fetal growth.

Feb. 28, 2018 See more In-depth