Which antidepressants should be avoided during pregnancy?

The SSRI paroxetine (Paxil) is generally discouraged during pregnancy. Some research suggests that Paroxetine may 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.

Are there any other risks for the baby?

If you take antidepressants throughout pregnancy or during the last trimester, your baby might experience temporary discontinuation symptoms — such as jitters or irritability — at birth. However, tapering dosages near the end of pregnancy isn't generally recommended. It's not thought to minimize newborn withdrawal symptoms. In addition, it might pose challenges for you as you enter the postpartum period — a time of increased risk of mood and anxiety problems.

Research studying the connection between antidepressant use during pregnancy and the risk of autism in offspring remains inconclusive. One recent study found that, for the children of women who used antidepressants during pregnancy, the risk of developing autism was small. A 2017 systematic review suggested a significant association between increased autism risk and maternal use of antidepressants, but the link appears to more consistent during preconception use of antidepressants than during each trimester. Further research is needed.

Should I switch medications?

The decision to continue or change your antidepressant medication is up to you and your health care provider. Concerns about potential risks must be weighed against the possibility that a drug substitution could fail and cause a depression relapse.

What happens if I stop taking antidepressants during pregnancy?

If you stop taking antidepressants during pregnancy, you risk a depression relapse. Untreated depression during pregnancy is associated with increased complications, including premature birth, low birthweight, fetal growth restriction and other complications during the postpartum period. In addition, stopping an SSRI abruptly might cause various signs and symptoms, including:

  • Nausea and vomiting
  • Chills
  • Fatigue
  • Anxiety
  • Irritability

What's the bottom line?

If you have depression and are pregnant or thinking about getting pregnant, consult your health care provider. Sometimes mild to moderate depression can be managed with psychotherapy, including counseling or other therapies. If your depression is moderate to severe or you have a recent history of depression, the risk of relapse might be greater than the risks associated with antidepressants.

Deciding how to treat depression during pregnancy isn't easy. The risks and benefits of taking medication during pregnancy must be weighed carefully. Work with your health care provider to make an informed choice that gives you — and your baby — the best chance for long-term health.

Aug. 25, 2017 See more In-depth