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Antidepressants and Pregnancy: Are They Safe To Take While Pregnant?

Most people understand that it is common sense to avoid drugs and alcohol during pregnancy. Various drugs and other substances have been shown to cause birth defects and developmental problems among babies. It is well documented that drinking alcohol during pregnancy can lead to birth defects, and even smoking marijuana while pregnant could put a child at risk for impaired cognitive functioning. What about taking antidepressants during pregnancy? After all, they are considered “safe” and “legal” drugs…

Is it safe to take antidepressants during pregnancy?

In many cases, antidepressants are regarded as being safe to take during pregnancy. However, certain drugs such as Paxil and various MAOIs have been specifically linked to causing birth defects. If you are on Paxil or an MAOI and take it throughout pregnancy, you are putting your baby at significant risk of drug-induced defects and developmental problems.

To avoid putting your baby at risk, your best option is to avoid antidepressants during pregnancy.  However, if you know that you cannot cope without antidepressants, you still have options.  Antidepressants that are considered safe to take while pregnant include: most SSRIs (except Paxil) and most tricyclic antidepressants. Additionally the atypical antidepressant Wellbutrin hasn’t been associated with any significant risks during pregnancy.

Antidepressants and Pregnancy: The Research

Between 1.8% and 2.8% of pregnant women are on SSRI medications. Untreated maternal depression poses its own set of risks, but could the SSRIs cause harm to the unborn baby? It is important to keep in mind that even if an SSRI is considered “safe” it can still pose a risk to the fetus and neonatal child.

Evidence suggests that the risk of birth defects from exposure to an SSRI in the first trimester is relatively low. However, mothers must understand that SSRIs can cross the placenta and are commonly found in breast milk. Various factors such as the particular SSRI you are taking, the drug metabolism of the mother and child, as well as exposure in later stages of pregnancy.

Most infants that are exposed to SSRIs late in pregnancy can experience various withdrawal symptoms after they are born. In some cases these symptoms are severe and additional medical assistance is necessary. Typically these symptoms are found in less than 1/3rd of babies exposed to SSRIs and need to be monitored for 2 consecutive days following birth.

At this moment, the long-term effects of exposure to antidepressants during pregnancy aren’t well documented. Some hypothesize that they may interfere with brain development and cognition. This could lead to difficulties with learning, behavioral problems, and other cognitive deficits. Although these are just possibilities, it is better to do whatever you can to minimize risk of exposure for your child.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/23080479

Dangers of Antidepressants During Pregnancy

There are several dangers associated with taking antidepressant medications during pregnancy. These include things like: developing ADHD, developing autistic spectrum disorders, behavioral problems, developmental delays, birth defects, social difficulties, and low-grade withdrawal symptoms when the child is born.

ADHD: According to new research in 2014, antidepressant usage during pregnancy could increase the child’s risk of developing attention-deficit disorder. Initially it was speculated that using antidepressant medications may increase a baby’s risk of developing autism, but no links in this particular study were found. However, upon further investigation researchers noted a link between their usage and children with ADHD.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/25163745
  • Source: http://www.ncbi.nlm.nih.gov/pubmed/25155880

Autism: Some research has suggested that using antidepressants during pregnancy could increase a child’s risk of developing autistic spectrum disorders. Although some research found no causal evidence, new research (including a meta-analysis) found a link between exposure to antidepressants in the womb and autistic spectrum disorders. This further supports the idea that antidepressants affect brain development.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/25152842

Behavioral problems: There is some evidence suggesting that children exposed to antidepressants in the womb may develop behavior problems. These behavior problems may be linked to neurodevelopmental delays, epigenetic alterations, and possibilities of ADHD and autism. Risk of behavioral problems is considered relatively low if you’re on a safe medication, but still a risk nonetheless.

Cardiac malformations: For individuals taking Paxil, it has been linked to cardiac malformations among infants. It should be noted that if you are pregnant, you should never take Paxil. Paxil is the only SSRI that is linked to causing significant birth defects. There appeared to be a relationship with Paxil dosage as well. The greater the dose (particularly over 25 mg), the greater the potential for defects.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/17187388

Cognitive deficits: Although prenatal exposure to antidepressants hasn’t been directly linked to cognitive deficits, some speculate that it may cause them. More research needs to be conducted in this area to determine what drugs cause risk of these deficits. It is believed that since antidepressants are transferred to the fetus through the placenta, it could affect the baby’s neurotransmission and disrupt neural development.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/25089614

Club foot: This is a condition in which the baby’s foot appears to rotate abnormally inwards. This makes it appear as if the baby is walking on their ankles instead of their actual feet. Although most babies recover from this condition prior to early childhood, if you take SSRI antidepressants your baby’s risk of developing club foot increases significantly.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/25171134

Delayed motor development: A child’s motor skills may take significantly longer to develop if exposed to antidepressants during pregnancy. This includes things like their reflexes and movements. It is thought that developmental stages may be delayed if a baby is exposed to antidepressant drugs.

Internalizing problems: Some studies have found a link to antidepressant use during pregnancy and the baby internalizing problems later in life. Although this finding is somewhat debatable, it is a finding nonetheless and shouldn’t be overlooked. This supports the idea that antidepressants can have a detrimental effect on neurodevelopment.

Social difficulties: In addition to developing ADHD and/or autism, a link was found between antidepressants and social difficulties. This could make life significantly more difficult for a child if he or she is unable to perform well in social settings.  This may not be something that you are willing to risk by taking an antidepressant.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/24863148

Withdrawal symptoms: There is some evidence supporting the idea that once the baby is born, it will go through a withdrawal from the antidepressant that the mother had taken. It is well documented that the baby absorbs the drug in the placenta, and thus becomes conditioned to the substance. When the baby is born, it is no longer exposed to the drug and goes through a withdrawal period that could include things like irritability and jitteriness. In some cases, the withdrawal symptoms could be dangerous and the baby will need to be closely monitored.

Alternatives to antidepressants during pregnancy

Prior to taking antidepressants while pregnant, it is important to consider some alternative options. Be sure to read the article called “10 Natural Cures for Depression” and consider some of those options before assuming you need an antidepressant. If your depression becomes difficult to control, there are still proven drug-free treatment options that can be pursued.

  • CBT (Cognitive Behavioral Therapy): Many experts agree that Cognitive Behavioral Therapy is a better treatment for depression during pregnancy than taking antidepressants. Some even think that CBT is a superior treatment option in general for depression. CBT attempts to address the faulty thinking patterns associated with depression and then correct them. Many studies have proven that CBT is just as effective as antidepressant medication. This is certainly something to consider if you want to stay drug-free.
    • Source: http://www.ncbi.nlm.nih.gov/pubmed/24911438
  • Exercise: Another option that’s completely free is exercising. Significant evidence shows that frequent cardio exercise can improve mental health and fight depression. There are many psychological benefits of exercise that you can reap during your pregnancy if you stay active. Exercise is known to boost endorphin production and stimulate feel good neurotransmitters like dopamine.
  • Psychotherapy: Another option you have is to see a psychotherapist to talk about your depression. The therapist may want to utilized CBT, but may also use other effective types of talk therapy. If you can find a qualified psychotherapist that allows you to vent your emotions and thoughts, it may significantly help you with your depression during pregnancy.

Antidepressants To Avoid During Pregnancy (Birth Defects)

If you know that you need to take an antidepressant during pregnancy, it is important to first talk about it with a qualified medical professional. You may want to schedule an appointment with a psychiatrist to discuss the safest antidepressant options. There are certain drugs that should be avoided during pregnancy because they are linked to birth defects and other developmental problems.

  • Paxil (Paroxetine): This SSRI is the most important to avoid during pregnancy because it has been linked to many birth defects. It has been noted as causing heart defects when a mother takes it during her first few months of pregnancy.  You may have seen lawsuits regarding this particular antidepressant on TV and the news.  Initially the manufacturer failed to report the fact that it caused birth defects.  These days most doctors are aware of the risks and will advise pregnant mothers to avoid Paxil.
  • MAOIs: The Monoamine Oxidase Inhibitors are typically not recommended during pregnancy because they can stunt growth of the fetus. Additionally they may raise the mother’s blood pressure to an abnormally high level, which could harm the child.  These are older drugs with dietary interactions that most people only take as a last-line treatment option for major depression.

What antidepressants are safe during pregnancy?

No antidepressant drug should be considered 100% safe during pregnancy. However, there are many antidepressants that have been thoroughly researched and are considerably safer than others. Although there are many types of antidepressants to choose from, most doctors will prescribe a safe SSRI medication with a favorable track record for those who are pregnant.

  • SSRIs: Most SSRI drugs are considered the safest antidepressants to take during pregnancy with the exception of Paxil. Various SSRIs that are considered safe include: Celexa, Lexapro, Prozac, and Zoloft. These are a newer class of medications that are favored over older antidepressants like MAOIs and tricyclics.
  • Wellbutrin: One atypical antidepressant option that is commonly utilized to treat depression is that of Wellbutrin. This drug works differently than most SSRIs and has a good safety profile for those who are pregnant. This drug tends to be prescribed if the depression is caused by low arousal and isn’t accompanied by anxiety.
  • Tricyclics: Older tricyclic drugs tend to work well for treating certain types of depression. The TCA class of antidepressants is also considered pretty safe during pregnancy. If you are on a tricyclic, be sure to talk to your doctor and discuss potential risks that it may pose to your baby. Most are regarded as being considerably safer than MAOIs.

It should be noted that even the drugs considered “safe” aren’t always perfect. In older studies, various tricyclic medications have been found to increase risk of deformed limbs. Later studies did not confirm these earlier findings, but it is still important to take this information into consideration. Even the SSRI class that is considered safe has had some drugs linked to problems.

Some studies have found that Celexa, Prozac, and Zoloft could potentially cause PPHN (Persistent Pulmonary Hypertension of the Newborn) and other heart defects. Most experts agree though that risk of defects with these drugs is extremely low.

Discontinuing antidepressants before or during pregnancy

If you have decided to discontinue antidepressants before or during your pregnancy, be sure to not quit cold turkey. A cold turkey withdrawal can lead to very disturbing symptoms that could make pregnancy incredibly difficult. If you know you want to discontinue your medication, be sure to work with your doctor and come up with a gradual tapering protocol to minimize potential withdrawal symptoms.

Understand that if you aren’t taking any antidepressants while pregnant, you should have an alternative way to treat your depression. Your best bet is to seek help from a psychotherapist, a healthy diet, and physical exercise. If you simply quit taking your medication and don’t have any other way to treat your depression, you could end up in an even worse situation. Untreated maternal depression can also lead to problems for your child.

Finally it is important to keep in mind that you also have the option of switching medications. If you are on something like Paxil or an MAOI, you may want to switch to other medications instead of quitting treatment for depression altogether. There are plenty of other relatively safe options for you to choose from.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/25094036

Antidepressants While Pregnant: Weighing the Pros (Benefits) and Cons (Risks)

Are you already pregnant or thinking about getting pregnant? If you are on antidepressants and aren’t already pregnant, you may want to consult a professional to discuss whether an antidepressant can affect your unborn baby. Additionally it is important to educate yourself with all risks associated with taking psychiatric drugs while harboring an unborn fetus.

If you are able to maintain good mental health and take care of yourself during pregnancy, you may want to avoid taking antidepressants altogether. For those who need antidepressants during pregnancy, the goal should always be to minimize exposure and risk to the unborn baby. In order to minimize risk, you will want to make sure you are on a medication that is regarded as being “medically safe” and on the lowest possible dose (while still giving you an antidepressant effect).

There are reports of babies experiencing low-grade antidepressant withdrawal symptoms when they are initially born. This is because they were absorbing the antidepressant that was being taken during pregnancy and the supply was cut off when they left the womb. Additionally it should be noted that even though certain drugs are considered “safe,” all of the potential risks and long-term effects are not well studies or documented.

Before making a decision as to whether you need antidepressants during pregnancy, consider your unborn child. Do you really want to put your baby at greater risk for developmental delays, impaired motor functioning, and/or other birth defects because you needed an antidepressant? Although the risks are lower with certain drugs, it is important to understand that there is still risk.

Take the time to gather facts and weigh the pros and cons before making a decision as to whether you are going to take an antidepressant during pregnancy. If you need help deciding what to do, seek medical help and talk things over with a doctor. The ultimate goal is to help you maintain a good mood during pregnancy while giving your baby the best possible chance of good mental health and normal physical development.

What is your opinion on using antidepressants while pregnant? Do you think it’s relatively safe or should it be avoided at all costs? Feel free to share your thoughts in the comments section below.

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