All depression medications carry some risk of side effects. During pregnancy, there are heightened concerns over the risks posed to the mother, the fetus and the course of the pregnancy. Treatment decisions are complicated because what may be best for the mother may not be best for the unborn child, or vice versa. Additionally, research has shown mixed results about the potential side effects of each drug. Ultimately, decisions about depression medications during pregnancy are best made on a case-by-case basis in close collaboration with your doctor.
Selective Serotonin Reuptake Inhibitors
Selective serotonin reuptake inhibitors (SSRIs) are antidepressants that improve mood by boosting the amount of the neurotransmitter serotonin in the brain. Although there are many SSRIs, not all are recommended for use in pregnant women because of the risk of potential side effects. Some of the complications that have been identified among pregnant women include a small increased risk of miscarriage, withdrawal symptoms (tremors, convulsions, irritability and increased crying) in newborns whose mothers took SSRIs near the end of the pregnancy, and the risk of birth defects in newborns whose mothers took SSRIs during the first trimester. Babies of mothers who take SSRIs during the second half of their pregnancy may also be more likely to develop a rare but very serious breathing problem called persistent pulmonary hypertension.
The SSRIs preferred by the experts for use in pregnancy are fluoxetine, sertraline and citalopram. Another commonly prescribed SSRI in the general population called paroxetine should be avoided by pregnant women as its use during a woman's first trimester has been linked to an increased risk of fetal heart defects.
Tricyclic Antidepressants
Tricyclic antidepressants (TCAs) are an older type of antidepressants that improve mood by inhibiting reuptake of serotonin and norephinephrine in the brain. While they are known to have more serious side effects in the general population (including tremors, delirium, urinary retention and low blood pressure), there are some medications in this class that may be considered for use among pregnant women who are depressed. These medications include amitriptyline and nortriptyline. While some studies have suggested these drugs may increase risk for limb malformation in the fetus, these concerns have not been validated in more-recent studies.
Bupropion
Bupropion works by balancing the amounts of the neurotransmitters dopamine and norepinephrine in the brain. Existing studies of pregnant women taking bupropion have shown no significant increases in miscarriage beyond the rates observed in those taking an SSRI or tricyclic drug. There have been mixed results regarding the potential for heart malformations in newborns of women taking bupropion during the first trimester. Overall, bupropion is thought to be a good alternative for pregnant women who have not responded to other antidepressants.
