Can you take antidepressants whilst pregnant

But aside from Paxil which Dr. Cohen says is controversial for risks of cardiac complications SSRIs have not, on the whole, been linked to an increase in birth defects above the baseline risk. Two recent studies have raised other concerns about the use of antidepressants during pregnancy: A paper published in the March issue of the journal PLOS One linked preterm birth defined as earlier than 37 weeks and antidepressant use. The study found a 96 percent higher risk of preterm birth for women who had taken antidepressants during their final trimester.

But doctors aren't quick to point the finger at medication just yet. She notes that the study is "not conclusive" and adds that untreated depression is also a risk for preterm birth. Another study, published in Pediatrics , showed that prenatal exposure to SSRIs, especially during the first trimester, may "increase susceptibility" to certain forms of autism spectrum disorders in boys. But Dr. Cohen stresses that this shows an association between an increased risk for autism and SSRI use in pregnancy, and not a cause-and-effect relationship.

Other potential side effects of antidepressants during pregnancy include a serious but very rare condition called persistent pulmonary hypertension of the newborn, and a disorder called neonatal adaptation syndrome, which antidepressant-exposed newborns have a to percent chance of developing.

The condition clears up on its own, but can result in fussiness, poor feedings , respiratory difficulty, and, in rare cases, seizures. Pregnant women and their doctors must carefully consider the risks of treating depression with medication versus the risk of the mother's illness, Dr. Treece says. Changes to medication ideally should happen before conception so you have time to adjust.

Ultimately, only you and your physician can determine what's best for you. Researchers found that some birth defects occur about two or three times more frequently among babies born to women who took certain types of SSRI medications early in pregnancy.

This analysis can help guide healthcare providers and women to the safest options to appropriately treat depression or other mental health conditions during pregnancy while minimizing the risk of major birth defects in the developing baby. Selective serotonin reuptake inhibitors SSRIs are medications used to treat depression and other mental health conditions. Previous studies provide conflicting evidence about potential links between the use of SSRIs during pregnancy and certain birth defects.

Depression and other mental health conditions can be serious. Many women need to take medication during pregnancy to appropriately manage their symptoms. If you are pregnant or thinking about becoming pregnant, talk with your doctor about any medications you are taking or thinking about taking.

Other Antidepressants: The data is even more limited with regard to the use of vortioxetine Trintellix , vilazodone Viibryd , levomilnacipran Fetzima. If there are effective alternatives, we typically recommend switching to another antidepressant.

In settings where we have limited data regarding the reproductive safety of a particular antidepressant, we may consider switching to an antidepressant with a better characterized reproductive safety profile. It is important, however, to carefully consider the benefits and risks of making this switch. With any switch, there is the risk of relapse when making a change in the maintenance treatment. Thus, there are situations where we recommend continuing an antidepressant with limited reproductive safety information because there are no effective alternatives and the risk of relapse is significant.

At some point in the early s, there emerged the belief that sertraline Zoloft was the safest antidepressant to use during pregnancy, and many women taking other antidepressants were encouraged to switch to sertraline during pregnancy. It is somewhat unclear where this opinion came from — maybe one paper suggesting lower placental passage of sertraline compared to other antidepressants; however, there is and never was any solid data to support the assertion that sertraline is safer or the safest antidepressant.

Reflexively switching women to sertraline puts women at risk for recurrent illness. While sertraline is effective for the treatment of depression and anxiety and is a reasonable choice for many women, one problem with sertraline is that it tends to be under-dosed.

The typical starting dose is 50 mg; however, many individuals will need mg to mg to effectively manage their symptoms. Especially when sertraline treatment is initiated in the primary care setting, we often see women whose dose is too low to effectively manage their symptoms. The most current data regarding the use of paroxetine Paxil during pregnancy does not indicate an association between the use of paroxetine during pregnancy and risk for cardiovascular malformations.

However, in , GlaxoSmithKline GSK elected to change product label warnings for the antidepressant paroxetine Paxil , advising against the use of this drug by women who are pregnant.

This decision was based on two preliminary studies which suggested a small increase in the risk of cardiovascular malformations among infants exposed to paroxetine in utero.

For many years, this concern regarding risk of heart defects resulted in recommendations that women taking paroxetine should either stop paroxetine or to switch to a different antidepressant during pregnancy.

However, in , a study from the Motherisk Program in Toronto reported on the outcomes of over paroxetine-exposed infants and found no association between the use of paroxetine during pregnancy and increased risk of cardiovascular malformations.

Nonetheless, some women and their treaters continue to feel uncomfortable with the use of paroxetine during pregnancy. Furthermore, many websites including reputable sites like the Mayo Clinic continue to urge women to avoid paroxetine during pregnancy because of the risk of malformations.

Both the public and doctors have been skeptical of antidepressant therapy during pregnancy. Since the drugs pass through the placental barrier, the blood-brain barrier and they also pass into the breast milk, they thus increase the level of monoamines in the developing fetus and can affect the functional maturation of the brain. Since there has not been a sufficient number of well-controlled studies to assess the safety of antidepressants, the scientific community is mostly inclined not to treat depression during pregnancy by drugs.

However, the current experience of doctors as well as experts shows that untreated depression can adversely affect the health of both mother and child. Complications are mainly associated with increased morbidity in pregnant women, including preeclampsia and eclampsia, suicidal tendencies of mothers, later PPD depressions and mother-child relation disabilities. In children, particularly reduced birth weight, increased risk of preterm labor, and increased irritability of the newborn have been observed.

The most frequent physiological manifestations of affected children are reduced vaginal tonus, increased levels of cortisol and noradrenaline and lower levels of dopamine and serotonin Talge et al. The consequences of untreated depression can be so serious that they overweigh the potential risk caused by the use of antidepressants during pregnancy Oyebode et al.

There are currently several screening methods e. Patients thus diagnosed should be monitored for at least one year after birth. In patients with mild to moderate disease, psychotherapy is recommended, whereas antidepressant therapy is recommended in patients who suffer from severe depression. Treatment of depression during pregnancy raises a number of questions concerning the safety of psychiatric drugs. These can ultimately affect the health of the pregnant mother, pregnancy, fetal and neonatal development, as well as the overall health of the individual.

The effects of treated depression are known from the available literature. For newborns who have been exposed to antidepressants during the prenatal period, excessive crying, restlessness, tremor, feeding problems, reflux and sleep disorders have been reported to be characteristic Sanz et al.

However, an association between the treatment with paroxetine during pregnancy and congenital heart disorders was reported Oyebode et al. Importantly, untreated maternal depression carries its own risks for both mothers and unborn babies, often showing very similar detrimental outcome profiles. It is known from clinical practice that pregnant mothers exposed to antidepressants have more spontaneous abortions and an increased number of stillbirths.

Treatment in the third trimester of pregnancy is closely linked to an increased incidence of Poor Neonatal Adaptation PNA. PNA is characterized by a decrease in the Apgar score normal range 7—10, relatively low 4—6 and critically low is less than 3 , hypoglycemia, weak muscle tone, respiratory difficulties, and total restlessness Oyebode et al.

It should be noted that in some cases the clinical picture is consistent with the serotonin syndrome. Children exposed to prenatal venlafaxine in the postnatal period had a slightly reduced IQ compared to children whose mothers did not suffer depression during pregnancy. In children of affected mothers, higher incidence of problematic behavior was also observed Nulman et al.

Similarly, children who were perinatally exposed to SSRIs especially fluoxetine had decreased birth weight, neurobehavioral disorders and decreased heart rate Rayen et al.

The complexity of these issues is highlighted, as depression itself can adversely affect the development of the child. It is therefore difficult to divide the effect of depression itself and subsequent treatment. For example, newborns whose mothers suffered from depression during pregnancy are characterized by increased irritability, reduced activity and attention, as well as lacking mimic expressions compared to neonates of healthy mothers. Some studies also noted elevated cortisol levels in depressed mothers as well as decreased peripheral serotonin and dopamine levels, decreased vagal tonus, and electroencephalogram changes Yonkers et al.

Experimental work on rats and rabbits did not detect malformations or morphological changes in pups after administration of SSRIs and SNRIs to pregnant females. Findings from in vivo studies did not confirm these conclusions. These works did not evaluate possible functional or behavioral disorders of pups. Rayen et al. There is a longer latency to the first copulation and a longer latency in ejaculation in adult subjects.

It is believed that elevated serotonin levels due to perinatal administration of SSRIs fluoxetine could affect male sexual behavior. Serotonin is a key neurotransmitter responsible for the correct development of sexual centers in the brain. Other studies found that females who were perinatally affected by fluoxetine had facilitated sexual behavior, compared with adult females who underwent antidepressant treatment during adulthood exhibiting reduced sexual behavior.

According to the authors, this could point to the activation and organizational effects of fluoxetine. The authors assume the involvement of certain compensatory mechanisms in developmental processes, which may be permanent and are directed to decreasing serotonin levels during adulthood Rayen et al. Elevated BDNF levels were also observed in post-mortem hippocampi of patients treated with antidepressants Chen et al.

Larsen et al. Thorne et al. In micromolar concentrations it stimulates expression of proinflammatory cytokines and induces cell apoptosis. However, by aging the high concentration led to a decrease in MAP-2 levels resulting in a subsequent collapse of the cytoskeletal system and cell death. Delay in serotonergic neuronal growth may delay maturation of astroglial cells, leading to slowing neuronal maturation that may be associated with functional learning and memory deficits Pawluski et al. Prenatally administered VENL did not result in significant changes in the length of pregnancy of rats, in litter size, in the number of stillborn pups, or duration of lactation between the affected and control groups da-Silva et al.

It is also known from the literature that administration of VENL caused increased locomotor activity in rats. Increased behavior climbing, swimming may in this case reflect increased serotonin and dopamine levels.

Increased levels of dopamine due to VENL administration were described also in the striatal region of the brain de Oliveira et al. Current studies focus on BDNF assessment, which is an indicator of nerve plasticity and neurogenesis.