It's challenging to study and understand the risks of any drug given to pregnant women. During pregnancy, two patients — the mother and the fetus — are exposed to the drug. Medications that are safe for a woman are sometimes risky for a fetus. Because of this, researchers have not studied many drugs during pregnancy.
Medical experts get most of their information about antidepressants during pregnancy by:
- Drawing on research about drugs that have been approved for women who aren't pregnant
- Conducting studies on animals
- Studying women who took antidepressants before they knew they were pregnant
Several drugs have been used for many years without any obvious signs of serious risk to the baby. But some researchers have reported that some antidepressants may have increased risks. SSRIs are a newer group of drugs than TCAs. Researchers are continuing to study them.
Research has clearly shown that women who are not pregnant and are depressed are very likely to become ill again if they stop taking their medications. But we have less information about whether this is also true for pregnant women.
Here are some other things that research has told us.
- One study in 2006 found that pregnant women with major depression are very likely to become ill again during their pregnancy if they stop taking their medication. A depressed woman may have trouble taking care of herself during pregnancy. This could threaten the health of the fetus.
- Many studies have found no link between antidepressants and serious malformations in newborns. But in 2005, the U.S. Food and Drug Administration (FDA) issued a warning about Paxil (paroxetine) based on several studies. The warning said that taking the drug during the first three months of pregnancy may increase the risk of birth defects, particularly heart defects. Scientists do not yet know enough to draw a firm conclusion. The American College of Obstetricians and Gynecologists recommends that pregnant women or women planning to become pregnant avoid Paxil, if possible. Other types of treatment for depression may be a better choice.
- Some babies born to mothers who are taking SSRI antidepressants show signs of “withdrawal.” For instance, they may have breathing or feeding problems. Their movements may be jerky. Some have seizures. Health providers who care for newborn babies are aware of these risks and can provide treatment. It's important for the baby's provider to know ahead of time that the mother has taken antidepressants during pregnancy.
- Babies exposed to SSRIs in late pregnancy (after 20 weeks) may be more likely to have persistent pulmonary hypertension (PPHN). This rare, but serious, condition affects the lungs and blood vessels. Not enough studies have been done to know for certain if SSRIs cause the disorder. More research is needed.
- Some researchers have studied children whose mothers took antidepressants. They have found no link to serious problems with language, behavior or intelligence.
- Some studies have shown a link between antidepressants and premature delivery.
Choosing an Antidepressant
This decision is difficult because we don't know all the answers. No drug is entirely safe. A woman and her health care team must look at her case and carefully weigh:
- The risks and benefits of various drugs
- The risks and benefits of other types of treatment
- The risk of untreated depression for the woman and her baby
St. John's Wort and Other Herbal Remedies
St. John's wort is an herb that some people use to treat depression. According to the National Center for Complementary and Alternative Medicine some research has shown that St. John's wort is useful for treating mild to moderate depression. Other studies have shown that it is does not help one type of major depression.
Herbal products, such as St. John's wort, vary in strength and quality from product to product. We need more research to help us know whether St. John's wort is useful and safe for treating depression in pregnant women.
IMPORTANT: We know very little about the effect of St. John's wort on the fetus. Do no take this herb or other herbal remedies without first speaking to your health provider.
- The Organization of Teratology Information Services (OTIS), (866) 626-6847. Provides fact sheets on pregnancy and specific antidepressants, including Prozac and Zoloft.
- Depression During and After Pregnancy, a resource for women, their families and friends, provided by the U.S. Department of Health and Human Services