Is it OK to take antidepressants while pregnant?

Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert Answer

Dear Judy,

Let me start with the type of answer no one likes to hear, which is that there is no simple answer to your question. It all depends on circumstances. Here is the problem:

Over the past several years, a number of studies suggested that frequently used antidepressants may be associated with an increased risk of babies being born with abnormalities.

For example, a recent study has shown that women who took Prozac or Paxil during pregnancy had approximately twice the risk of delivery children with abnormalities of the heart. Fortunately the vast majority of these abnormalities were mild and didn't pose a huge threat to the infant, but it does make one pause.

By the way, pregnant women who smoked while taking antidepressants had a much higher risk of their babies having heart abnormalities, so that is definitely something a pregnant woman should avoid.

Paxil has also been associated with babies being born with serious gut and brain abnormalities. Even though these outcomes are very rare, Paxil should probably be avoided during pregnancy. There is an old class of antidepressants called monoamine oxidase inhibitors that should also be avoided.

But here is the tricky part. Increasing data show that mothers who become significantly depressed or highly anxious during pregnancy are also more likely to give birth to children with abnormalities. For example, anxiety disorders are associated with an increased risk for forceps deliveries, prolonged labor, fetal distress and pre-term delivery. Maternal depression increases the risk for low birth weight delivery.

Although it hasn't been definitively proven yet, there are a number of reasons to suspect that depression and anxiety damage fetal development because these are conditions in which the body is flooded with stress hormones, as well as changes in the immune system.

It can't be good for a developing fetus to get a constant message that it exists in a dangerous environment. Animal studies have shown that a single injection of a stress hormone in the uterus changes the way the animal functions for its entire lifetime, and, worse, changes how its genes are expressed in a way that can be passed from mother to offspring for several generations.

If the same thing is true for humans, it suggests that a mother's depression may be physiologically passed on not just to her daughter, but to her granddaughter through changes in gene expression.

So what do I recommend in general?

I think that taking antidepressants while pregnant is overall better than having a terrible depression. But pregnancy is one time in which it is especially useful to consider other options, especially psychotherapy. Getting sleep, limiting stress exposure (good luck!), eating a healthy diet and exercising can also all help milder depressions.

A final point: There are other medications frequently used for mood disorders that are far more dangerous than antidepressants.

I can't list them all here, but many of the drugs used for bipolar disorder (also called manic depression) can regularly cause a number of serious birth defects. If you are taking lithium or any type of mood stabilizer and you are pregnant or thinking of becoming pregnant, it is extremely important that you discuss with your doctor and/or psychiatrist.