If you are pregnant, deciding whether to start or continue taking antidepressants can be a difficult decision. Leaving depression untreated can have a negative impact on fetal development and mental health.
After learning the facts about each type of antidepressant, you can discuss the pros and cons of your choice with your doctor and mental health care provider.
Depression during pregnancy
Someone once believed that pregnancy can prevent depression caused by hormonal changes, but research does not support this theory. In fact, the situation may be the opposite: women with a history of anxiety or depression may more There is a risk of depression during pregnancy.
During pregnancy, hormonal changes affect chemicals in the brain, some of which are directly related to depression.
Depression during pregnancy (also called prenatal depression or prenatal depression) is one of the most common complications during pregnancy. According to the American College of Obstetricians and Gynecologists (ACOG), 14% to 23% of women experience depression during pregnancy. For reference, about 10% of women in the United States suffer from depression.
Pregnancy and antidepressants
Blood volume almost doubles during pregnancy, which can affect the efficacy of certain drugs. Some women’s metabolism also changes. If you choose to take antidepressants, this will affect the way your body absorbs, distributes, breaks down and eliminates antidepressants.
In the United States, as many as 8% of pregnant women report being prescribed or using antidepressants. If you want to continue taking antidepressants during pregnancy, please consult your doctor on how to reduce your risk. They may adjust your dose or start you on a different antidepressant.
Use antidepressants while breastfeeding
Antidepressants can be passed to the baby through breast milk. However, the amount secreted into breast milk is less than the amount that crosses the placenta.
The following selective serotonin reuptake inhibitors (SSRI) are some of the most well-studied drugs used during breastfeeding:
- Paroxetine (Paroxetine)
- Prozac (fluoxetine)
- Zoloft (sertraline)
According to multiple studies, the serum antidepressant levels of nursing infants are either very low or undetectable, and there are no reports of short-term adverse reactions. For these reasons, they are considered relatively safe to use during breastfeeding.
It is important that women continue to use any SSRI during pregnancy and breastfeeding. There is no indication of switching from one antidepressant to another for safe breastfeeding.
Antidepressants and fertility effects
The most commonly used antidepressants are SSRIs and serotonin-norepinephrine reuptake inhibitors (SNRIs). Monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCA), and atypical antidepressants are also used, but at a lower frequency.
Before 2018, the U.S. Food and Drug Administration (FDA) classified and labelled all drugs based on research on their safety, including their safety when taken during pregnancy.
The new system provides information about pregnancy exposure, potential risks, and clinical considerations, and is designed to help doctors use clinical judgment to make better decisions based on each individual’s needs.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Selective serotonin reuptake inhibitors (SSRIs) are the most commonly used class of antidepressants during pregnancy. Some of the most common SSRIs used to treat depression during pregnancy include:
Hundreds of studies have looked at SSRI exposure and congenital abnormalities. Despite the mixed results of the study, the overall conclusion is that SSRIs are generally considered safe during pregnancy. But they are not without risks.
According to a 2015 study by the Centers for Disease Control and Prevention (CDC), the incidence of congenital abnormalities in newborns of biological parents taking Paxil and Prozac is 2 to 3.5 times higher. However, because some abnormalities are rare, the risk of abnormality is still lower than the 3% to 5% risk of the general population.
Specifically, the use of Paxil in the first trimester is associated with a variety of birth defects, including heart defects, problems with the formation of the brain and skull (anencephaly), and defects in the abdominal wall. The study also confirmed the connection between the use of Prozac and two types of congenital abnormalities: heart wall defects and irregular skull shape (premature cranial sutures).
The same study in 2015 found no evidence of an association between the use of SSRIs (such as Celexa, Zoloft, and Lexapro) and birth defects, although other studies do.
There is also controversy about the association between the use of SSRI during pregnancy and the risk of persistent pulmonary hypertension (PPHN) of the newborn, a rare disease of infants with poorly inflated lungs. A 2006 study linked the use of SSRI in the third trimester of pregnancy with a 6-fold increase in the risk of PPHN. But many researchers say this connection is greatly exaggerated.
As many as 30% of SSRI-exposed newborns will have a series of symptoms called Perinatal Neonatal Adaptation Syndrome (PNAS). This syndrome usually manifests as nervousness, irritability, eating problems, and difficulty breathing. The average onset time varies from birth to 3 days and can last up to 2 weeks.
It is important to note that PNAS has no negative results or sequelae, and most babies resolve on their own within a few days.
Serotonin-Norepinephrine Reuptake Inhibitor (SNRI)
Serotonin-norepinephrine reuptake inhibitor (SNRI) blocks the reuptake of serotonin and another neurotransmitter called norepinephrine.
Common SNRIs include:
Studies have shown that the use of Effexor in early pregnancy may be related to a variety of congenital abnormalities, including heart defects, brain and spine defects, cleft lip and palate. However, the risk of these abnormalities is still lower than the risk of the general population.
Tricyclic antidepressants (TCA)
Tricyclic antidepressants (TCA) are the oldest class of antidepressants. They work by blocking neurotransmitters and other receptors in the brain. Although they can effectively treat depression as SSRIs, they can cause more adverse reactions. For this reason, they are not used as first-line treatment and are rarely used during pregnancy.
The most commonly prescribed TCAs used during pregnancy include:
- Ilavir (amitriptyline)
- Nopmine (desipramine)
- Pamelo (nortriptyline)
- Tofranil (imipramine)
There is insufficient research to determine whether the use of TCA during pregnancy negatively affects the developing fetus. However, a study published in 2017 indicated that TCA may be associated with an increased risk of digestive defects and defects in the eyes, ears, face, and neck.
Monoamine oxidase inhibitors (MAOIs)
Monoamine oxidase inhibitors (MAOIs) work by breaking down neurotransmitters such as dopamine and serotonin. Like TCA, MAOIs tend to have more side effects than SSRIs and SNRIs. Due to the associated side effects and increased risk of hypertensive crisis, the use of MAOIs during pregnancy is generally not recommended.
Popular MAOIs include:
- Nardil (phenelzine)
- Emsam (Selegiline)
- Maplan (Isocarbazide)
- Parnate (Tranylcypromine)
Case reports published in journals in 2017 Reproductive Toxicology It was noted that women taking high doses of MAOI had fetal malformations in both pregnancies. Both pregnancies resulted in fetal abnormalities, one of which was severe enough to cause stillbirth. The second baby was born with severe physical and neurological disorders.
The authors of the paper speculate that high doses of MAOI have an effect on pregnancy outcomes, but it is unclear whether (or how) these drugs cause specific malformations. There may be other factors, such as other medications taken during pregnancy and the age of the parents (both over 40). The family also refused to be tested to investigate the genetic cause of the birth defect.
Nardil (a more commonly used MAOIs) has limited research on the potential risks to the developing fetus. The FDA label states that healthcare providers need to weigh the potential risks and benefits of Nardil when prescribing pregnant women. This recommendation is consistent with other MAOI antidepressants and other classes of drugs.
Atypical antidepressants are antidepressants that do not belong to any of the other four types of antidepressants. When other antidepressants do not work, they are usually prescribed.
Common drugs in this group include:
- Oleptro (trazodone)
- Remeron (mirtazapine)
- Serzone (Nefazodone)
- Trintellix (vortioxetine)
- Wellbutrin (bupropion)
Like SSRIs, atypical antidepressants tend to have fewer side effects than other antidepressants. However, as with other drugs, there are potential risks associated with use during pregnancy.
Natural remedies for depression
There are some over-the-counter medications or alternative therapies that can treat depression, such as St. John’s Wort. There are no rigorous, formal studies on the risks of exposure to supplements such as St. John’s warts during pregnancy.
However, anyone planning to use St. John’s wort needs to understand the potential interactions. For example, taking St. John’s Wort with medicines, supplements or foods containing 5-hydroxytryptophan (5-HTP), L-tryptophan or SAMe can increase the risk of serotonin syndrome.
As with medications, if you are pregnant or breastfeeding, please consult your doctor if you are taking nutritional supplements or herbal medicine.
For information on specific medications or alternative therapies, the mother-to-child exposure database maintained by the Teratology Information Specialist Organization (OTIS) may be a useful resource. The fact sheet created by the non-profit organization summarizes existing research on the use of prescription drugs and herbal supplements during pregnancy.
Risk of untreated depression
It is important to remember that untreated depression also carries risks. Many studies have shown that the stress of the mother during pregnancy can have a negative impact on the development of the fetus, and may affect the child’s later behavior and emotional health.
Physical and emotional stress during pregnancy can cause or aggravate depression. These symptoms of depression can also affect a person’s ability to meet their own needs-from overall self-care to specific care during pregnancy, such as prenatal appointments.
People with depression may also be more likely to use substances to cope with their symptoms. The risks associated with drinking alcohol and using illegal drugs during pregnancy are well known. The use of substances during pregnancy can have serious long-term consequences for parents and children.
Stopping antidepressants puts you at risk of recurring depressive symptoms. The risk may be greater when you are pregnant and when you have just given birth.
Don’t stop antidepressants without talking to your doctor or mental health care provider first. Unless they instruct you to do so, don’t stop taking the medicine suddenly. Stopping antidepressants can cause side effects, which may be exacerbated by pregnancy.
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Each type of antidepressant has its own risks. If you are trying to decide whether to stop taking antidepressants during pregnancy, consult your doctor. They can help you weigh the benefits of taking antidepressants during pregnancy with the potential consequences associated with not treating depression.
Taking antidepressants should not hinder your healthy pregnancy. Your doctor can help you find a medicine that treats symptoms of depression and is safe for you and your baby. If you decide to stop taking antidepressants during pregnancy, you should have a reliable support system and strategies to help you cope with depression symptoms.