Is it safe to take antidepressants during pregnancy?

By Timothy Tracy, Ph.D.

April 20, 2006

It’s hard to find a straight answer on whether expectant women should continue taking antidepressants during pregnancy and what effect the medication has on newborns. Recent studies have been as contradictory and unclear as news about the benefits or drawbacks to a low-carbohydrate diet.

A May 2005 study found that infants born to women taking antidepressants during the last trimester of pregnancy were more likely to experience irritability, seizures, tremors, and respiratory ailments. The results indicate that infants born to these women go through withdrawal after birth.

In January, a study published in the Journal of the American Medical Association found that women who stopped using antidepressants during pregnancy were more likely to suffer a relapse of depression than women who stayed on their medications. Put simply, pregnancy didn’t offer the protection against depression that some previously believed.

Yet another study published in April found that pregnant women taking selective serotonin reuptake inhibitors (SSRI)—antidepressants that boost serotonin levels—have a higher risk of delivering stillborn babies. Canadian researchers found that women taking SSRIs to deal with aggression were twice as likely to give birth to stillborn babies and deliver underweight infants. Women using these medications also were slightly more likely to deliver a baby prematurely and have seizures during pregnancy.

Unfortunately, there isn’t a one-size-fits-all approach for depressed women. The wisest counsel is that each pregnant woman should consult her health-care provider. Together, they should make the decision about whether a woman should continue or discontinue taking antidepressants while pregnant, considering all the risks involved with both choices.

Providers will generally consider the severity of the woman’s depression, what medication she takes, and whether she can switch to a different drug. The problem is that most medications don’t have dosing guidelines for pregnant women. Guidelines for many drugs—including those commonly used in pregnancy—typically are based on studies conducted on men. The drug studies that involve women use only women who aren’t pregnant.

A 2005 study at the University of Minnesota found adjustments to medication in pregnant women depend on the stage of pregnancy and the medication given. Studies like this will help pregnant women get the right dose of medication to successfully manage chronic conditions such as diabetes, HIV, or depression.

Your health care provider needs to know every medication--including over-the-counter, prescription, and herbal supplements--you take at all times. This is never more important than during pregnancy. When women are pregnant, their dosages might need to be adjusted, or they might need to switch to a different drug that doesn’t affect their developing baby.

Before you head to your next appointment, take five minutes and make a list of all the medications you’ve taken in the past 12 months. And don’t stop taking any medication without checking with your health-care provider--regardless of whether you are pregnant.

The answers aren’t black and white. And that’s why you need to talk to your doctor.

Timothy Tracy, Ph.D., is head of the Department of Clinical and Experimental Pharmacology at the University of Minnesota College of Pharmacy and is a member of the Center of Excellence in Women’s Health. He has two grants from the National Institutes of Health to study drug metabolism and disposition and also focuses his research on women’s health. This column is an educational service of the University of Minnesota. Advice presented should not take the place of an examination by a health-care professional. For more health-related information, go to http://www.healthtalk.umn.edu.