If you have a mental health condition or need to take an antidepressant while you’re pregnant, you’re not alone. About one in eight women experience depression during pregnancy.
Depression is a mood disorder and is different from feeling sad or down for a couple of days. Signs of depression need to last almost every day for at least two weeks and include:
- A depressed mood all or most of the day
- Decreased interest in things you used to enjoy
- Trouble sleeping or sleeping too much
- Changes in appetite
- Low energy
- Restlessness
- Difficulty concentrating
- Thoughts of self-harm
Antidepressants are a type of medication given to treat depression, though they can also be prescribed for other mental health conditions. These medications work by balancing out chemicals in your brain, known as neurotransmitters, which play a large role in how one experiences mood.
Although it’s common for new mothers to experience postpartum depression after the baby is born, depression during pregnancy is not uncommon either, as a result of changing hormones, anxiety about the pregnancy, or preexisting mental health conditions.
“Depression during pregnancy is associated with poor outcomes, including preterm birth, hypertension, low birth weight, NICU stays, and long socio-emotionally impacted infants,” says Dr. Nicole Derish, a psychiatrist who runs a private practice specializing in women’s mental health. The outcomes of letting depression go untreated can be far worse than any adverse short-term effects an antidepressant might provide—if it has any negative effects at all.
Depression during pregnancy is not uncommon either, as a result of changing hormones, anxiety about the pregnancy, or preexisting mental health conditions.
Reproductive psychiatrists are specialists that can manage your mental health medications while you’re pregnant and can help you with a personalized treatment plan, explains Dr. Derish.
Is it safe to take an antidepressant during pregnancy?
No antidepressant is more effective than another in treating depression, according to the American Psychiatric Association (APA). But certain classes of antidepressants have fewer side effects than others, such as selective serotonin reuptake inhibitors (SSRIs). When it comes to pregnancy, specific antidepressants have been studied more extensively for their safety.
“People are often shocked to find out that there are actually no psychiatric medications approved by the FDA for the treatment of women who are pregnant,” explains Dr. Derish. If you hear about a certain medication being “safer” in pregnancy, it means there is usually a lot of data to support the use in women who are pregnant.
Dr. Derish explains if you have had depression in the past and the antidepressant you were on worked well for you, it may be a good idea to consider staying on that same medication or beginning it again before trying out a new medication. That’s because a new medication might not work as well for you or could have side effects that are difficult to deal with. For your specific medication, have a conversation with your provider about its safety and effectiveness during your pregnancy.
Often, says Dr. Derish, any issues can be resolved by lowering your dose or changing the timing of when you take your medications, such as switching from morning to night if you’re feeling nauseous.
Because a lot of what you put in your body can affect the fetus, it makes sense that you may be worried about taking an antidepressant during pregnancy. Many people are worried that antidepressants can cause birth defects, but thankfully, those chances are minimal. Let your provider know about your concerns and work with them to come up with a plan and possible medication you feel comfortable with. Many doctors will start with a lower dose, especially early in pregnancy, to help reduce the chances of potential complications.
If you have had depression in the past and the antidepressant you were on worked well for you, it may be a good idea to consider staying on that same medication.
Talk with your doctor if you have been on an antidepressant for several months with no improvement in your symptoms or feel your symptoms have gotten worse. Don’t stop taking an antidepressant without having a conversation with your doctor. Some medications can cause withdrawal symptoms such as dizziness, fever, headache, and vomiting.
What are the different types of antidepressants prescribed during pregnancy?
There are several classes of antidepressants that might be prescribed during pregnancy. Each type works slightly differently and has different side effects.
Selective serotonin reuptake inhibitors (SSRIs)
SSRIs help boost serotonin levels in your brain and include sertraline (Zoloft), escitalopram (Lexapro), and fluoxetine (Prozac). Because they’re generally the most well-tolerated class of antidepressant, they’re the most commonly prescribed, regardless of pregnancy status.
“For people with depression who start treatment with an antidepressant, SSRIs are the most common first choice as they offer as much benefit as other medications, fewer side effects, and the least amount of risk in terms of safety,” explains Dr. Derish. Side effects can include nausea, feeling tired, difficulty sleeping, and low sex drive.
Serotonin and norepinephrine reuptake inhibitors (SNRIs)
SNRIs work similarly to SSRIs, but in addition to balancing serotonin levels, they also have an effect on norepinephrine, a chemical that helps regulate mood.
Venlafaxine (Effexor) and duloxetine (Cymbalta) are most commonly prescribed SNRIs during pregnancy. You might experience drowsiness, constipation, and dry mouth.
Tricyclic Antidepressants (TCAs)
TCAs are an older class of medications and might be used if SSRIs or SNRIs aren’t working for you. They help balance serotonin and norepinephrine and are rarely used in pregnancy because newer antidepressants have fewer side effects. Nortriptyline (Pamelor) and amitriptyline (Elavil) can be considered if SSRIs can’t be used, according to Dr. Derish. You may experience side effects such as constipation, dry mouth, and fatigue.
Other antidepressants
There are some medications that don’t fall into any class of antidepressants and can be an alternative if other medications aren’t working. Bupropion (Wellbutrin) and mirtazapine (Remeron) are two medications that are often prescribed during pregnancy, says Dr. Derish.
SSRIs are the most common first choice as they offer as much benefit as other medications, fewer side effects, and the least amount of risk in terms of safety.
Though not usually used for depression alone since it’s not as well studied in pregnancy, doctors will sometimes prescribe mirtazapine for insomnia and hyperemesis gravidarum (persistent and severe vomiting) if you also have depression. This is “because the medicine makes people hungry and sleepy so we take advantage of those side effects!” explains Dr. Derish.
It can take six to eight weeks for antidepressants to work and help you feel better. If a medication works for one person, it doesn’t mean it works for everyone. You might find you need to try more than one in order to find one that helps. There can be uncertainty when deciding to use antidepressants in pregnancy, but your mental health is just as important as your physical health.