Using Antidepressants in Pregnancy

There are treatment considerations when a woman who is on an antidepressant medication is considering getting pregnant or is pregnant. If you are in one of these situations you should discuss treatment options with your provider. When considering treatments of depression in pregnant women, there is consideration of risk due to depressive disorder to the mother and fetus, risk to the fetus, and risks around delivery. There are effective medication treatments and non-medication treatments for depressive disorders. Discontinuation of antidepressant medication during pregnancy is associated with a high rate of depression relapse. The risk to mother and infant of not treating depression is substantial, both during pregnancy and post-partum. With regard to risk to the fetus, there is experience with commonly used medications. The SSRI and SNRI medication classes do not appear to increase the risk for major congenital anomalies, with the exception of paroxetine. A number of studies found increased risk of cardiac malformations with paroxetine, though this association remains controversial. There are also antidepressant medications from other classes that have been associated with congenital anomalies by some studies, including bupropion and clomipramine. With regard to perinatal risk, a neonatal adaptation syndrome has been estimated to occur in about one-third of deliveries. These adverse effects in infants tend to be mild and transient. It may be helpful to have mothers and infants remain in the hospital for two days post-delivery to ensure that the infant is healthy.

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