Many women are already taking antidepressants when they discover they are pregnant. Antidepressants such as Amitriptyline (Elavil®) and Bupropion (Wellbutrin®) are commonly used and are felt to be safe by most medical health providers.
The more commonly used Serotonin Reuptake Inhibitor (SSRI) antidepressants such as Fluoxetine (Prozac®), Sertraline (Zoloft®), Escitalopram (Lexapro®), and Venlafaxine (Effexor®) also seem to be relatively safe and the current recommendation by most medical authorities is to not stop or change your medication when you become pregnant. One exception is Paroxetine (Paxil®) which has been shown to cause fetal abnormalities and severe withdrawal and should probably be avoided completely in pregnancy.
There seems to be no increase in fetal malformations or stillbirths if you take an SSRI while pregnant. Another worry we had a few years ago was a possible increase in the rare Persistent Pulmonary Hypertension in the Newborn (PPHN) if you took the medication during the last trimester of your pregnancy.
This is when the normal circulatory transition that occur after birth does not occur, leading to a decrease in oxygen to the baby’s brain at birth. This may cause neurological issues. The risk for PPHN based upon some recent large studies appears to much less common than what we thought before, well under 1%.
The last issue we see with SSRI’s, is occasional more jitteriness, irritability and feeding issues in the newborn after birth if the mother takes them at the end of the pregnancy. This is called poor neonatal adaptation (PNA) and can last up to 2 weeks and is not dangerous. A common practice to stop the medicine a few weeks before delivery in order to prevent this does not seem to reduce its risk while at the same time will increase the risk of worsening depression for the mother.
Overall, pregnancy and the postpartum period is a time where depression can frequently worsen and recent large studies suggest that medical consequences of taking SSRI’s don’t seem to be significant in the great majority of cases. Most medical health providers will therefore recommend their patients to stay on the same medication while pregnant.
Always consult with your health care provider before starting or stopping any medications for depression. It is a good idea to come up early on with a plan for your pregnancy and postpartum period.