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Is It Safe to Take Antidepressants During Pregnancy & While Breastfeeding?

The utilization of antidepressants happens to be the primary treatment options for most types of depression. With their help, you can easily relieve many of your symptoms and feel your best with the passage of time. However, there is a whole lot more involved when you are trying to conceive, pregnant or breastfeeding your newborn.

At one point in time, it was believed that pregnancy hormones can go a long way in protecting women from depression. However, this belief has been deemed untrue by researchers who have been studying the effects of pregnancy hormones on depression and anxiety disorders. Most importantly, pregnancy has the potential to trigger a range of emotions that make it more difficult to cope with depression. 

Depression treatment during pregnancy is essential. This is because women who have untreated depression do not normally seek optimal prenatal care, eat the right foods that are necessary for their health and the development of their babies and just don’t have the energy to look after themselves properly. 

This may lead to complications like low birth weight, premature birth and certain other problems for the baby together with an increased risk of postpartum depression for you, as well as difficulty bonding with the baby. However, considering how debatable the utilization of antidepressants is, here’s a look into the safety concerns that deem it best for pregnant women to stay away from their usage:

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7  What Do the Experts Have to Say?

It’s largely believed by both ob-gyn experts and psychiatric experts that women who have mild depression and have remained symptom-free for about six months have a much better chance of stopping their utilization of antidepressants both while trying to conceive and during pregnancy under a doctor’s supervision. In such a case, all that maybe required is psychotherapy together with lifestyle measures in order to manage depression.

It is easily possible for pregnant women to make it through their pregnancy without having to use antidepressants if they:

  • Exercise frequently
  • Talk with a therapist on a regular basis
  • Spend time in the outdoors
  • Minimize stress
  • Practice meditation and yoga

However, in case any of the following points are true, it’s best for you and your baby to stay on antidepressants during pregnancy if:

  • You have ever been suicidal
  • You have a history of recurrent or severe depression
  • You suffer from other mental illnesses

6 Antidepressants Can Be Harmful to Your Baby

One of the most prominent risks associated with taking antidepressants during pregnancy is that of Persistent Pulmonary Hypertension of the Newborn (PPHN). For those who don’t know, this is a life-threatening condition in which a baby has high blood pressure in the lungs, which in turn causes severe breathing problems. 

No matter if there are controversial reports over the issue; the problem is still significant enough for any pregnant woman to want to avoid using antidepressants. Also, another concern for moms-to-be taking these meds is the chance of heart defects in the baby. The FDA warned in 2005 that paroxetine (Paxil) could lead to holes and other structure problems in a newborn's heart. But a study published last year didn't confirm the risk.

Another health concern

About 3 in 10 babies born to moms who take SSRIs during pregnancy are at higher risk of developing a temporary condition called poor neonatal adaption syndrome. The symptoms of this condition are typically inclusive of:

  • Low blood sugar
  • Weak cry
  • Seizures
  • Jitteriness
  • Poor muscle tone

However, what must be mentioned here is that researchers believe that the condition does not cause any long-lasting effects in a child.

5 Antidepressants Can Trigger Autism in Your Baby

A number of research studies have shown that women who stick to using antidepressants in the later stages of their pregnancy are more likely to give birth to a child with autism. Most importantly, research studies have identified one particular group of antidepressants known as SSRIs or Selective Serotonin Reuptake Inhibitors like Zoloft, Paxil and Prozac.

According to researchers of the University of Montreal, the utilization of antidepressants, particularly SSRIs during the second and/or third trimester of a pregnancy has the potential to increase the risk of autism spectrum disease in children, even after considering mental depression. With these findings, experts were initially worried that many women will be scared and hence stop taking antidepressants. 

However, it was also noted that the absolute risk is very small and very few children were diagnosed with autism. The team of researchers from the University of Montreal conducted the study over more than 145,000 children born in Quebec between 1998 and 2009. They found 4,700 babies, or 3 percent of the total group, whose mothers took some type of antidepressant while pregnant. 

An interesting find

Only 31 babies, or 1 percent of the group whose mothers took antidepressants in later pregnancy, were later diagnosed with autism.

It should be mentioned here that the babies who were diagnosed with autism were more likely to have been born to mothers who took antidepressants in the second or third trimester of pregnancy. More careful analysis showed it was only the SSRIs.

"Other classes of antidepressants were not statistically significantly associated with an increased risk of autism spectrum disorder," they wrote.

4 You May Have a Miscarriage

A research study that was performed on more than 5,000 women in Canada showed an association between the utilization of antidepressants (SSRIs in particular) and an increased risk for miscarriage. However, the experts involved in this particular research further cautioned that this association does not imply a cause-and-effect relationship.

Among those who had miscarried, nearly 5.5% had taken antidepressants during pregnancy. Compared with the women who had not miscarried, those who had were more likely to be older, live in an urban environment, be recipients of social assistance, have a diagnosis of severe depression or anxiety, visited a psychiatrist in the year prior to pregnancy, have had longer duration of exposure to antidepressants, and have health issues including diabetes and asthma.

A deeper analysis

On the whole, the analysis acquired through the said bit of research showed that women who used any class of antidepressant drugs during pregnancy had a 68% higher risk of having a miscarriage as compared to women who had never used antidepressants. 

To break it down, there was a 61% increased risk among women who used SSRIs, a 75% increased risk of miscarriage for women who used the SSRI named Paxil, and a 19% increased risk of miscarriage among women who had a history of depression.

3 Antidepressants Can Lead to Birth Defects

Latest research suggests that babies born to women who continue to take antidepressants during their pregnancy have an increased risk for a particular heart defect. Conducted in Denmark, the research study shows that the risk is greatest when pregnant women take more than one SSRI antidepressant or switch between different SSRIs early in pregnancy.

It’s fairly common for SSRIs like Paxil, Prozac, Zoloft, Lexapro and Celexa to be prescribed to pregnant women for depression. Although the overall risk is rather low, there’s still the chance that women who take antidepressants during pregnancy will give birth to a baby with congenital heart problems. 

However, what should be noted here is that babies born to women who had filled prescriptions for more than one SSRI during their pregnancy had a fourfold increase in septal heart defects. Just so you know, this is a serious malformation of the wall that divides the left and right sides of the heart.

The details aren’t clear

The findings of this particular research study have definitely added to the endless confusion that surrounds the safety of certain SSRIs and their utilization during pregnancy. Back in 2005 when this research was carried out, the FDA had taken the initiative to single out the drug called Paxil. It was further warned that the utilization of this antidepressant is associated with an increased risk for heart defect. 

It has since become common practice for doctors to switch women taking Paxil to another SSRI when they become pregnant or are considering pregnancy. But more recent studies suggest that women who take Paxil have no greater risk for delivering babies with the heart defect than women who take other antidepressants.

2 The Different Medication Options Available to Pregnant Women

With all this debate regarding the safety of antidepressants being prescribed to pregnant women, we are left to wonder how such women can be treated for depression. Well, the good news is that certain antidepressants are considered much safer for pregnant women than others. The safest antidepressants that can be prescribed to pregnant women are:

  • Citalopram (Celexa)
  • Bupropion (Wellbutrin)
  • Fluoxetine (Prozac, Sarafem)
  • Sertraline (Zoloft)
  • Amitriptyline (Elavil)
  • Nortriptyline (Pamelor)
  • Desipriamine (Norpramin)

Now in case you’re pregnant and taking an antidepressant that is not mentioned on this list, then don’t panic. Even the most controversial antidepressants including Paxil have been found to have relatively low risk. However, if you can, it’s best for you to avoid using the more controversial anti-depressants for even the smallest risks associated with them. 

Talk to your doctor and see what he or she thinks would be best for you. If you’re not pregnant, but planning on becoming pregnant, it may be worth trying a different medication if you are concerned about the safety of your current antidepressant. Again, talk to your doctor to see if this is a good option for you.

A good decision

Irrespective how small the risk, there’s no way a mother would want to expose her baby to unnecessary risks and medications. Making the decision to take or stop taking antidepressants in pregnancy is not easy. There’s no right answer. You must look at your own set of circumstances and make the decision based on the risks and benefits unique to you. If you and your doctor think you may be able to stop your medication during pregnancy, it’s certainly worth a try. 

But, never stop taking your medication without talking to your doctor first. Most antidepressants require weaning to safely stop the drug. If you need to stay on an antidepressant while you’re pregnant, it’s best for you to not panic. Remember, the risks associated with most of the antidepressants in pregnancy are fairly low.

1 Utilization of Antidepressants While Breastfeeding

Just so you know, postpartum depression is an extremely common condition that affects up to 15% of mothers. The worst part about it is that it can have devastating effects on the mother and even the relationship that she shares with her newborn in case it remains untreated. Most importantly, a number of adverse effects in terms of cognitive and behavioral development have been reported in children whose mothers remain untreated.

Over the past few years, increasing numbers of women have been diagnosed with and treated for postpartum depression. Anti-depressants that are classified as serotonin-norepinephrine reuptake inhibitors and selective serotonin reuptake inhibitors are typically used as first-line agents for treatment purposes. Because breastfeeding has many well established advantages for both the mother and the baby, exclusive breastfeeding is now encouraged. 

What about antidepressants in breast milk?

With that, the utilization of antidepressants during breastfeeding has become an important topic as mothers struggling with depression decide how to feed their newborns.

Most antidepressants are excreted in low concentrations in breast milk. For this reason, it is considered rather safe for lactating women to use antidepressants for treatment purposes.

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