What is the best antidepressant to take during pregnancy? (5 safe options)
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The Optimistminds editorial team is made up of psychologists, psychiatrists and mental health professionals. Each article is written by a team member with exposure to and experience in the subject matter. The article then gets reviewed by a more senior editorial member. This is someone with extensive knowledge of the subject matter and highly cited published material.
In this article, we will discuss the safest antidepressants to use in pregnancy. We will also discuss the potential benefits and risks of taking antidepressants during pregnancy and if there is any way to avoid taking these medications.
What is the best antidepressant to take during pregnancy?
The following antidepressants are considered safe to use in most pregnant women:
- Sertraline
- Fluoxetine
- Escitalopram
- Citalopram
Sertraline (Common brand name: Zoloft)
Sertraline is a selective serotonin reuptake inhibitor (SSRI), which is one of the most commonly prescribed antidepressants in pregnancy. According to the National Health Service (NHS) guidelines, sertraline is safe to take by pregnant women (1).
However, there are a few exceptional cases, and close monitoring is crucial to ensure the safety of both the mother and the fetus. Although sertraline is not teratogenic or causes birth defects, research indicates that using this antidepressant during the first trimester may cause cardiac birth defects (2).
However, the data gathered from research studies was not statistically significant. Doctors should still watch out for potential malformations in developing babies to prevent any potential birth defects.
It is also important to note that the dosage strength taken by pregnant women can also affect the therapeutic safety and efficacy.
Furthermore, sertraline is associated with some side effects which may add up to pregnancy-related symptoms, like nausea, vomiting, etc and make this journey uncomfortable for the mother.
So, make sure you keep all the important points in mind before going for any antidepressant when there’s life growing inside you
Fluoxetine (Common brand name: Prozac)
Fluoxetine is another SSRI considered by the NHS for use during pregnancy (3). Fluoxetine is one of the most commonly prescribed antidepressants and is often well tolerated.
However, research indicates that the use of fluoxetine during the first trimester can affect the growing fetus. One research study monitored the effects of fluoxetine use during the first trimester on newborns (4).
The study indicated that such babies had a higher potential for developing cardiac birth defects. This suggests that the use of fluoxetine during the first trimester should be avoided or restricted to severe depression cases only.
Escitalopram (Common brand name: Lexapro)
Escitalopram is another SSRI that can be used during pregnancy, according to the NHS (5). Research indicates that escitalopram is not typically associated with malformation of the growing fetus or potential cardiac birth defects (6).
However, it may affect the body weight of the newborn. It is important to note that not every pregnant woman is susceptible to this. Women are different and have different factors affecting their health.
A healthy pregnant woman without any comorbidities can usually take escitalopram safely. However, if there is any comorbidity, history of substance abuse, or any other underlying factors that can potentially affect the fetus, the use of antidepressants should be carefully monitored.
As with any medication, escitalopram is also associated with some side effects which may affect women differently.
Citalopram (Common brand name: Celexa)
Citalopram, another SSRI, can also be taken during pregnancy (7). However, the research studies indicate the same thing with citalopram as with other SSRIs.
Research indicates that citalopram may also cause malformation of the growing fetus and may potentially cause cardiac or septal birth defects in the growing fetus (8). The risk is relatively low as compared to other classes of antidepressants but can affect some newborns severely.
Furthermore, citalopram is also associated with some side effects and might not be the best choice for every woman.
What antidepressant-induced side effects can affect pregnant women?
Antidepressant-induced side effects in pregnant women may include:
- Nausea
- Vomiting
- Changes in appetite
- Weight fluctuations
- Sleep disturbances
- Fatigue
- Headaches
- Dizziness
These common side effects, when combined with the typical discomforts of pregnancy, such as morning sickness and hormonal changes, can contribute to an overall sense of discomfort for expectant mothers.
Healthcare providers should carefully consider these factors when prescribing antidepressants to minimise potential side effects and prioritise the well-being of both the mother and the baby.
How to choose the best antidepressant to take during pregnancy?
The choice of the best antidepressant during pregnancy should be made by a qualified healthcare provider. The doses are also carefully adjusted to minimise potential side effects. Pregnancy is a delicate process, and most medications can cause toxicity or affect the growing baby.
This includes not only antidepressants but also other medications like painkillers, antibiotics, anti-inflammatory drugs, etc. This makes the choice of meds for mothers very limited.
Most of the time, mothers have to bear the symptoms and not take any medication for the sake of the developing baby. However, mental health conditions do not wait or subside, especially if they are clinically significant.
Cases of expectant mothers committing suicide out of depression have been reported previously. Antidepressants can prevent that and can enhance the overall mental well-being of an expectant mother.
It’s essential for a woman to be mentally strong when she’s going through this phase, the phase of creating an entire human being. So, make sure you prioritise your and your baby’s health and discuss your concerns with your doctor.
References
- National Health Services (NHS). Pregnancy, breastfeeding and fertility while taking sertraline [Internet]. Available from: https://www.nhs.uk/medicines/sertraline/pregnancy-breastfeeding-and-fertility-while-taking-sertraline/#:~:text=Sertraline%20and%20pregnancy,sertraline%20have%20a%20normal%20heart.
- Bérard A, Zhao JP, Sheehy O. Sertraline use during pregnancy and the risk of major malformations. Am J Obstet Gynecol. 2015 Jun;212(6):795.e1-795.e12. doi: 10.1016/j.ajog.2015.01.034. Epub 2015 Jan 28. PMID: 25637841. https://pubmed.ncbi.nlm.nih.gov/25637841/
- National Health Services (NHS). Pregnancy, breastfeeding and fertility while taking fluoxetine [Internet]. Available from: https://www.nhs.uk/medicines/fluoxetine-prozac/pregnancy-breastfeeding-and-fertility-while-taking-fluoxetine/#:~:text=Fluoxetine%20and%20pregnancy,fluoxetine%20have%20a%20normal%20heart.
- Gao SY, Wu QJ, Zhang TN, Shen ZQ, Liu CX, Xu X, Ji C, Zhao YH. Fluoxetine and congenital malformations: a systematic review and meta-analysis of cohort studies. Br J Clin Pharmacol. 2017 Oct;83(10):2134-2147. doi: 10.1111/bcp.13321. Epub 2017 Jun 10. PMID: 28513059; PMCID: PMC5595931. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5595931/
- National Health Services (NHS). Pregnancy, breastfeeding and fertility while taking escitalopram [Internet]. Available from: https://www.nhs.uk/medicines/escitalopram/pregnancy-breastfeeding-and-fertility-while-taking-escitalopram/#:~:text=Escitalopram%20and%20pregnancy,will%20have%20a%20normal%20heart.
- Klieger-Grossmann C, Weitzner B, Panchaud A, Pistelli A, Einarson T, Koren G, Einarson A. Pregnancy outcomes following use of escitalopram: a prospective comparative cohort study. J Clin Pharmacol. 2012 May;52(5):766-70. doi: 10.1177/0091270011405524. Epub 2011 Nov 10. PMID: 22075232. https://pubmed.ncbi.nlm.nih.gov/22075232/#:~:text=Escitalopram%20does%20not%20appear%20to,in%20infants%20weighing%20%3C2500%20g.
- National Health Services (NHS). Pregnancy, breastfeeding and fertility while taking citalopram [Internet]. Available from: https://www.nhs.uk/medicines/citalopram/pregnancy-breastfeeding-and-fertility-while-taking-citalopram/#:~:text=Citalopram%20and%20pregnancy,citalopram%20have%20a%20normal%20heart.
- Kang HH, Ahn KH, Hong SC, Kwon BY, Lee EH, Lee JS, Oh MJ, Kim HJ. Association of citalopram with congenital anomalies: A meta-analysis. Obstet Gynecol Sci. 2017 Mar;60(2):145-153. doi: 10.5468/ogs.2017.60.2.145. Epub 2017 Mar 16. PMID: 28344955; PMCID: PMC5364096. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5364096/#:~:text=Suspected%20major%20malformations%20that%20have,)%20%5B7%5D%2C%20and%20birth