Can I take antidepressants during pregnancy?
While pregnancy is often portrayed as a chapter filled with joy and positivity, the reality can be something quite different. It’s very common to experience depression during pregnancy and postpartum. If you’re struggling with symptoms of depression while expecting, you may be wondering whether psychiatric medications, such as antidepressants, are an option for you. Dr. Holly Betterly MD, Board-Certified Psychiatrist in Weston, FL, provides insight into the role of antidepressant medications during pregnancy.
This post is provided for educational purposes only, and is not intended as a substitute for professional medical advice. If you have questions, always reach out to your doctor for more information.
Struggling with your mental health? Reach out for professional support. Dr. Betterly is a board-certified psychiatrist in Weston, FL dedicated to helping you overcome depression, anxiety, and OCD. She offers appointments at her office in Weston, FL, conveniently located in Weston Town Center, as well as via telehealth for patients across Florida. Request an appointment today to start your journey to better mental health.
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How common is depression during pregnancy?
If you’ve been experiencing symptoms of depression during pregnancy, you’re not alone. A 2023 article from Social Psychiatry and Psychiatric Epidemiology examined the prevalence of perinatal depression, or depression occurring during pregnancy or up to one year postpartum. This systematic review found that an estimated one in four pregnancies worldwide are impacted by depression. The American College of Obstetrics and Gynecology (ACOG) provides a more conservative estimate of about one in ten pregnancies affected. While the exact rate varies depending on the source, the bottom line is that perinatal depression is extremely common.
Risk Factors for Perinatal Depression
The review article mentioned above identified a number of factors which may increase someone’s risk for experiencing perinatal depression. These include:
Personal history of mental health conditions, such as depression or anxiety
Child care stress
Infant temperament
Stressful life events (such as the death of a loved one)
Lack of social support
Marital conflicts/dissatisfaction
History of abuse
Can I take antidepressants during pregnancy?
If you’re experiencing symptoms of depression during pregnancy and want to find out whether medications may be an option for you, it’s important to reach out to your doctor for personalized advice. Your OBGYN or psychiatrist are both great places to start.
When we think about prescribing antidepressant medications, it’s important to remember that there is no “one size fits all” approach. To determine whether a specific medication is safe and appropriate for you as an individual, your doctor must take into consideration your unique health circumstances. Certain medications cannot be prescribed in combination with other medications, or to people with certain medical conditions. Your personal doctor is knowledgeable about your health history and can provide you with personalized guidance.
While only your doctor can determine if an antidepressant medication is appropriate for you, it’s important to point out that many antidepressant medications can be used safely during pregnancy. The American College of Obstetrics and Gynecology (ACOG) clinical practice guidelines provide a strong recommendation against withholding or discontinuing mental health medications on the basis of pregnancy alone.
How common is antidepressant use during pregnancy?
A study from earlier this year in JAMA Network Open found that based on insurance claims data, antidepressant use dropped by nearly half during pregnancy, from about 4% of the women taking antidepressants during the year prior to pregnancy, to only about 2% of women taking antidepressants during pregnancy. Within a month of childbirth, the rates of antidepressant use increased back to pre-pregnancy rates. The data didn’t show an increase in psychotherapy claims during pregnancy, suggesting that many women may unfortunately be going without mental health treatment during pregnancy. Untreated perinatal depression can have serious consequences, as we review in the next section.
Weighing the risks vs. the benefits
Your doctor can provide information about which options for depression treatment are most appropriate for you in consideration of your unique health circumstances. They should engage you in a discussion about the risks and benefits of the available treatment options, as well as the risks and benefits of no treatment. This can help you to make an informed decision about how you wish to proceed, selecting the option that best aligns with your needs, preferences, and values. Don’t be afraid to ask questions!
It’s important to remember that when we are weighing risks and benefits, we need to consider not just the potential risks of medication options, but also the potential risks of no treatment. While medications may carry a risk for side effects or harm to a developing baby, untreated depression also carries serious risks.
Risks of Untreated Depression in Pregnancy
The American College of Obstetrics and Gynecology highlights that untreated depression during pregnancy has been linked to:
Poor fetal growth
Early labor
Low birth weight
Your baby experiencing health complications after birth
Symptoms of depression often impact our ability to take care of ourselves, affecting our sleep, energy, and appetite. Under the heavy weight of depression, it can be difficult to stay on top of self care, such as attending important prenatal check-ups. It may also be challenging to find the motivation to prepare for the safe arrival of your baby, leading you to put off purchasing a crib or installing a carseat. Left untreated, perinatal depression can have serious consequences for both you and your baby.
What do the professional guidelines say?
The American College of Obstetrics and Gynecology (ACOG) provides a clinical practice guideline for the Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum.
This guideline evaluates the evidence for the safety and effectiveness of mental health medications during pregnancy and lactation. It provides a number of recommendations for treatment, classified by the strength and evidence quality of the recommendation.
How does ACOG define a “Strong Recommendation”?
According to the guideline, a “Strong Recommendation” means that the “benefits clearly outweigh harms and burdens. Most patients should receive the intervention.”
Some “Strong Recommendations” from the ACOG guideline include:
That obstetricians start medications for perinatal depression, refer patients to appropriate behavioral health resources when indicated, or both
Against withholding or discontinuing mental health medications for pregnancy or lactation status alone
That therapy be considered a first-line treatment option for mild-to-moderate perinatal depression
That Selective Serotonin Reuptake Inhibitors, or SSRIs, be used as a first-line medication option for perinatal depression.
For those who have never taken antidepressants in the past, sertraline and escitalopram are reasonable options.
For those who have taken antidepressants in the past, medication choice should be individualized based on their past response to medication.
