Depression
What Antidepressants Can You Take While You’re Pregnant?
Depression is a common mental health condition during pregnancy. There are several antidepressants that are considered safe to take when you’re expecting.
Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are typical first-choice antidepressants during pregnancy. Certain tricyclic antidepressants (TCAs) may also be safe options, but they tend to cause more side effects.
Experts recommend avoiding monoamine oxidase inhibitors (MAOIs) while pregnant due to safety concerns for unborn babies. There isn’t as much pregnancy safety research available about bupropion (Wellbutrin SR, Wellbutrin XL) and mirtazapine (Remeron). Your healthcare professional should only prescribe them if the benefits outweigh the risks.
Major depressive disorder (often just called depression) is a common mental health condition. It's estimated that depression affects nearly 1 in 5 U.S. adults. And it’s a condition that can happen during pregnancy too (called perinatal depression).
While there are many antidepressants available, medication choices can be more limited when you’re pregnant. It’s not uncommon to want to avoid medications altogether during pregnancy. But if you do need help treating depression during pregnancy, there are safe options.
Here, we’ll discuss the safest antidepressants during pregnancy — and which ones are usually avoided. We’ll also provide some other helpful tips for managing depression symptoms.
There are three main types of antidepressants that you can safely take during pregnancy:
Selective serotonin reuptake inhibitors (SSRIs)
Serotonin and norepinephrine reuptake inhibitors (SNRIs)
Certain tricyclic antidepressants (TCAs)
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SSRIs are some of the most commonly prescribed antidepressants. Examples include:
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
SSRIs are considered some of the safest antidepressants in pregnancy. Of these medications, citalopram and sertraline have the most evidence to support their safety. But this doesn’t mean they’re completely risk-free.
Taking SSRIs during pregnancy can lead to a condition in newborns called adaptation syndrome. This is similar to withdrawal symptoms and is temporary. Infants who experience it may be cranky, have trouble sleeping, or have feeding problems. Adaptation syndrome usually goes away within a baby’s first 2 weeks of life.
Fluoxetine and paroxetine carry some more risks to fetuses than others in this class. Studies found that infants who were exposed to these SSRIs before birth had a slightly increased risk of:
Experiencing adaptation syndrome — seen with fluoxetine and paroxetine
Pulmonary hypertension (high blood pressure in the lungs and heart) — seen with fluoxetine and paroxetine
Heart problems — seen with fluoxetine and paroxetine
Skull bone development problems — seen with fluoxetine
Missing a large portion of the brain and skull at birth (anencephaly) — seen with paroxetine
Being born with intestines or other internal organs outside of the body — seen with paroxetine
SSRIs during pregnancy: Read more about why selective serotonin reuptake inhibitors (SSRIs) are first-choice antidepressants during pregnancy.
What does it feel like? Read firsthand accounts of what postpartum depression feels like.
Treating anxiety while pregnant: It’s common to have both depression and anxiety. But which anxiety medications are safe to take during pregnancy?
But keep in mind, even though the risk is higher with fluoxetine and paroxetine, it’s still very low for all SSRIs. So if you’ve been taking either fluoxetine or paroxetine before you were pregnant, it’s possible your prescriber may suggest continuing it.
SNRIs are also a common choice for treating depression and work similarly to SSRIs. Well-known examples include duloxetine (Cymbalta, Drizalma Sprinkle) and venlafaxine (Effexor XR). The American College of Obstetricians and Gynecologists recommends SNRIs as an option during pregnancy if you can’t take an SSRI.
There isn’t quite as much safety research available about SNRIs during pregnancy as there is with SSRIs. Some studies have found that they don’t cause harm to a fetus. Others have found that they may slightly raise the risk of heart, kidney, and urinary problems for infants. But keep in mind that the overall risk for these issues after taking an SNRI is very low.
SNRIs also carry a risk of adaptation syndrome. Again, this condition is temporary and generally mild for most affected newborns.
TCAs have been around longer than SSRIs or SNRIs. One medication in this class — nortriptyline (Pamelor) — may be safer than other TCAs during pregnancy. And because it works differently from SSRIs and SNRIs, nortriptyline could be an option if those antidepressants haven’t worked well for you.
Studies haven’t linked nortriptyline to harming a fetus. And research suggests TCAs, as a class, don’t cause long-term developmental problems in children. But there aren’t as many safety studies available for TCAs as there are for SSRIs during pregnancy.
However, many people have a hard time tolerating the side effects of nortriptyline and other TCAs. These medications can cause constipation and dizziness — common issues that happen during many pregnancies. They also have a risk of causing dry mouth, confusion, and a rapid heart rate. So while TCAs likely won’t harm your fetus, they may not be the best option for you.
There are a number of antidepressants that are less preferred or may harm a fetus. It’s important to let your healthcare team know if you’ve been taking one of these medications before you knew you were pregnant. That way, you can make a plan together to help keep you and your fetus as safe as possible.
Monoamine oxidase inhibitors (MAOIs) have been on the market for decades. Examples include phenelzine (Nardil) and tranylcypromine (Parnate). Because of their side effects and long list of interactions, they’re not first-choice antidepressants. People typically only take them if other medications aren’t working for them.
It’s not recommended to take MAOIs during pregnancy. Studies in humans are limited. But studies of pregnant animals found that MAOIs harmed animal fetuses. These studies also found that, after birth, these animals were more aggressive than animals who weren’t exposed to MAOIs before birth. The few reports that are available about humans suggest MAOIs may also harm a fetus.
Bupropion (Wellbutrin SR, Wellbutrin XL) is an atypical antidepressant. It can be taken for both depression and to help people quit smoking. Information about how safe this medication is during pregnancy is limited and conflicting.
Two studies suggested there may be a potential link between taking bupropion during the first trimester (up to week 13 of a pregnancy) and heart problems. But other studies haven’t found the medication to be linked to harming a fetus.
Because the research isn’t clear, it’s best to discuss taking bupropion during pregnancy with your healthcare team. They’ll be able to tell you if its benefits outweigh its risks for you.
Mirtazapine (Remeron) is another atypical antidepressant. It’s often prescribed when people have both depression and insomnia (trouble sleeping). This is because it commonly causes drowsiness as a side effect. Mirtazapine isn’t preferred during pregnancy because there’s conflicting information about its safety.
Some of the available research shows there may be a higher risk of certain birth defects or pregnancy complications when mirtazapine is taken during the first trimester. This included facial defects and preterm birth (giving birth earlier than expected). Other studies suggest that mirtazapine is unlikely to harm a fetus.
More studies are needed to say how safe mirtazapine is during pregnancy. Speak to your healthcare team if you’re taking mirtazapine and are pregnant.
Benzodiazepines are medications that may be taken for short-term anxiety relief. But it’s usually recommended to avoid them during pregnancy, or to use them sparingly. Benzodiazepines may raise the risk of preterm birth and lower birth weights. They also carry a risk of dependence with regular use. And they may cause infants to experience withdrawal symptoms after they’re born.
Typically, SSRIs are a first choice for managing anxiety. And as mentioned, they’re also a safe group of medications to take during pregnancy.
Hydroxyzine (Vistaril) is another safe anxiety treatment. This antihistamine can help quickly relieve symptoms and is safe to take if you’re pregnant. It could be a potential alternative to benzodiazepines if you need a fast-acting anxiety medication.
Maybe you’re looking for ways to manage your depression without medication. Everyone’s treatment regimens are unique. The most important step is to talk with your healthcare team if you’re experiencing depression. They’ll work with you to find a treatment plan that suits your needs.
Therapy is an effective way of managing and treating depression. There are many types of therapy available. Cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) are commonly recommended for depression. Discuss which option would be the best fit for you with your healthcare team.
Other activities that can help improve depression symptoms include:
Taking care of your basic needs, such as maintaining personal hygiene
Connecting with people you trust to help provide social support
Engaging with a hobby (or finding a hobby if you don’t have one yet)
Spending time in nature, such as gardening or sitting outside in the sunlight
Exercising or adding movement to your routine in a way that you enjoy
Helping others
Journaling
Prioritizing sleep and practicing good sleep hygiene
Meeting with a pregnancy support group
No antidepressants are specifically FDA approved to take during pregnancy. This is because it’s common for medication manufacturers to exclude pregnant women from their studies. But there is research on the safety of certain antidepressants during pregnancy. Experts use this safety data to recommend certain medications as preferred options while you’re expecting. SSRIs are considered a first choice for managing depression during pregnancy.
No antidepressants are specifically FDA approved to take during pregnancy. This is because it’s common for medication manufacturers to exclude pregnant women from their studies. But there is research on the safety of certain antidepressants during pregnancy. Experts use this safety data to recommend certain medications as preferred options while you’re expecting. SSRIs are considered a first choice for managing depression during pregnancy.
Mood stabilizers, such as lithium (Lithobid), do have risks during pregnancy. They may raise the risk of certain heart problems in fetuses, especially if taken during the first trimester. Anti-seizure medications, such as carbamazepine (Tegretol, Equetro), are linked to a spinal nerve problem called spina bifida. Atypical antipsychotic medications, such as olanzapine (Zyeprexa), seem to be a safer option during pregnancy. Large studies have found that most atypical antipsychotics aren’t linked to harming a fetus.
Lexapro (escitalopram) is an SSRI. It’s one of the safest antidepressants to take during pregnancy. But if you’re unable to take Lexapro, your prescriber may suggest trying another SSRI. Potential pregnancy-safe alternatives include Celexa (citalopram) and Zoloft (sertraline). If you can’t take any SSRIs, experts recommend trying an SNRI, such as Effexor XR (venlafaxine). These medications have less safety data available than SSRIs, but are considered the next best option.
Depression is a common mental health condition that can happen during pregnancy. If needed, there are safe medication options to treat depression when you’re expecting.
Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are considered the safest antidepressants in pregnancy because they pose the lowest risks to fetuses. Monoamine oxidase inhibitors (MAOIs) are typically avoided when possible because there’s concern they could be harmful.
Discuss which antidepressant is best for you during pregnancy with your healthcare team. Together, you can work towards finding a depression treatment that fits your needs.
If you or someone you know is struggling with anxiety or depression or has had thoughts of harming themselves or suicide, know that help is available. The National Suicide Prevention Lifeline (1-800-273-8255) provides 24/7, free, confidential support for people in distress.
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