Is It Safe to Take Antidepressants Like Zoloft and Prozac During Pregnancy?

A common concern during pregnancy is wanting to use medications that are as safe as possible. If you struggle with mental health, you may have to juggle existing symptoms of conditions like depression or anxiety with new ones that may happen during pregnancy. Often, antidepressants are used to help with this. 

Depression during pregnancy is common. Data from 2011 shows that about 9% of people who are pregnant and 10% of people who are postpartum have symptoms of depression. For many reasons, depression often goes unrecognized during pregnancy. Because of this, screening for depression is now recommended during prenatal visits with your healthcare provider.

People who are pregnant may use antidepressants for different reasons, including mental health conditions like depression or anxiety. You may have used them before pregnancy, or you may have started them during pregnancy. Regardless of when you started taking them, it’s common to wonder if they’re safe to use while pregnant.

In this article, we will dive a little deeper into certain types of antidepressants and what you should know about their safety while pregnant or nursing.

What are SSRIs?

There are many different antidepressants available. One class of antidepressants is selective serotonin reuptake inhibitors (SSRIs). SSRIs are effective, and they are some of the most commonly prescribed antidepressants during pregnancy. 

What are examples of SSRIs?

Many SSRIs are available. Some examples include: 

• Citalopram (Celexa)

• Escitalopram (Lexapro)

• Fluoxetine (Prozac)

• Paroxetine (Paxil)

• Sertraline (Zoloft)

• Vilazadone (Viibryd)

How do they work?

SSRIs work by affecting chemicals in the brain called neurotransmitters. Neurotransmitters help brain cells communicate. One important neurotransmitter is called serotonin. For people with depression or other mental health conditions, the amount of serotonin in the brain is often lower than it would be otherwise.

When you take an SSRI, more serotonin becomes available for the brain to use. Sometimes it takes several weeks after starting an SSRI for serotonin levels to rise enough to help relieve depression symptoms. 

What side effects should I know about?

All SSRIs work similarly to raise the amount of serotonin in the brain, so their side effects can be comparable. It’s important to remember that some people may have side effects, and some don’t. You might also respond to some SSRIs differently than others. If you aren’t able to tolerate the side effects of one SSRI, you might be able to use a different one. 

Common side effects can include:

• Headache

• Nausea and vomiting

• Sexual problems, like erectile dysfunction

• Sleep problems, like insomnia

• Restlessness

• Weight gain

You can try taking an SSRI with food to help prevent nausea and try taking your antidepressant at a different time of day if it makes you too tired or unable to fall asleep.

Rare but serious side effects may also occur. Serotonin syndrome is a potentially serious complication that can occur when there’s too much serotonin in your body. Combining SSRIs with other medications that boost serotonin can raise your risk of serotonin syndrome. 

Symptoms of serotonin syndrome can include:

• Anxiety

• Confusion

• Movement changes

• Muscle rigidity

• Rapid heart rate

• Seizures

• Sweating

• Tremors

• Fever

SSRIs also carry a warning for an higher risk of suicide, particularly for people younger than 24 years old. The risk of suicide is highest in the first few weeks or months of starting an SSRI. If you have possible symptoms of serotonin syndrome or have thoughts of self-harm, call a healthcare provider as soon as possible.

Is it safe to take SSRIs during pregnancy?

SSRIs work well for certain mental health conditions like depression and anxiety. You might have started using them before pregnancy, or you could have started them during pregnancy. 

The American College of Obstetrics and Gynecology (ACOG) provides treatment guidelines —  recommended strategies for healthcare providers to use to treat their patients — for a number of conditions related to pregnancy. In their guideline for managing depression in pregnancy, ACOG says that there isn’t a significant reason to believe that SSRIs cause serious harm to an unborn baby. In other words, SSRIs are a treatment option that can be considered for people that are pregnant. 

Are there any risks?

Sertraline appears to be one of the safest SSRIs to use in pregnancy, but other SSRIs, such as citalopram, escitalopram, fluoxetine, and vilazodone, are likely safe too. Studies suggest that there is little risk with taking SSRIs during pregnancy, but they still could affect your baby.

According to one study, about 30% of babies born to mothers who took an SSRI or serotonin- norepinephrine reuptake inhibitor (SNRI) — a similar type of antidepressant — during pregnancy develop adaptation syndrome. Adaptation syndrome is behavioral symptoms that a newborn can experience if the mother took an SSRI or SNRI during pregnancy — they’re similar to temporary withdrawal symptoms that go away.

Symptoms can include:

• Difficulty breathing

• Jitteriness

• Irritability

• Other symptoms, such as sleep problems and temperature changes 

Other studies say that there might be a small risk of pulmonary hypertension — high blood pressure between the heart and lungs — in the baby when SSRIs are taken during pregnancy. Thankfully, a large study of nearly 4 million pregnant people showed that the risk is smaller than we originally thought. 

Older studies of paroxetine use in people that are pregnant showed a higher risk of heart defects in infants. Newer studies show that this risk is most relevant during the first trimester of pregnancy. People that are pregnant can consider switching SSRIs with the help of their healthcare provider if they don’t feel comfortable with the potential risks. 

Your pharmacist and other healthcare providers have access to more safety data about these medications. They can help you navigate many potential risks. 

Can I nurse while taking sertraline or fluoxetine?

So, what about after my baby is born? 

A common question at this stage is whether it’s safe to nurse while using an SSRI. In general, the benefits of SSRIs outweigh their risks while nursing. But, they can go into breast milk and get to the nursing baby. Escitalopram and sertraline might pass less into breast milk and could be considered safer options if you are starting a new SSRI during this time.

If you aren’t sure about the safety of a medication while nursing, ask your pharmacist or provider for advice and information.

Are there any risks?

There are some reports of side effects in the baby when SSRIs are used while nursing. Most reports are with fluoxetine and citalopram. Babies may experience:

• Colic, or crying for more than 3 hours a day

• Crying

• Less frequent feeding

• Irritability

• Sleep difficulties

• Watery stools

Despite these potential risks, pumping and discarding milk from exposure is not recommended. 

Are there other antidepressants I can take during pregnancy?

There are other options if SSRIs have not worked for you. 

SNRIs — such as venlafaxine (Effexor) or duloxetine (Cymbalta) — might also be used. Tricyclic antidepressants (TCAs) — such as amitriptyline (Elavil) or nortriptyline (Pamelor) — can be considered as well. Like with SSRIs, a strong risk of harm to the unborn baby has not been reported with SNRIs or TCAs. Bupropion (Wellbutrin) or trazodone (Desyrel) can be considered during pregnancy as well.

Before stopping your antidepressant or starting a new one, it’s important to talk with your healthcare provider to see what your best option may be. 

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Written by:

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP, has over a decade of experience as a pharmacist, professor, and researcher. She was a full-time clinical professor in the pharmacy practice department at D’Youville School of Pharmacy before subsequently joining the faculty of the pharmacy practice department at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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