Key takeaways:
When anxiety during pregnancy starts to affect your day-to-day life, your healthcare provider may discuss medication treatment options with you.
Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are first-choice anxiety medications during pregnancy.
Certain benzodiazepines and tricyclic antidepressants (TCAs) may sometimes be used during pregnancy. But they have more risks and should only be taken after careful discussion with a healthcare provider.
Save on related medications
Life is littered with moments of anxiety. You might feel it before a big test or when you’re faced with a problem that doesn’t have a simple solution. In these moments, it’s natural to feel concern, worry, or nervousness — all symptoms of anxiety. But for people with generalized anxiety disorder (GAD), these symptoms can be overwhelming and long-lasting.
Anxiety symptoms can develop or worsen during pregnancy. It’s estimated that over 50% of women experience worse anxiety or depression during pregnancy. And if anxiety is left untreated during pregnancy, it can raise the risk of low birth weight and preterm delivery. This means a baby is born smaller or earlier than expected.
When anxiety starts to impact your day-to-day life, you may look into options to help manage your symptoms. Anxiety medications may be a treatment option that you and your healthcare provider discuss. But you may wonder which treatments are safe during pregnancy.
Search and compare options
In this article, we’ll look at anxiety medications that are considered safe during pregnancy. We’ll also discuss which medications may be less preferred.
What anxiety medications are safe during pregnancy?
Antidepressants are commonly used to treat anxiety. Even though antidepressants are used for depression, some of them are often first-choice options for anxiety.
There are many antidepressants available. Two of the most common classes of antidepressants used for anxiety in pregnancy are selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs).
Selective serotonin reuptake inhibitors (SSRIs)
SSRIs are a common group of medications used to treat anxiety. Examples of SSRIs include:
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
SSRIs are considered safe and effective for anxiety during pregnancy. They are first-choice medications. Most studies suggest that taking SSRIs have low risks of birth defects. SSRIs may take a few weeks to start improving your symptoms. And, they have to be taken every day to be effective.
Read more like this
Explore these related articles, suggested for readers like you.
Of the available options, most studies suggest that sertraline and citalopram are the safest SSRIs during pregnancy. Sertraline and escitalopram are considered safe to use while nursing after pregnancy.
Compared to other SSRIs, paroxetine and fluoxetine may have a slightly higher risk of certain birth defects. They may also have a higher risk of adaptation syndrome. Adaptation syndrome includes temporary withdrawal symptoms that can happen to a newborn when the mother takes an SSRI during pregnancy.
Paroxetine and fluoxetine may also have a higher risk of pulmonary hypertension — high blood pressure in the heart and lungs of a baby. However, a large study of nearly 4 million pregnant women showed that this risk is still small.
Serotonin and norepinephrine reuptake inhibitors (SNRIs)
SNRIs are another group of antidepressants that are considered safe and effective for anxiety during pregnancy. They’re also considered first-choice medications. Like SSRIs, SNRIs must be taken every day. And, they may take a few weeks to become effective. Examples of SNRIs include duloxetine (Cymbalta) and venlafaxine.
Studies of duloxetine and venlafaxine suggest that they don’t raise the risk for birth defects. Duloxetine also appears to be safe for mothers to take while nursing. Similar to SSRIs, SNRIs have a risk of adaptation syndrome for newborns.
Hydroxyzine
Hydroxyzine (Vistaril) is an antihistamine medication. Although not a first choice, it can be effective for anxiety. It’s also considered a safe option during pregnancy. Hydroxyzine works fairly quickly and doesn’t need to be taken every day to be effective.
What anxiety medications may not be as safe during pregnancy?
Some anxiety medications aren’t as safe during pregnancy. This is often because side effects are less tolerable than with the medications discussed above.
Benzodiazepines
Benzodiazepines, such as alprazolam (Xanax), are commonly used for anxiety. But they’re less preferred during pregnancy due to safety concerns. Typically, benzodiazepines are only used during pregnancy when the benefits outweigh the possible risks.
In a large review of eight studies, benzodiazepines didn’t raise the risk of birth defects. But when benzodiazepines were combined with antidepressants, this risk went up slightly. However, using benzodiazepines during pregnancy has been linked to a higher risk of preterm birth in other studies.
Additionally, benzodiazepines have a risk of dependence, meaning your baby may come to rely on these medications. After giving birth, your baby could experience withdrawal symptoms. If you’re concerned about this, discuss it with your healthcare provider. Don’t try to stop these medications without your healthcare provider’s OK.
Tricyclic antidepressants
Tricyclic antidepressants (TCAs), such as clomipramine (Anafranil), are another group of antidepressants that may be prescribed for anxiety. Early studies seemed to show a higher risk of birth defects with TCAs compared to mothers who didn’t take them. But more recent studies show that they pose a low risk to unborn babies.
However, TCAs can cause side effects that may make them less preferred in pregnancy. Side effects can include constipation, drowsiness, or dizziness. These are already common discomforts that happen during pregnancy. TCAs can worsen them.
What should I do if I took a less preferred anxiety medication before I knew I was pregnant?
If you took a less-preferred anxiety medication before realizing you were pregnant, contact your healthcare provider right away. You can talk with them about the concerns you have. They may recommend an ultrasound to look for any problems depending on the situation. Or, they might recommend medication changes to help lower the risk of complications.
If you’re unable to reach your healthcare provider, you can visit the MotherToBaby website or call them toll-free at 1-866-626-6847. MotherToBaby is a group of experts who specialize in medication use during pregnancy. They also have text, email, and live chat options to talk with someone when your provider is unavailable.
What are other things I can do to treat anxiety while I’m pregnant?
You may prefer to avoid anxiety medications during pregnancy altogether. In that case, you might be wondering what else you can do to manage your anxiety.
Therapy is a recommended part of anxiety treatment. There are several types of therapy available, including traditional talk therapy and cognitive behavioral therapy (CBT). But CBT is generally considered the most effective for anxiety.
Other medication-free ways you can manage anxiety during pregnancy include:
Exercising regularly
Taking measures to get more sleep, such as having a consistent bedtime routine
Practicing mindfulness with techniques like meditation
Eating a balanced and healthy diet
Doing activities or engaging in hobbies you enjoy
The bottom line
Anxiety is common during pregnancy. When it starts to affect your daily life, you may be considering a medication for your symptoms. Antidepressants, like SSRIs or SNRIs, are first-choice options for managing anxiety in pregnancy. Hydroxyzine might be helpful if you’d like to take medication only when your anxiety symptoms are at their worst.
Certain benzodiazepines and TCAs may sometimes be used during pregnancy. But they have risks and side effects to be aware of. Talk with your healthcare provider to decide which anxiety treatment is the best option for you.
Why trust our experts?
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.
References
The American College of Obstetricians and Gynecologists. (2021). Anxiety and pregnancy.
The American College of Obstetricians and Gynecologists. (2021). What medicine can I take for allergies while I'm pregnant?
Anxiety and Depression Association of America. (2015). Pregnancy and medications.
Armstrong, C. (2008). ACOG guidelines on psychiatric medication use during pregnancy and lactation. American Family Physician.
Centers for Disease Control and Prevention. (2020). Pregnant or thinking of getting pregnant?
Corti, S., et al. (2019). Neonatal outcomes in maternal depression in relation to intrauterine drug exposure. Frontiers in Pediatrics.
Garakani, A., et al. (2020). Pharmacotherapy of anxiety disorders: Current and emerging treatment options. Frontiers in Psychiatry.
Grigoriadis, S., et al. (2019). Benzodiazepine use during pregnancy alone or in combination with an antidepressant and congenital malformations: Systematic review and meta-analysis. The Journal of Clinical Psychiatry.
Grigoriadis, S., et al. (2018). Maternal anxiety during pregnancy and the association with adverse perinatal outcomes: Systematic review and meta-analysis. The Journal of Clinical Psychiatry.
Haßdenteufel, K., et al. (2020). Reduction in physical activity significantly increases depression and anxiety in the perinatal period: A longitudinal study based on a self-report digital assessment tool. Archives of Gynecology and Obstetrics.
Huitfeldt, A., et al. (2020). Associations of maternal use of benzodiazepines or benzodiazepine-like hypnotics during pregnancy with immediate pregnancy outcomes in Norway. JAMA Network Open.
Huybrechts, K. F., et al. (2015). Antidepressant use late in pregnancy and risk of persistent pulmonary hypertension of the newborn. JAMA.
MotherToBaby. (n.d.). Contact.
MotherToBaby. (n.d.). Is it safe for me and my baby?
Moraczewski, J., et al. (2021). Tricyclic antidepressants. StatPearls.
National Institute of Mental Health. (2018). Anxiety disorders.
National Suicide Prevention Lifeline. (n.d.). National suicide prevention lifeline.
Norris, M. M. (2013). Use of antidepressants during pregnancy and lactation. Mental Health Clinician.
Office on Women’s Health. (2019). Body changes and discomforts.
Ornoy, A., et al. (2017). Antidepressants, antipsychotics, and mood stabilizers in pregnancy: What do we know and how should we treat pregnant women with depression. Birth Defects Research.
Womersley, K., et al. (2017). What are the risks associated with different selective serotonin re-uptake Inhibitors (SSRIs) to treat depression and anxiety in pregnancy? An evaluation of current evidence. Psychiatria Danubina.
