What Can I Take for Anxiety While I’m Pregnant?

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.

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.

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

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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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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.