Taking antidepressants during pregnancy

In response to this new research, the American College of Obstetricians and Gynecologists (ACOG) now recommends that the decision to use SSRIs and related drugs in pregnancy should be made on an individual basis. In addition, ACOG recommends that women who are pregnant or planning to become pregnant should specifically avoid taking Paxil.

That means you should avoid taking SSRIs during pregnancy unless you absolutely need to. If you're taking Paxil, you'll need to stop or switch to another medication before you conceive.

Past studies found no significant difference in the rates of miscarriages and stillbirth between women who took SSRIs and women who didn't. An older class of drugs known as tricyclics, which includes amitriptyline (Elavil) and imipramine (Tofranil), has also been considered safe, as have newer drugs such as bupropion (Wellbutrin).

However, the most recent research analysis, published in 2006, showed that SSRIs are associated with a small increase in the risk of miscarriage.

Another analysis showed that babies whose mothers take SSRIs during pregnancy may be more likely to be born prematurely, have low birth weight, spend time in a neonatal intensive care unit, and have trouble adapting to life outside the womb. This was particularly the case for babies of women who were also taking other drugs for mental conditions or who smoked or drank alcohol.

Recent studies have noted withdrawal symptoms in nearly a third of newborns whose mothers were treated with SSRIs near the end of their pregnancy. The most commonly reported symptoms included tremors, convulsions, irritability, and increased crying.

These symptoms were relatively benign and short-lived, lasting only one to four days after birth. Some doctors recommend that their pregnant patients taper off to a lower dosage or stop taking antidepressants ten to 14 days before their due date to prevent withdrawal symptoms in their newborn.

Finally, a small, well-designed study found that babies whose moms took SSRIs in the second half of pregnancy were six times more likely to be born with a rare but serious breathing problem. The disorder, called persistent pulmonary hypertension, was still uncommon among these babies — only about one percent developed it. More research will be needed to confirm these conclusions.

As for Paxil, four studies published in the past two years found that the babies of women who took this drug in the first trimester had a greater risk of birth defects.

NOTE: Antidepressants known as monoamine oxidase inhibitors (MAOIs), such as phenelzine (Nardil) and tranylcypromine (Parnate), may cause birth defects and are not considered safe to use during pregnancy.

If you're clinically depressed, it's important to get the treatment you need, whether it's psychotherapy or medication or both. Some new preliminary research suggests that when depression or anxiety goes untreated during pregnancy, it may be harmful to you and your baby, possibly raising your risk of preterm labor, premature delivery, and a lower-birthweight baby.

Untreated depression during pregnancy can also continue after you deliver. Many studies have shown that if a mother is depressed after delivery, her child is more likely to have trouble with cognitive, social, and psychological development.

If you're pregnant and having symptoms of depression, consult your healthcare provider and get a referral to a counselor or psychiatrist. These professionals can help you figure out what kind of care is best for you and whether you should be taking antidepressant medication.

If you're already taking an antidepressant and you want to stop taking it while you're pregnant, be sure to consult your doctor on how best to do this. Quitting suddenly may cause withdrawal symptoms, and you'll need to make sure that you continue to get the support you need.