Risk of Antidepressants in Pregnancy
Major new study sheds light on which antidepressants cause birth defects.

Women who suffer from depression often feel like they are caught between a rock and a hard place. Antidepressants make life worth living, but so does having a family. To make matters worse, women who struggle with the disease of infertility are more likely to be depressed, and more likely to be on antidepressants. Up until now, research results have been inconclusive on the safety of antidepressant use during pregnancy. A large new study by researchers at the US Centers for Disease Control (CDC) sheds more light on this controversial topic.

Some antidepressants cause an increased risk in birth defects, while others do not.

The SSRI in Pregnancy Study

This study of over 27,000 women looked at link between SSRI use and birth defects. SSRIs (selective serotonin reuptake inhibitors) are the most common class of antidepressants prescribed in the US, and include the following:

  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)

This study looked at women who reported taking one of the above SSRIs at least once in the period from one month before conception through the third month of pregnancy. The study excluded woman with diabetes because of the strong association between diabetes and birth defects, and women who reported using other drugs with known risk of birth defects.

The Good News

This study provided much needed nuance to the previous inconclusive studies on the risk of birth defects when taking SSRIs in pregnancy. An increased risk was not found for sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro). This was good news since sertraline (Zoloft) was the most commonly used SSRI in the study: 40% of women in the study who reported taking a SSRI took sertraline.

The Bad News

Researchers found that:

  • Taking fluotetine (Prozac) during the first trimester of pregnancy was associated with increased odds of heart and brain/skull defects in an infant.
  • Taking paroxetine (Paxil) was associated with increased risk of heart, brain/skull, and abdominal defects.

The birth defects associated with paroxetine or fluoxetine occur 2-3.5 times more frequently among the infants of women treated with these SSRIs early in pregnancy.

Actual Risk to Individual Baby is Low

Keep in mind that the actual risk to an individual mother and baby is still quite small. For example, the highest risk found in the study was between maternal use of paroxetine (Paxil) and brain/skull and heart defects in their infants. While the study found a strong association between these birth defects and this drug, the absolute risk to a baby whose mother was treated with paroxetine early in pregnancy would be only 7 per 10,000 for brain/skull defects and 24 per 10,000 for heart defects.

Bottom Line

Don’t panic. Talk with your doctor before you make any decision.

Depression is a serious illness with inherent risks to both mother and baby regardless of treatment options. The decision of whether to take medication and what medication to take can only be made with close consultation of a doctor who knows you.

I strongly recommend listening to this interview we did on Coping with Depression When Pregnant or Trying to Get Pregnant. It was one of the best summaries of weighing the risks that I’ve heard. We interviewed Dr. Adam Urato, with Tufts Medical Center and Dr. Alice Domar, Executive Director of the Domar Center for Mind/Body Health at Boston IVF, an assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School, and a senior staff psychologist in the department of Ob/Gyn at Beth Israel Deaconess Medical Center.


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Image credit: Roberto Carlos Pecino