Which Antidepressants Are Safest During Pregnancy?

Question: Which Antidepressants Are Safest During Pregnancy?

While many different medications are used to treat OCD, this article will focus on antidepressants. Newer antidepressants like the SSRI's and SNRIs are the most commonly prescribed medications for OCD. A

Answer:

I discussed some of the basics of OCD treatment during pregnancy in an earlier article. Many women, however, have questions specific to the medication they may be taking for OCD. Is it safe? How safe? How much is really known about the long-term effects of psychiatric medication and pregnancy?

No one "experiments" on pregnant women to see which medications are safe or unsafe. Rather, safety information is collected over the years by various pregnancy exposure registries, like the ones maintained by the US Food and Drug Administration (FDA). Much of the time, this means that the longer a drug has been on the market, the more is known about its effects on pregnancies.

In addition, the FDA has created general categories, ranging from A (definitely safe) to X (definitely unsafe) to guide patients and prescribers. Safety during breastfeeding is an entirely separate issue, which will be addressed later, too.

In this article, I focus on the newer antidepressants: SSRIs (Prozac, Paxil, Zoloft, Luvox, Celexa and Lexapro) and SNRI's (Effexor and Cymbalta):

Most of these medications fall into FDA pregnancy category C, meaning that there are "no adequate and well-controlled studies in pregnant women" for these drugs. Research has indicated that there may be issues with newborn drug withdrawal (restlessness, poor feeding) following delivery. There have also been reports of a serious newborn lung problem called "persistent pulmonary hypertension." However, many pregnant women with OCD have benefitted tremendously from these meds, and there are known risks to the mother and baby when OCD symptoms become severe.

Paxil, however, was moved to category D in 2005, meaning that there are known risks associated with it. Studies showed an increased risk of heart defects in babies whose mothers had taken Paxil during pregnancy. Paxil, therefore, is no longer recommended in pregnant women.

Again, each woman is different, so it is extremely important to discuss your specific medications with your healthcare provider.

_Sources:

ACOG Committee on Obstetric Practice. "Treatment With Selective Serotonin Reuptake Inhibitors During Pregnancy." Obstetrics and Gynecology 2006; 108:1601-3.

USA Food and Drug Administration website.

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