Are antidepressants safe during pregnancy?

I don’t take antidepressants, but one out of every eight American pregnant women does—yet there’s very little information about how safe they are for the developing fetus. Only about a dozen drugs have been approved by the FDA for use in pregnant women, and they are all drugs that treat birth- or pregnancy-related problems—not unrelated conditions that might happen to arise during pregnancy, such as mood disorders. As a result, pregnant women are essentially guinea pigs when it comes to taking prescription drugs.

As for the use of antidepressants in particular, there is some evidence suggesting cause for concern. In 2005, the FDA announced that babies born of mothers who take paroxetine (Paxil and Seroxa) during their first trimester are up to twice as likely to exhibit fetal heart defects. A 2005 study published in the Lancet also found that some newborns born of mothers taking paroxetine suffer from withdrawal symptoms such as convulsions and abnormal crying for several days.

More recently, in June, a study published in the Canadian Medical Association Journal reported that pregnant women who take SSRIs are twice as likely to miscarry as women who do not. Another study published in the Archives of Pediatric and Adolescent Medicine suggests that women taking SSRIs are twice as likely to have preterm births compared with the general population and that their babies are more likely to spend time in the neonatal intensive care unit.

These worrying findings do not necessarily mean that women taking SSRIs should go cold turkey when they get pregnant. Untreated depression increases the risk of prematurity, low birth weight and neonatal complications, too. Sengwee Darren Toh, an epidemiologist at the Harvard School of Public Health, points out that these similar outcomes make it “quite difficult to tease out effects of the drugs from those of underlying depression.”

But for women who take SSRIs who have not been diagnosed with clinical depression—for instance, those who take the drugs for obsessive-compulsive disorder, pain management or even severe premenstrual symptoms—there may be safer options. A September 2009 report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists argued that psychotherapy is a suitable treatment for some pregnant women suffering from mild forms of depression or other mood disorders. Your best bet, of course, is to talk to a doctor—you may have more options than you realize.