Antidepressants are a primary treatment option for most types of depression. But there are benefits and risks to consider when taking antidepressants during pregnancy. Here's what you need to know.

Why is treatment for depression during pregnancy important?

If you have untreated depression, you might not seek optimal prenatal care or eat the healthy foods you and your baby need. Experiencing major depression during pregnancy is associated with an increased risk of premature birth, low birth weight, decreased fetal growth or other problems for the baby. Unstable depression during pregnancy also increases the risk of postpartum depression, early termination of breast-feeding and difficulty bonding with your baby.

Are antidepressants an option during pregnancy?

A decision to use antidepressants during pregnancy is based on the balance between risks and benefits. Overall, the risk of birth defects and other problems for babies of mothers who take antidepressants during pregnancy is very low. Still, few medications have been proved safe during pregnancy and certain types of antidepressants have been associated with a higher risk of complications for babies.

If you use antidepressants during pregnancy, your health care provider will try to minimize your baby's exposure to the medication. This can be done by prescribing a single medication (monotherapy) at the lowest effective dose, particularly during the first trimester.

Which antidepressants are considered OK during pregnancy?

Generally, these antidepressants are an option during pregnancy:

• Certain selective serotonin reuptake inhibitors (SSRIs). SSRIs are generally considered an option during pregnancy, including citalopram (Celexa), fluoxetine (Prozac) and sertraline (Zoloft). Potential complications include an increased risk of heavy bleeding after giving birth (postpartum hemorrhage), premature birth and low birth weight. Most studies show that SSRIs aren't associated with birth defects. However, paroxetine (Paxil) appears to be associated with a small increased risk of a fetal heart defect.
• Serotonin and norepinephrine reuptake inhibitors (SNRIs). SNRIs also are considered an option during pregnancy, including duloxetine (Cymbalta) and venlafaxine (Effexor XR). However, research suggests that taking SNRIs at the end of pregnancy is associated with postpartum hemorrhage.
• Bupropion (Wellbutrin). This medication is used for both depression and smoking cessation. Although bupropion isn't generally considered a first line treatment for depression during pregnancy, it might be an option for women who haven't responded to other medications. Research suggests taking bupropion during pregnancy might be associated with heart defects.
• Tricyclic antidepressants. This class of medications includes nortriptyline (Pamelor). Although tricyclic antidepressants aren't generally considered a first line or second line treatment, they might be an option for women who haven't responded to other medications. The tricyclic antidepressant clomipramine might be associated with fetal birth defects, including heart defects. Use of these medications during the second or third trimester might also be linked with postpartum hemorrhage.

Which antidepressants should be avoided during pregnancy?

The SSRI paroxetine (Paxil) is generally discouraged during pregnancy. Some research suggests that paroxetine might be associated with a small increase in fetal heart defects.

In addition, monoamine oxidase inhibitors (MAOIs) - including phenelzine (Nardil) and tranylcypromine (Parnate) - are generally discouraged during pregnancy. MAOIs might limit fetal growth.

Are there any other risks for the baby?

If you take antidepressants during the last trimester of pregnancy, your baby might experience temporary discontinuation symptoms — such as jitters, irritability, poor feeding and respiratory distress — for up to a month after birth. However, there's no evidence that discontinuing or tapering dosages near the end of pregnancy reduces the risk of these symptoms for your newborn. In addition, it might increase your risk of a relapse postpartum.

The connection between antidepressant use during pregnancy and the risk of autism in offspring remains inconclusive, but most studies have shown that the risk is very small and other studies have shown no risk at all. Further research is needed.

Should I switch medications?

The decision to continue or change your antidepressant medication will be based on the stability of your mood disorder. Talk to your health care provider. Concerns about potential risks must be weighed against the possibility that a drug substitution could fail and cause a depression relapse.

What happens if I stop taking antidepressants during pregnancy?

If you stop taking antidepressants during pregnancy, you risk a depression relapse with associated complications including worsening mood, the inability to take care of yourself or your pregnancy, and postpartum depression or postpartum psychosis.

What's the bottom line?

If you have depression and are pregnant or thinking about getting pregnant, consult your health care provider. Deciding how to treat depression during pregnancy isn't easy. The risks and benefits of taking medication during pregnancy must be weighed carefully. Work with your health care provider to make an informed choice that gives you, and your baby the best chance for long-term health.