Antidepressant Medication during Pregnancy & Postpartum

Most commonly used Antidepressant Medication

  SSRI: Selective Serotonin Reuptake Inhibitors

         
  • Prozac  (also called Fluoxetine )      
  • Paxil  (also called Paroxetine)      
  • Zoloft  (also called Sertraline)

  TCA: Tricyclic Antidepressants

         
  • Anafranil (also called Clomipramine)      
  • Elavil (also called Amitriptyline)      
  • Aventyl (also called Nortriptyline)      
  • Norpramin (also called Desipramine)      
  • Tofranil (also called Imipramine)

How do Antidepressants work?

In individuals with Major Depression, the levels of the chemical messengers serotonin and norepinephrine in the brain are lower than in nondepressed individuals. The Selective Serotonin Reuptake Inhibitors act by increasing the levels of serotonin in the brain. The Tricyclic Antidepressants’ act by increasing the levels of both serotonin and norepinephrine in the brain. Both classes of antidepressants are highly effective but differ in their side effect profiles. Different women may have a better response to one antidepressant over another. Unfortunately, there is no way of knowing at the time of diagnosis which antidepressant will be most beneficial to a particular woman. It may take up to 3-4 weeks for the antidepressant to take effect. It is important to take the medication regularly and to take it for a period of not less than 6 months.

Use of Antidepressant Medication: During Pregnancy

For women suffering from severe Major Depression during pregnancy treatment with appropriate medication remains a viable, but challenging option. The risks of treatment must be weighed up against the consequences of no treatment. All antidepressants have side effects: the goal of treatment is to minimize these side effects. Women should be maintained on the lowest possible dose that will have an antidepressant effect. The risk of exposing your baby to the antidepressant medication (no matter how low the dose) has to be weighed against the risk of not getting treatment.

The goal of treatment is optimal health of the mother and her baby. To date, the bulk of the literature shows that the use of antidepressants during pregnancy is, for the most part, safe.

SSRI: Selective Serotonin Reuptake Inhibitors

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Prozac  (also called Fluoxetine )

Some studies find an increase in minor perinatal complications (such as jitteriness) associated with Fluoxetine  exposure late in gestation.

Studies find that there are no long-term effects on IQ, language and behavioural development in pre-school children.
* * *
Paxil  (also called Paroxetine) and Zoloft  (also called Sertraline)

Limited information: however recent studies find exposure to Paroxetine or Sertraline is not associated with increased risk of major fetal malformations or higher rates of miscarriage, stillbirth, or prematurity.

TCA: Tricyclic Antidepressants

Studies of the effects of tricyclic antidepressants in pregnancy have not found any connection between the use of these medications and physical malformation in the infant.

Past studies found minor evidence of withdrawal in the infant upon delivery (e.g., irritability, poor sucking reflex).

Newer studies show no evidence of increased rates of perinatal complications.

Children exposed during pregnancy have not been found to show delayed cognitive - intellectual, language or behavioral development.

Use of Antidepressant Medication in the Post Partum period.

Effects of Antidepressant Medication on Breastmilk.

Breastfeeding is promoted when women are experiencing a Major Depression. Breastfeeding is viewed as an important opportunity to enhance the quality of the mother-child interaction and is vigorously promoted because of the substantial body of evidence showing that breastfeeding has so many advantages.

Breastfeeding while taking an antidepressant:

Lactating mothers who are breast feeding should be treated with the lowest possible effective dose in order to minimize infant exposure to antidepressants.  Low levels of antidepressants are found in the breastmilk.  Analysis of the babies blood will usually show trace amounts of antidepressants only.

Maternal blood levels of Sertraline tend to peak about 5-7 hours after the mother has ingested the medication.  Some clinicians suggest avoiding breast feeding the baby for 5-7 hours after taking the medication.

Provided by ArmMed Media
Revision date: June 21, 2011
Last revised: by Janet A. Staessen, MD, PhD