Effects of Taking Psychiatric Medications During Pregnancy

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Are psychiatric medications safe during pregnancy and breastfeeding? Detailed information on taking antidepressants, antipsychotics, mood stabilizers, antianxiety medications during pregnancy and breastfeeding.

According to the Merck Manual, more than 90% of pregnant women take prescription or nonprescription (over-the-counter) drugs or use social drugs (such as tobacco and alcohol) or illicit drugs at some time during pregnancy. The Merck Manual says "in general, drugs, unless absolutely necessary, should not be used during pregnancy because many can harm the fetus. About 2 to 3% of all birth defects result from the use of drugs other than alcohol."

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Sometimes drugs are essential for the health of the pregnant woman and the fetus. For instance, a British Medical Journal article on antipsychotics during pregnancy reports "Withholding antipsychotic treatment may expose mother and fetus to more harm than benefit as, in addition to behavioural disturbance which may put both at risk, physiological changes associated with psychosis could affect fetoplacental integrity and development of the central nervous system."

In such cases, a woman should talk with her doctor or other health care practitioner about the risks and benefits of taking psychiatric medications. Before taking any drug (including over-the-counter drugs) or dietary supplement (including medicinal herbs), a pregnant woman should consult her health care practitioner. A health care practitioner may recommend that a woman take certain vitamins and minerals during pregnancy.

The Merck Manual states: "Most antidepressants appear to be relatively safe when used during pregnancy." If you take antidepressants throughout pregnancy or during the last trimester, The Mayo Clinic website states: "your baby may experience temporary withdrawal symptoms - such as jitters or irritability - at birth."

Psychiatric Medications That May Cause Problems During Pregnancy

Type Examples Problems
Antianxiety drug Diazepam (Valium) When the drug is taken late in pregnancy, depression, irritability, shaking, and exaggerated reflexes in the newborn. Benzodiazepines (Xanax) are also associated with prenatal syndrome, including feeding problems, hypothermia, and deficiency in baby's muscle tone.
Antidepressant drug
SSRI Antidepressants Citalopram (Celexa), Fluoxetine (Prozac, Sarafem), Sertraline (Zoloft) Associated with a rare but serious newborn lung problem (persistent pulmonary hypertension of the newborn, or PPHN) when taken during the last half of pregnancy. Considered an option during pregnancy. Paroxetine (Paxil) should be avoided during pregnancy as it's associated with with fetal heart defects when taken during the first three months of pregnancy.
Tricyclic Antidepressants Amitriptyline, Nortriptyline (Pamelor) Suggested risk of limb malformation in early studies, but not confirmed with newer studies. Considered an option during pregnancy.
MOAI Antidepressants Phenelzine (Nardil), Tranylcypromine (Parnate) May cause a severe increase in blood pressure that triggers a stroke and should be avoided during pregnancy.
Other Bupropion (Wellbutrin) No established risks during pregnancy. Considered an option during pregnancy.
Anticonvulsants Carbamazepine (Tegretol) Some risk of birth defects.
Bleeding problems in the newborn, which can be prevented if pregnant women take vitamin K by mouth every day for a month before delivery or if the newborn is given an injection of vitamin K soon after birth
Phenobarbital (Luminal) Same as those for carbamazepine.
Phenytoin (Dilantin) Same as those for carbamazepine.
Trimethadione (Tridione) Increased risk of miscarriage in the woman.
High (70%) risk of birth defects, including a cleft palate and defects of the heart, face, skull, hands, or abdominal organs
Valproate (Deparene) Some (1%) risk of birth defects, including a cleft palate and defects of the heart, face, skull, spine, or limbs
Mood-stabilizing drug Lithium (Lithane, Lithonate) Birth defects (mainly of the heart), lethargy, reduced muscle tone, poor feeding, underactivity of the thyroid gland, and nephrogenic diabetes insipidus in the newborn
Atypical Antipsychotic drug olanzapine (Zyprexa), quetiapine (Seroquel) Possibility of low birth weight; premature births. Concerns have been raised that olanzapine in particular tends to be associated with significant weight gain. Theoretically, during pregnancy this could be associated with an increased incidence of outcomes, including increased rates for birth defects such as neural tube defects and an increased risk of obstetric complications. (there's very little data on atypical antipsychotic medication use during pregnancy)

Again, a strong reminder, not to take anything on this page as medical advice. It is extremely important for you to discuss the issue of taking psychiatric medications during pregnancy with your doctor. The medical standard in deciding whether or not to administer psychiatric medication during pregnancy is the risks and benefits of taking the drugs during pregnancy must be weighed carefully on a case-by-case basis. Work with your doctor to make an informed choice that gives you and your baby the best chance for long-term health.

(more articles on taking various types of psychiatric medications while pregnant or nursing)

Sources:

  • Merck Manual (last reviewed May 2007)
  • BMJ 2004;329:933-934 (23 October), doi:10.1136/bmj.329.7472.933
  • McKenna K, Koren G, Tetelbaum M, et al. Pregnancy outcome of women using atypical antipsychotic drugs: A prospective comparative study. J Clin Psychiatry 2005;66:444-9.[Medline]
  • Mayo Clinic website, Antidepressants: Are they safe during pregnancy?, Dec. 2007

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