Antidepressants can be used during pregnancy if the benefits outweigh the risks. To limit side effects, doctors always give preference to drugs that have little effect on the fetus and the health of the pregnant mother.
Should you take antidepressants during pregnancy?
Depression during pregnancy is a very common psychological disorder. The sensitivity inherent in pregnancy makes pregnant women prone to pessimism, sadness, distress and excessive anxiety. Without support from those around, pregnant women can face severe stress and depression.
The risk of depression during pregnancy is increased in people with a family history of emotional disorders, themselves facing psychological trauma related to childbirth, personality or anxiety, sensitivity, etc. To date, the exact cause of depression is unknown. However, experts found that a significant decrease in serotonin at the synaptic cleft is a direct factor in the disease.
Depression gets worse over time and can prompt suicidal thoughts and behaviors. During pregnancy, a woman’s hormones change suddenly, so she becomes more unstable and sensitive. If not detected and treated early, depression during pregnancy can progress to serious complications and effects.
Using antidepressants is an effective method in the treatment of depression in general and depression during pregnancy in particular. This group of drugs is divided into many types but all share the same mechanism of selectively inhibiting the reuptake of neurotransmitters, thereby increasing the concentration of serotonin, norepinephrine, … in the brain.
Antidepressants help balance neurotransmitters in the brain, thereby improving mood and reducing physical symptoms caused by depression. Although highly effective, some people worry that the drug may affect the health of pregnant women and fetuses.
In fact, there are no drugs that are absolutely safe for pregnant women. However, certain medications can be used during pregnancy after it has been determined that there is no increase in birth defects and pregnancy complications. Therefore, antidepressants can be used for pregnant women who are depressed or are facing other psychological and mental disorders.
Using antidepressants during pregnancy offers the following benefits:
- Elevate mood, reduce melancholy, sadness, suffering and pessimism
- Create appetite, help pregnant women eat in moderation to ensure the health of themselves and the fetus
- Improve sleep and reduce related physical symptoms
- Prevention of unfortunate consequences such as suicide, self-harm
In fact, doctors will evaluate the risk and risk before prescribing antidepressants for pregnant women. If you have only mild depression, the condition can be managed with psychotherapy and family support.
Antidepressants are usually prescribed for pregnant women in the following cases:
- Continuous insomnia, lasting 3 or more days
- Losing weight or not gaining weight for a long time
- Excessive anxiety, pessimism, depression, sadness and loss of interest and interest in things around
- Having suicidal thoughts
Antidepressants for pregnant women
Antidepressants are the main group of drugs used to treat depression. Currently, there are quite a number of drugs used in clinical practice. If used for pregnant women, the doctor will choose the drug based on the following principles:
- The drug is highly safe, has little effect on the fetus and pregnant woman
- Good, long-lasting anti-depressant effect
- The frequency of drug use is low (only 1-2 times/day)
Here are some types of antidepressants used by pregnant women:
1. Selective serotonin reuptake inhibitors (SSRIs)
Selective serotonin reuptake inhibitors are the most commonly used class of antidepressants today due to their high safety and few side effects. Currently, SSRIs are the first choice when treating depression in pregnant women.
These drugs act as selective serotonin reuptake inhibitors, thereby increasing serotonin levels in the brain. As mentioned, decreased serotonin at the synaptic cleft is a direct cause of emotional, thinking, and behavioral symptoms in depressed patients. By increasing serotonin levels in the brain, SSRIs can improve symptoms of the disease.
Selective serotonin reuptake inhibitors used during pregnancy:
SSRIs are the safest class of antidepressants during pregnancy. However, this group of drugs still has some potential risks when used. Specifically:
- Paroxetine may increase the risk of birth defects in the fetus, specifically heart defects, but the rate is not high. Other types of SSRIs such as Escitalopram, Citalopram, Sertraline, etc. have almost no increased risk of malformations, so they are often preferred for pregnant women with depression.
- Other studies have shown that taking SSRIs during pregnancy doubles the risk of congenital heart defects.
- Using Sertraline during pregnancy can increase the risk of anal atrophy in the fetus up to 4 times higher than normal.
- The use of SSRIs during pregnancy has also been associated with perinatal complications such as preterm labor, neonatal plasma overdosage, hanging belt syndrome, low birth weight, and low Apgar scores.
Through the studies that have been done, Psychiatrists generally avoid taking Paroxetin during pregnancy. Currently, Fluoxetin and Sertraline are the two most commonly used selective serotonin reuptake inhibitors.
2. Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Serotonin-norepinephrine reuptake inhibitors are not commonly used by SSRIs during pregnancy. Therefore, this class of drugs is also less studied than SSRIs. However, some medications have been studied for safety in pregnant and breastfeeding women. Therefore, SNRIs can also be used to treat depression during pregnancy if needed.
The drug has a serotonin-norepinephrine reuptake inhibitor mechanism, so it both increases serotonin levels and increases norepinephrine in the brain. However, the effectiveness of SNRIs and SSRIs is not too different.
Some of the possible risks of taking serotonin-norepinephrine reuptake inhibitors (SNRIs) during pregnancy include:
- Using Duloxetin can cause birth defects (1.8%) and increase the risk of spontaneous abortion 3 times higher than normal.
- Meanwhile, use of Venlafaxine during pregnancy found no association with birth defects.
Research data on the safety of serotonin-norepinephrine reuptake inhibitors (SNRIs) are limited. However, through the studies that have been done, it can be seen that Venlafaxine and Duloxetine are relatively safe to use for pregnant women.
3. Tricyclic antidepressants
Tricyclic antidepressants can be used to treat depression during pregnancy. This class of drugs is usually used only when the above classes of drugs do not respond. According to some studies that have been done, taking tricyclic antidepressants during pregnancy can cause some side effects such as increased heart rate, excessive sedation, low blood pressure, weight gain, and constipation.
In addition, use of Clomipramine has been associated with birth defects (most commonly cardiovascular defects). In addition, most tricyclic antidepressants carry a risk of postpartum hemorrhage if used during the second or third trimester.
Most tricyclic antidepressants are classified as Group C in the safety table when used in pregnant women. Therefore, your doctor will evaluate the risks and benefits before prescribing this class of drugs during pregnancy.
In addition to the above classes of drugs, bupropion may also be considered for the treatment of depression during pregnancy. This is an antidepressant with a different mechanism than the above drugs. Research has shown that bupropion use during the first trimester of pregnancy increases the risk of ventricular septal defects and cardiac malformations.
Note when taking antidepressants during pregnancy
Using antidepressants can improve symptoms of depression and prevent complications from suicide and self-harm. Besides, after taking the drug, pregnant women can eat and sleep in moderation, thereby ensuring their own health and the development of the fetus.
Along with the benefits, taking antidepressants during pregnancy is not without risks and risks. Therefore, before taking the drug, pregnant women should note some important information as follows:
- Only use the drug when prescribed by a doctor, and at the same time, you should inform your doctor about your pregnancy and special health problems (if any).
- Use drugs at the right dose, do not adjust the dose on your own and combine multiple drug groups without the doctor’s prescription.
- Pay attention to unusual symptoms while using the drug to promptly notify the doctor. For mild side effects, your doctor will recommend some non-drug improvement measures. Conversely, if serious side effects occur, the doctor will consider reducing the dose or replacing the safer drug.
- Antidepressants all have a central nervous system. Therefore, during the period of taking the drug, it is necessary to avoid the use of alcoholic beverages and narcotics.
- Antidepressants can make pregnant women gain weight quickly by increasing cravings – especially sweet and starchy foods. To avoid rapid weight gain and prevent related health problems, pregnant women should divide their meals and use foods high in fiber to create a feeling of fullness for a long time.
- During the time of taking the drug, it is advisable to have regular check-ups so that the doctor can monitor your health and handle any unusual problems.
- To increase the effectiveness of treatment, pregnant women with depression should combine with psychotherapy. This method is carried out in the form of a conversation, so it has absolutely no impact on the body and has no side effects.
- Depression during pregnancy can be severe and recur after delivery. Therefore, the family needs to support the pregnant mother during the treatment process, and at the same time should show care and love so that the pregnant woman can recover quickly.
Using antidepressants for pregnant women should be done with caution because of many potential risks. Therefore, pregnant mothers need to follow the doctor’s instructions, and at the same time should combine additional safety measures to control depression thoroughly.