NICE guidelines
- Discuss the benefits and harms of treatment
- For advice when dealing with antidpressants for pregnant women contact
- specialist perinatal mental health team
- secondary mental health service
- the UK Teratology Information Service (UKTIS) on 0344 892 0909
- https://www.medicinesinpregnancy.org/Templates/Pages/BumpsProductIndexSearchPage.aspx?id=97672&epslanguage=en&text=antidepressants for more detailed information regarding antidepressants
- 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
- NO ANTIDEPRESSANT HAS BEEN PROVEN SAFE IN PREGNANCY but the following are safer than others:
SSRIs
- Generally considered an option during pregnancy:
- Citalopram
- Sertraline
- Potential complications include maternal weight changes and premature birth
- Most studies show that SSRIs are not associated with birth defects.
- Avoid paroxetine due to increased risk of a fetal heart defect (safe in breastfeeding)
- January 2021 MHRA alert: the use of SSRI/SNRI antidepressants during the month before delivery may result in a small increased risk of postpartum haemorrhage. Prescribers should consider this risk in the context of an individual patient’s bleeding and thrombotic risk assessment during the peripartum period and the benefits of antidepressants for the patient’s mental health during this time.
SNRIs
- duloxetine
- venlafaxine
Tricyclic antidepressants.
- nortriptyline
- Not first or second line but might be an option for women who haven't responded to other medications
- clomipramine might be associated with fetal birth defects, including heart defects
Last trimester
- antidepressants during the last trimester may result in baby experiencing temporary discontinuation symptoms
- jitters, irritability, poor feeding and respiratory distress
- for up to a month after birth
- No evidence that discontinuing or tapering dosages near the end of pregnancy reduces the risk of these symptoms
- This might even increase your risk of a relapse postpartum
Other long term medications during pregnancy
- Inhaled drugs for asthma can be taken as normal during pregnancy
- Metformin - Can be used in pregnancy for both pre-existing and gestational diabetes. Women with gestational diabetes should discontinue treatment after giving birth
- Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension
- High doses teratogenic in animals but therapeutic doses unlikely to be harmful
Link to share with patients
References
