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Discussing Antidepressant Use with Perinatal Patients

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(Discussion should include yet not be limited to the below)

Overview

  • Both medication and non-medication options should be considered
  • Encourage non-medication treatments (e.g., psychotherapy) in addition to medication treatment or as an alternative when clinically appropriate 
  • No decision regarding whether to use antidepressants during pregnancy is perfect or risk-free, and there are also risks to having untreated mental health symptoms in the perinatal period
  • SSRIs are among the best studied class of medications during pregnancy
  • Also, taking antidepressants is compatible with breastfeeding

Risks of antidepressant use during pregnancy

  • No increase in birth defects compared to untreated mental health symptoms in pregnancy
  • The preponderance of evidence does not suggest birth complications (preterm birth, babies that are born a little smaller, etc) when compared to untreated depression/anxiety 
  • Studies do not suggest long-term effects on children
  • Possible PNAS (poor neonatal adaptation syndrome)—not particularly common but when it does occur, baby can be a bit jittery or fussy for a few hours to days. Generally, no medical intervention is required and there are no long term negative effects.

Risks of under treatment or no treatment of depression during pregnancy

  • Increases the risk of pregnancy complications 
  • Increases the risk of postpartum depression 
  • Can make it harder for moms to take care of themselves and their babies
  • Can make it harder for moms to bond with their babies

If lactating: SSRIs and some other antidepressants are considered a reasonable treatment option during breastfeeding. The benefits of breastfeeding while taking antidepressants generally outweigh the risks. The amount of medication that goes into the breast milk is relatively small and there is no evidence of significant short or long term consequences to babies who are exposed to SSRIs through breast milk.

See Antidepressant Treatment Algorithm for guidelines on prescribing medications.

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Recommended toolkit resources

Return to Perinatal Provider Toolkit