To use or not to use : Antidepressants during pregnancy and motherhood

To use or not to use : Antidepressants during pregnancy and motherhood

Here are some common queries on using antidepressants during pregnancy, answered by our experts

White Swan Foundation

There are several misconceptions about using antidepressants while trying to get pregnant or during pregnancy and after childbirth. Here are some frequently asked questions on the effect of antidepressants on pregnancy and motherhood

Note: It is always advised to consult your gynaecologist along with a psychiatrist before taking any decision on your medication before, during and after pregnancy. 

Will antidepressants affect my reproductive system? Can I use them while I am trying to have a baby?

If a woman is trying to get pregnant while she is being treated for a mental illness, it is advised that she take the decision in consultation with her gynaecologist and psychiatrist. Some antidepressants can supress a woman's sexual drive or delay ovulation. At the same time, medication alone cannot cause fertility issues. There are a host of other stressors (such as the illness itself) that impact the woman's chances of getting pregnant: the woman's physical health, external stressors and any anxiety she may have about the illness. So medication is not the only factor that determine a woman's chances of getting pregnant.

Will antidepressants affect my baby’s physical and mental health?

Antidepressants can affect the physical health of a person, but the effects can vary from one person to another. Therefore, if a woman is planning a pregnancy, it is recommended that she go through pre-pregnancy counselling, where the degree of severity of the illness can be assessed. Based on the assessment, her prescription is altered to her specific needs.

For mothers without an illness, the chances of giving birth to a baby with congenital deformities is about five births in every thousand. Among women who are taking antidepressants, the risk increases marginally - to seven births per thousand. 

Some women stop taking medication when planning a pregnancy  because they are concerned about the medication affecting the unborn child. Others go off medication before getting married, due to a fear of social stigma. Both of these are not advisable, as they can cause a relapse.

Can I breastfeed while I’m on antidepressants?

Breastfeeding is certainly advisable for a woman who is under medication for her mental health issues. Breastfeeding can contribute to the mental wellbeing of the mother and promote mother-infant bonding. She should consult her doctor to modify her doses and the frequency of taking them.

Can I exercise instead of taking antidepressants?

It is not recommended to go off medication and depend only on a physical activity for treatment. Exercise can only complement the existing treatment system. You can, however, discuss about it with your gynaecologist and psychiatrist before taking any decision. 

I'm on antidepressants and also have mood swings. How do I know if the changes in my mood are due to the illness or hormonal changes associated with pregnancy?

Mood swings that occur due to hormonal changes are very sporadic and less intense than that of an illness. If the woman is experiencing recurrent lows, or if she is having thoughts of suicide or self-harm, she should immediately seek professional help. The family plays an important role in making sure the woman doesn't face stress. The spouse and family can keep a check on how she is feeling on a daily basis, find out if there is anything bothering her, and if she needs any help.

What are the questions I should ask my doctor about antidepressants?

(a) Can my illness affect my unborn child?

(b) What will be the effect of medication on my pregnancy and my ability to breastfeed?

(c) Are there any additional precautions I need to take for pregnancy?

Ideally, the pregnant woman should undergo a combined assessment of a gynaecologist and psychiatrist. The treating doctor needs to be informed about her medication so that the dosage may be adjusted taking into account her current health condition. Medication such as SSRIs in the later stages of pregnancy can cause health issues such as pulmonary hypertension in the baby. Therefore, the family also needs to be fully aware of her physical and mental health condition.

How do I handle people who say “If I were you, I would not take the medication”?

Motherhood is a journey where several family members tend to give advice to the woman. The idea that any antidepressant is going to harm the baby is a wrong notion. There is scarce evidence that antidepressants (SSRIs) have a direct effect on the baby's health, but children of mothers with untreated depression are prone to conduct disorders, ADHD, and developmental disorders. It is ultimately the choice of the woman to use antidepressants; her doctor can only suggest her about the appropriate medication and explain the pros and cons, it is only the mother who can take a decision on using them.  

This content has been created with inputs from Dr Latha Venkatram, obstretrician – gynaecologist at Rangadore Memorial Hospital, Bangalore, and Dr Ashlesha Bagadia, psychiatrist at Fortis La Femme, Bangalore.

Do you have any queries on antidepressants and pregnancy? Send in your questions to mentioning 'antidepressants and pregnancy' in the subject line.

White Swan Foundation