Community Psychiatry’s Julian Lagoy, M.D. was featured in SingleCare discussing the health effects of antidepressants while pregnant. 

By: Sara Lindberg | January 12, 2021

An important part of being an expectant parent is keeping your child healthy. That includes learning which prescriptions are safe to take during pregnancy—such as antidepressant medications. And while taking an antidepressant such as Sertraline (Zoloft) during pregnancy is not 100% risk-free, going through pregnancy with untreated depression may come with more risks.

In fact, the American College of Obstetricians and Gynecologists (ACOG) says that depression during pregnancy can have adverse health effects for both the mom-to-be and baby. This includes problems with the growth of the fetus, premature birth, low birth weight, and complications after birth.

Deciding whether to continue taking an antidepressant during pregnancy is something you need to discuss with your healthcare provider. Here are the basics you need to know.

Is it safe to take Zoloft during pregnancy?

Zoloft is a brand name for the drug sertraline, which belongs to a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). These drugs work by increasing the amount of serotonin, a natural neurotransmitter, in the brain. SSRIs are used to treat depression, panic disorder, obsessive-compulsive disorder, social anxiety disorder, and post-traumatic stress disorder.

“The family of SSRIs, especially Zoloft, is considered one of the safest choices of antidepressants during pregnancy,” says Sherry Ross, MD, OB-GYN, and women’s health expert at Providence Saint John’s Health Center in Santa Monica, California.

However, for some moms-to-be, Dr. Ross says the decision to continue an SSRI during pregnancy ultimately comes down to weighing the risks versus the benefits.

Although the side effects of taking an SSRI while pregnant are generally minimal, Dr. Ross says there may be some potential side effects for the baby if taking the drug in the last trimester. These include jitters, irritability, poor feeding, hyperactive reflexes, low blood sugar, abnormal muscle tone, vomiting, seizures, and respiratory distress during the first month of life.

A U.S. Centers for Disease Control and Prevention (CDC) study found that despite a slightly increased risk of certain birth defects from some SSRIs (paroxetine or fluoxetine), the actual risk among babies born to women taking one of these antidepressants is still very low. This is good news for moms-to-be who take sertraline since the study did not observe any link between birth defects and this drug.

Some women wonder if SSRI use, like Zoloft, can make it harder to get pregnant or increase their risk of miscarriage once they are pregnant. Although any prescription medicine comes with risks, there are currently no studies that address the issue of infertility.

There is also minimal information about the risk of miscarriage. One study found that the risk of miscarriage was similar between women exposed to SSRIs during early pregnancy and women who discontinued SSRI treatment before pregnancy.

Should you stop taking Zoloft when you find out you’re pregnant?

If you’re considering coming off of Zoloft during pregnancy, it’s critical that you do not stop taking it suddenly. “If you’re on a high dose of Zoloft and you stop it completely, you may experience adverse side effects and withdrawal,” says Julian Lagoy, MD, a psychiatrist at Community Psychiatry, in San Jose, California. That’s why he does not recommend stopping suddenly without talking to your provider.

Although it is safest not to take any antidepressant medication while pregnant, Dr. Lagoy says it may be worse for both mother and baby to discontinue medications like Zoloft during pregnancy since this could potentially lead to worsening mood and anxiety symptoms. With that in mind, it’s important to discuss this issue with your healthcare team before making any decision regarding medications. They will be able to advise you on the safest options for your pregnancy.

How much Zoloft is safe to take during pregnancy?

According to Dr. Ross, a safe and recommended dose of Zoloft begins at 25 mg to 50 mg per day. For moderate to severe depression, Dr. Ross says doses up to 200 mg are deemed safe to use during pregnancy.

When managing antidepressants during pregnancy, Dr. Lagoy says he strives to give the minimum dose possible. “Since hormones and mood can change throughout pregnancy and in different trimesters, it can be common to change the dosing throughout the pregnancy (although not always necessary to change doses in each trimester),” Dr. Lagoy explains. “The safest doses can be considered the lowest dose possible that is also an effective treatment.”

Is Zoloft safe to take while breastfeeding?

It’s not uncommon to have questions and concerns about your health and how it impacts your baby during the postpartum period. That’s why many new moms wonder if taking Zoloft and breastfeeding is considered safe.

The good news is it is generally considered safe to take Zoloft while breastfeeding. Only a very small amount of the drug may pass into breast milk, so the risk to your infant is minimal. Due to documented low levels of exposure during breastfeeding, findings from a meta-analysis concluded that sertraline is a first-line drug for breastfeeding women.

What other antidepressants are safe to take during pregnancy and while breastfeeding?

There are several antidepressants that are safe to use during pregnancy, but Dr. Lagoy says sertraline has the best research data regarding safety in pregnancy.

In addition to Zoloft, other antidepressants prescribed during pregnancy and the postpartum period include the SSRIs  Celexa (citalopram), Lexapro (escitalopram), Paxil (paroxetine) and Prozac (fluoxetine). Your doctor may also talk to you about serotonin-norepinephrine reuptake inhibitors (SNRIs) like Cymbalta (duloxetine) and Effexor (venlafaxine).

You should always discuss the risks and benefits with your provider regarding any of these medications while pregnant or during the postpartum period.

Click here to read the entire article on SingleCare.

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