Can a woman take antidepressants during pregnancy? Is it dangerous for the fetus? Can one do without medication? What antidepressant groups are allowed during pregnancy? Are Zoloft and pregnancy compatible? This and other issues are covered in this article.
Can A Woman Take Antidepressants during Pregnancy? Which Ones?
During pregnancy a woman may take antidepressants strictly under the supervision of a psychiatrist!
A complete rejection of antidepressants leads to the so-called “withdrawal syndrome” – increased depression, which negatively affects the development of the fetus, can cause miscarriage, the birth of a dead child and postpartum depression.
There are antidepressants of different generations that have a particular effect on the fetus. Moreover, the degree of exposure depends on the trimester of pregnancy, the type and generation to which this or that antidepressant belongs. Consider some types of antidepressants and their effects on the fetus.
Selective Serotonin Reuptake Inhibitors (SSRIs)
This group includes:
Paroxetine (Paxil, Rexetin, Risset) is contraindicated during pregnancy, because in the first trimester of pregnancy it can provoke:
- congenital heart disease, craniostenosis (premature closure of cranial sutures due to abnormal development of the skull),
- anencephaly (complete absence of cerebral hemispheres in combination with a defect in the bones of the skull)
- fetal hernia (part of the abdominal cavity is in the membranes of the umbilical cord).
Fluoxetine (Prodep, Prozac, Profluzak) is allowed, but in some cases in the second half of pregnancy can cause persistent pulmonary hypertension in newborns (persistent violation of pulmonary circulation).
Citalopram (Opra, Sedopram, Cipramil) is allowed, but sometimes in the first trimester it can provoke the occurrence of anencephaly, craniostenosis, and in the third – persistent pulmonary hypertension of the newborn.
Sertralin (Zoloft, Stimuloton, Asentra) is allowed in some cases. When taken in the second half of pregnancy, it can lead to persistent pulmonary hypertension in newborns. There is also a risk of septal congenital heart disease and fetal hernia.
It should be noted that all of the above fetal malformations are extremely rare, even with prolonged use of SSRIs. Therefore, antidepressants of this group are more often prescribed during pregnancy than antidepressants of other groups.
Zoloft Instructions and Indications for Use
Zoloft is prescribed:
- To treat or prevent a depressive condition of various origins.
- If a patient has OCD (obsessive-compulsive disorder).
- When symptoms of social phobia are observed.
- If the patient suffers from PTSD (post-traumatic stress disorder).
The drug is not recommended:
- If the patient is taking Pimozidum and MAO inhibitors at the same time.
- When breastfeeding.
- If the patient is individually susceptible to sertraline.
- Expectant mothers.
- Children under 6 years old.
In addition, the drug is prescribed with extreme caution if the patient has any organic brain abnormalities, including mental retardation, as well as epilepsy, renal / hepatic failure, significant weight loss, etc.
Symptoms: anxiety, drowsiness, ECG changes, mydriasis, nausea, vomiting, tachycardia.
Treatment: ensuring normal airway (oxygenation and ventilation of the lungs), gastric lavage, the appointment of emetic drugs, activated carbon with sorbitol. Control of the function of the heart and liver is necessary. Forced diuresis, dialysis, hemoperfusion, and exchange transfusion are not effective (considering the large volume of distribution).
Zoloft overdose may lead to emotional and behavioral changes, including an increasing risk of suicide.
Zoloft and Pregnancy
Well-controlled clinical studies of the use of sertraline in pregnant women have not been conducted. However, the analysis of a large amount of available information does not indicate that taking sertraline can cause congenital malformations. Animal studies have shown the possibility of the effect of the drug on reproductive function as a result of its toxic effects from the mother and / or pharmacodynamic effects of sertraline directly on the fetus.
While combining Zoloft and pregnancy one should take into account the results of postmarketing studies, during which some babies whose mothers took antidepressants from the group of serotonin reuptake inhibitors, including Zoloft, had symptoms associated with withdrawal effect. Treatment with sertraline is not recommended during pregnancy and should be taken only if the expected benefit of treatment outweighs its possible risk.
Taking Zoloft while Pregnant
If a pregnant woman was taking sertraline in the late stages of pregnancy, especially in the third trimester, it is recommended to monitor the condition of the newborn. Such infants may experience the following symptoms: respiratory failure, cyanosis, apnea, convulsions, unstable temperature, feeding difficulties, vomiting, hypoglycemia, hypertension, hypotension, hyperreflexia, tremor, irritability, lethargy, constant crying, drowsiness and difficulty falling asleep.
Such symptoms may be due to serotonergic effects, or may be signs of withdrawal effect. In most cases, complications appear immediately or very soon (<24 hours,) after delivery. Epidemiological data confirm that the use of a serotonin reuptake inhibitors during pregnancy, especially in the later periods, may cause an increased risk of developing chronic pulmonary hypertension in the newborn. The risk level is about 5 cases per 1000 pregnancies (in the general population there are 1-2 cases per 1000 pregnancies).
Women of childbearing age should use adequate methods of contraception during treatment with Zoloft.
Studies comparing the levels of sertraline and its main metabolite, dezmetilsertralin, in the mother’s blood and their concentration in umbilical cord blood during feeding showed that the effect of sertraline and its metabolites on the fetus is approximately one third of its effect on the mother. The use of Zoloft (sertraline) during the first trimester of pregnancy is associated with an increased likelihood of the following defects at birth: umbilical hernia (the risk is 6times higher), anal atresia and defects in limb reduction (four times), and septal defects (twice), but these specific themselves are rare and, therefore, the absolute risk is quite small.
Animal studies have shown that sertraline reduces sperm quality. In theory, this can have an impact on fertility. But to date, the effect on fertility in humans has not been observed.
Zoloft and Breastfeeding
Sertraline is able to penetrate into breast milk, so the drug is contraindicated during breastfeeding. Still, there is no accurate information about its safety during lactation, so it is advisable to stop breastfeeding while the drug is being used.
To date, the occurrence of adverse reactions in infants whose mothers took Zoloft during breastfeeding has not been reported, but the risk of their manifestation cannot be excluded.
The concentration of sertraline and desmethylsertraline in breast milk varies greatly. On average it is equal to the concentration in the blood plasma of the mother. As a result, more than half of breastfed babies receive less than 2 mg / day of sertraline and desmetilsertraline combined, and in most cases these substances are not detected in their blood.
In general, the combination of Zoloft and pregnancy/breastfeeding is not recommended except in cases where, according to the doctor, the benefits outweigh the possible risk.