Antidepressants in pregnancy: a review of commonly prescribed medications

Obstet Gynecol Surv. 2011 Dec;66(12):777-87. doi: 10.1097/OGX.0b013e31823e0cbf.

Abstract

Perinatal depression is an increasingly common comorbidity of pregnancy and is associated with adverse birth outcomes. Newer classes of antidepressants have been developed with a variety of mechanisms and improved side effect profiles. There is increasing use of these medications in reproductive-aged women. Medical providers have to balance the need to prevent relapse of maternal depressive symptoms with the need to minimize fetal exposure to medications. We review the literature on 10 of the most commonly used antidepressant medications: citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, venlafaxine, duloxetine, bupropion, and mirtazapine. The pharmacokinetic properties of the medications are detailed, as well as practical considerations for their use in pregnant and lactating women. Guidance on counseling and management of pregnancies complicated by perinatal depression is discussed.

Target audience: Obstetricians & Gynecologists and Family Physicians.

Learning objectives: After completing this CME activity, physicians should be better able to differentiate the current classes of medications utilized commonly for perinatal depression, evaluate the reported adverse effects of antidepressant medications on the patient and developing fetus and choose the appropriate antidepressant medications for a depressed patient who is breast-feeding.

Publication types

  • Review

MeSH terms

  • Abnormalities, Drug-Induced / prevention & control
  • Antidepressive Agents, Second-Generation / adverse effects
  • Antidepressive Agents, Second-Generation / pharmacokinetics
  • Antidepressive Agents, Second-Generation / therapeutic use*
  • Breast Feeding
  • Depression / drug therapy*
  • Drug Labeling
  • Female
  • Humans
  • Pregnancy
  • Pregnancy Complications / drug therapy*
  • Prenatal Care
  • Serotonin Uptake Inhibitors / adverse effects
  • Serotonin Uptake Inhibitors / pharmacokinetics
  • Serotonin Uptake Inhibitors / therapeutic use*
  • United States
  • United States Food and Drug Administration

Substances

  • Antidepressive Agents, Second-Generation
  • Serotonin Uptake Inhibitors