A: "Of the antidepressants that have been studied, we have the most safety data on the selective serotonin reuptake inhibitors (SSRIs)," says Healy Smith, M.D., a reproductive psychiatrist at the Women's Mental Health Clinic at New York-Presbyterian Hospital in New York City. Of the SSRIs, "Fluoxetine [Prozac], sertraline [Zoloft], and citalopram [Celexa] seem to be the most commonly prescribed for depression and sometimes anxiety during pregnancy." Tricyclic antidepressants (TCAs), which are an older type of medication, have not been associated with an increased risk of birth defects, according to the Massachusetts General Hospital, Center for Women's Mental Health. Less safety data exists with the newer antidepressants, including bupropion (Wellbutrin), venlafaxine (Effexor), and mirtazipine (remeron), but, so far, they have not been found to increase the risk of birth defects, she adds.
In 2005, the FDA issued a warning on the SSRI paroxetine (Paxil), saying that it may increase the risk for cardiovascular defects in a fetus. That decision "was based on three unpublished studies," says Stephanie Ho, M.D., a reproductive psychiatrist in private practice in New York City. The largest study explored paroxetine exposure in the first trimester, and, according to Dr. Ho, the results suggested that there was no increased risk of heart defects in children exposed to paroxetine in the first trimester compared with children whose mothers did not use paroxetine. If a woman does well on Paxil, and has failed trials with other antidepressants, Dr. Ho says that she will advise that Paxil can be used in pregnancy and the postpartum period safety.
A class of medications called benzodiazepines, used to treat anxiety during pregnancy, which include clonazepam (Klonopin), lorazepam (Ativan), alprazolam (Xanax), and diazepam (Valium), has been shown in some older studies to slightly increase the risk for cleft lip and palate, although subsequent studies have not confirmed that finding. "[If a woman is] under the care of a physician or reproductive psychiatrist, this class of medication can safely be used during pregnancy, if clinically warranted," Dr. Ho says.