Can I take antidepressants while trying to conceive again?

Question

Hi doctor,

I recently had a missed miscarriage at eight weeks. I was informed that the heartbeat stopped at approximately six weeks. I stopped all medication whilst trying to conceive and during the pregnancy (migraine medication and psychiatric medications; Rizatriptan, Fluoxetine, Quetiapine and Oxazepam).

I have two questions:

Is it safe to restart on antidepressants if I try again?
Should I lose weight before trying again, as my BMI is 26.1, which indicates I am overweight?

Please advise.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com

Sorry you had to go through that. A missed miscarriage is tough. Let me break it down simply. About restarting antidepressants – many women do continue pregnancy safely on certain antidepressants, but not all are equally safe.

Fluoxetine is one of the selective serotonin reuptake inhibitors (SSRIs) that is often used in pregnancy if needed.
Quetiapine can also be used sometimes.
Benzodiazepines (Oxazepam), we try to avoid them unless absolutely necessary.
Rizatriptan for migraines is usually avoided in pregnancy.

So the decision depends on your current mental health needs – untreated depression or anxiety also carries risks for pregnancy. You should sit down with your psychiatrist and obstetrician together before trying again.

About weight, a body mass index (BMI) of 26.1 is just into the overweight range, not obese. That alone does not explain the miscarriage. But, yes, optimizing weight, diet, and lifestyle improves fertility and pregnancy outcomes, so if you can lose four to six pounds before conceiving again, it helps, but it is not a strict requirement.

The miscarriage is most likely due to chromosomal abnormalities in the embryo, not because you stopped or took medications, and not because of your BMI alone.

If this were your first miscarriage, usually no extensive workup is needed. If recurrent, we check thyroid, blood sugar, antiphospholipid antibodies, and karyotyping.

In your case, the differential diagnosis can be

Hormonal imbalance.
Uterine factors (fibroids, septum).
Infections.
Uncontrolled medical illness.

We can say your diagnosis is a missed miscarriage, likely a sporadic chromosomal cause.

I would recommend the following:

Meet with a psychiatrist before trying again to plan the safest medication regimen (Fluoxetine is generally acceptable, but confirm).
Preconception check: thyroid, vitamin D, and folic acid supplementation.
Weight management with a balanced diet and exercise, if possible.
Wait for at least one natural cycle before conceiving again, mostly to allow the uterine lining to normalize.
Start taking Folic acid daily (start now).
Optimize mental health – untreated stress or depression itself increases risk.
Limit caffeine, avoid alcohol or smoking if any.
Lightweight loss (even five percent) helps metabolic balance.

Please update with your recent blood reports (thyroid, sugars, vitamin D) if you have them. And let me know if you are planning a pregnancy immediately or after some months, so I can guide you on timing and preconception supplements.

Also, have a joint consult with your psychiatrist and gynecologist to finalize a safe medication plan before trying again.

I hope this helps answer your query.

Thank you.