Are SSRIs safe in pregnancy for my 29-year-old friend?

Question

Hello doctor,

My best friend has been struggling with depression for the past few years. Although she has been on Selective Serotonin Reuptake Inhibitors (SSRIs), her symptoms continue to fluctuate. She is now 29 years old and married. Recently, she and her partner started considering the idea of trying for a baby, but she is terrified of what pregnancy and the postpartum period might do to her mental health.

She is also very concerned about postpartum depression and wonders if there are any preventive steps she can take if she does become pregnant. Please tell me.

Is it safe to continue taking antidepressants while trying to conceive? Will discontinuing the medication worsen her condition during pregnancy?
She also mentioned that her menstrual periods are irregular and extremely painful. Could depression or the medications be contributing to a hormonal imbalance like this?

Would it be safer to wait until her mental health is more stable before starting a family?
Additionally, she is curious about how hormonal contraception may affect mood swings in someone with clinical depression. Could an intrauterine device (IUD) be a better option than oral contraceptive pills for her?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

Continuing Selective Serotonin Reuptake Inhibitors (SSRIs) during conception and pregnancy is considered safe in many cases. For women with moderate to severe depression, staying on medication often outweighs the risks of discontinuing treatment. Abruptly stopping antidepressants or discontinuing them without close medical supervision can increase the risk of relapse, especially during pregnancy, when hormonal fluctuations can significantly affect mood. Some SSRIs, such as Sertraline (SSRI) and Citalopram (SSRI), are generally preferred during pregnancy due to their more favorable safety profiles.

Her irregular and painful menstrual periods may or may not be directly related to her depression. Chronic stress, mood disorders, and certain medications can disrupt hormonal regulation and affect the menstrual cycle. However, it is also possible that she may have an underlying condition, such as endometriosis or polycystic ovary syndrome (PCOS), which should be properly evaluated before drawing any conclusions.

Her fear of postpartum depression (PPD) is entirely valid. Women with a history of depression are at a higher risk of developing PPD. Fortunately, there are effective preventive strategies, including closely monitoring her mood throughout pregnancy and the postpartum period, establishing a strong emotional support system, adjusting medications during the third trimester, and creating a care plan well before delivery.

In terms of contraception, hormonal birth control pills can sometimes worsen mood symptoms in women with depression, although individual responses vary. In such cases, non-hormonal intrauterine devices (IUDs), such as copper IUDs, or low-hormone options, such as the

Levonorgestrel (progestin hormone) IUDs are often better tolerated.

Overall, while it is ideal to conceive when her mental health is relatively stable, pregnancy does not have to be postponed indefinitely. With proper planning, supportive care, and collaboration with her healthcare providers and partner, she can move forward safely with family planning while continuing to prioritize her mental health.

I hope this helps.

Thank you.