Permitted medication for pregnancy depression
There are a number of very well studied drugs that can be used in pregnancy depression and which do not harm the child. Due to the many experiences, the antidepressants of choice in pregnancy depression are amitriptyline, imipramine and nortriptyline from the group of tricyclic antidepressants; and sertraline and citalopram from the group of selective serotonin reuptake inhibitors (SSRI). None of the classic antidepressants (SSRI, tricyclic antidepressants) have shown any teratogenic effects, so that drug therapy can be carried out without problems in most cases.
However, other antidepressants such as Opipramol can also be used, especially if they have proven to be particularly beneficial in patients with difficult-to-control depression. However, there are only a few studies on their effects on the newborn, so their use must be viewed with caution. In general, however, women who are already on an antidepressant should continue to take it until birth.
The discontinuation or modification of medication should be avoided if possible, as this could have devastating effects for mother and child. Only fluoxetine should be avoided because of its very long half-life and thus poor control. Amitriptyline belongs to the class of tricyclic antidepressants and is therefore one of the oldest and most effective psychotropic drugs available.
In pregnant and nursing women it is one of the first choice drugs. Although studies in the 1970s and 1980s showed an increased rate of heart and extremity (arm and leg) malformations, current studies have not been able to prove these side effects.If amitriptyline is taken until the birth of the child, this can lead to temporary withdrawal symptoms in the newborn with shortness of breath and increased tremor. To avoid complications, the newborn should be admitted to a neonatal clinic for observation for a few weeks.
Due to its lack of effects on the child, amitriptyline is the best antidepressant for lactation. Citalopram and sertraline belong to the class of selective serotonin reuptake inhibitors and are two of the best studied drugs in relation to pregnancy. Along with amitriptyline, they are the best alternative in a drug therapy of pregnancy depression.
There are over 100,000 studies on the effects of citalopram and sertraline during and after pregnancy. None of them showed teratogenic side effects. If citalopram and sertraline are given until the end of pregnancy, temporary withdrawal symptoms (shortness of breath, increased tremor and hypoglycemia) may occur in newborns.
Again, the newborn should be observed in a neonatal clinic for a few weeks to prevent possible complications. During breastfeeding, therapy with sertraline is preferable to therapy with citalopram, as sertraline has no known side effects on the child. Citalopram may cause weakness in drinking, restlessness and mental clouding of the newborn. In such cases, a pediatrician should always be consulted.
