Q: Are antidepressants safe to take during pregnancy?

A: The drugs most commonly prescribed for depression — selective serotonin reuptake inhibitors (SSRIs) include fluoxetine (Prozac), paroxetine (Paxil), citalopram (Celexa), and sertraline (Zoloft), among others. Three closely related drugs are duloxetine (Cymbalta), nefazodone (Serzone), and venlafaxine (Effexor).

Past studies found no significant difference in the rates of miscarriages and stillbirth between women who took SSRIs and women who didn't. An older class of drugs known as tricyclics, which includes amitriptyline (Elavil) and imipramine (Tofranil), has also been considered safe, as have newer drugs such as bupropion (Wellbutrin).

More recent studies however show slightly different results that SSRIs are associated with a small increase in complications such as:

• Miscarriage
• Prematurity
• Low birth weight
• More time in the neonatal intensive care unit (NICU)
• Withdrawal symptoms
• Breathing problems (persistent pulmonary hypertension)
• Have trouble adapting to life outside the womb. This was particularly the case for babies of women who were also taking other drugs for mental conditions or who smoked or drank alcohol.

The American College of Obstetricians and Gynecologists (ACOG) recommends that the decision to use SSRIs and related drugs in pregnancy should be made on an individual basis. In addition, ACOG recommends that women who are pregnant or planning to become pregnant should specifically avoid taking Paxil.

That means you should avoid taking SSRIs during pregnancy unless you absolutely need to. If you're taking Paxil, you'll need to stop or switch to another medication before you conceive.

Never stop an antidepressant medication without first consulting your doctor.

Some doctors recommend that their pregnant patients taper off to a lower dosage or stop taking antidepressants ten to 14 days before their due date to prevent withdrawal symptoms in their newborn.

NOTE: Antidepressants known as monoamine oxidase inhibitors (MAOIs), such as phenelzine (Nardil) and tranylcypromine (Parnate), may cause birth defects and are not considered safe to use during pregnancy.

If you're clinically depressed before, during or after pregnancy, it's important to get the treatment you need, whether it's psychotherapy or medication or both.