Abstract Title: Exploring the Efficacy and Safety of Antidepressant Usage in Pregnancy

Background: Perinatal depression is common in approximately 20% of pregnant patients in the United States. Various health and safety challenges make it difficult to treat depression in pregnancy because of the likely toxicity and the side effects of the drugs on the fetus. This chapter provides a detailed review of antidepressants prescribed during pregnancy and assesses their efficacy and safety for both the pregnant patient and fetus. The literature emphasized on the case studies published during June 2021 through March 2024. The medications discussed are: Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs), and mood stabilizers.

Methods: The methodology of this body of work involved conducting a systematic literature review of research articles accessible from Google Scholar and PubMed. Selected research articles for this study were required to meet the following criteria: 1) article discusses the use of antidepressants in pregnancy 2) article possesses a publication date from June 2021 to March 2024 and 3) article assesses antidepressant use during pregnancy in the United States. Out of 146,000 total search results from Google Scholar and 4,910 total search results from PubMed, 16 studies met the final inclusion criteria for this study.

Results: SSRIs such as sertraline, fluoxetine, and citalopram, exhibit side effects such as respiratory distress, jitteriness, irritability, vomiting, and persistent pulmonary hypotension. However, there are no congenital side effects and the medication is deemed safe to use in pregnancy.

SNRIs are antidepressants and include drugs such as venlafaxine, duloxetine, and desvenlafaxine. The side effects of this drug class include gestational hypertension which is dose dependent. Although the medication has no congenital side effects, the medication is not safe to use in pregnancy.

Mood stabilizers include lithium, lamotrigine, valproate. Side effects are predominantely directed towards the pregnant patient and include dizziness, drowsiness, increased thirst, and rash. Congenital side effects of the drug class include dose-dependent cardiovascular malformations such as Ebstein anomaly. This drug can be used in specific cases by continuously monitoring blood levels.

Overall, SSRIs are deemed the first choice and the safest drug class to use to treat perinatal depression in pregnant patients.

Conclusion: Our review of recent literature suggests that while there are studies portraying a correlation between antidepressant use during pregnancy and health risks for the pregnant patient and/or fetus, it is difficult to conclude that exposure to antidepressants alone is causing those systemic health issues. Moreover, several studies have pointed out that there is no direct connection between antidepressant use, especially if taken at the lowest effective dose, and congenital malformations or health defects within the pregnant patient.

The lack of extensive data or small sample size were mentioned as factors as to why some researchers did not find a definitive correlation. Certain antidepressants, such as paroxetine were noted as contraindications during pregnancy and may not be recommended by health care providers. Although different classes of antidepressants demonstrate risks during pregnancy, the benefits often outweigh the risks by choosing medications that have no known teratogenic effects and fewer side effects for both the pregnant patient and fetus. It is vital to treat depression in pregnancy as it is the most common complication in pregnancy and has the greatest risk of development in the second and third trimesters (Gruszczyńska-Sińczak et. al., 2024). By choosing not to take the required antidepressants, the depressed mother may be jeopardizing her own health as well as that of her child. Of the drugs assessed, SSRIs should be used for moderate to severe depression, with sertraline, escitalopram, or citalopram being preferred first (Dama and Van Lieshout, 2024). Comprehensive strategies to address perinatal depression involve increased awareness, early diagnosis, clear guidelines, and effective treatment (Wang et. al., 2023).

Because pregnant patients are rarely enrolled in clinical trials, safety information of antidepressants is generally limited (Mansour et. al., 2023). Thus, this study demonstrates the need for thorough clinical trials assessing antidepressant use during pregnancy to determine safety guidelines and treatment options for patients dealing with perinatal depression.