Antidepressant drugs with pregnancy and lactation recommendations
| Class of agent | Commonly prescribed agents | Comments |
|---|---|---|
| Tricyclics and tetracyclics | Amitriptyline, nortriptyline, imipramine, desipramine | Amitriptyline and nortriptyline remain the preferred agents in this class for use in pregnancy and lactation |
| Selective serotonin reuptake inhibitors (SSRIs) | Sertraline, fluoxetine, citalopram, escitalopram, paroxetine | Sertraline is the preferred agent from this class during pregnancy and lactation Paroxetine is preferred during lactation |
| Serotonin-norepinephrine reuptake inhibitors | Venlafaxine, desvenlafaxine duloxetine | Based on limited to fair data, venlafaxine use in pregnancy and lactation does not increase risk to fetus or neonate Some clinicians have suggested that active drug in breast milk may help to alleviate symptoms of neonatal withdrawala |
| Dopamine-norepinephrine reuptake inhibitors | Bupropion | Published data on the safety of this agent are Limited Use an SSRI or tricyclic preferably when initiating treatment in pregnancy |
| Serotonin modulators | Trazodone | Published data on the safety of this agent are limited at this time; use an SSRI or tricyclic preferably when starting treatment in pregnancy |
↵a Koren G, Moretti M, Kapur B: Can venlafaxine in breast milk attenuate the norepinephrine and serotonin reuptake neonatal withdrawal syndrome. J Obstet Gynaecol Can 2006; 28:299–302.
Source: Adapted from Star J. Psychiatric disorders in pregnancy. In: Powrie RO, Greene MF, Camann W, editors. de Sweit’s Medical Disorders in Obstetrics Practice, 5th edition. Hoboken, NJ: Wiley-Blackwell, 2010:524–552.