Resources for Professionals
| Maternal Depression Screening and Care Pathway |  |
| Edinburgh Postnatal Depression Scale | English Spanish |
| Medication* | Risk/Benefit |
| Fluoxetine (Prozac) | Best studied, long half-life, high transfer into breast milk. |
| Sertraline (Zoloft) | Suggested by ACOG. Considered first line especially if medication naive. Unlikely to increase birth defects. |
| Paroxetine (Paxil) | Avoid prescribing in 1st trimester (associated with 50% higher incidence of heart defects). If already on Paxil, continue and do not change. |
| Bupropion (Wellbutrin) | Not as well-studied, good for women wanting to quit smoking. |
| TCAs | Sedating effects to treat insomnia, no shown association with congenital anomalies. NOT good for OCD or social phobias. |
| MAOIs | Not recommended: shown to cause fetal growth restriction. |
| Escitalopram (Lexapro) | Effective for comorbid depression/anxiety. Stronger than Celexa, safe but no study data yet. |
| Venlafaxine (Effexor) | Small number of human pregnancies to date are insufficient to draw a general conclusion. |
* All the medications listed here have “off label” indication. They reflect clinical and research experience of Dr. S. Misri and are free of industry bias.
Maurer-Spurej, E. Pittendreigh, C., & Misri, S. (2007). Platelet serotonin levels support depression scores for women with postpartum depression. Journal of Psychiatry and Neuroscience 32 (1): 23-29.
- Most antidepressants are generally safe witih pregnancy.
- Women may relapse if antidepressants are stopped prior to or after conception.
- Reinstate the one which produced best prior response.
- Don't choose between taking antidepressants and breastfeeding. Do both.
- All antidepressants are secreted in very small amounts into the breast milk.
- Zoloft and Paxil are almost undectable, hence deemed safe.
- Do not change from one antidepressant in pregnancy to another postpartum.
