My husband and I are discussing the possibility of trying to have a baby. I am concerned about staying on medication during pregnancy. If I was planning on getting pregnant, how do I decide whether to stay on the medication I am on or taper off it? Is it safe to be on medication while pregnant?

You’ve started with the right first step: anticipating and planning ahead.

Our biggest concern is about medications causing malformations or birth defects. We’re also concerned about any long-term effects of on mental or psychological health, but those effects are harder to assess. We can never guarantee that any medication is 100% safe, but we can generally classify medications into three groups: Those known to significantly increase risk of birth defects, those that may increase risk of birth defects, and those not known to increase risk.

In that first group, Valproate (Depakote) and Carbamazepine (Tegretol) are known to increase risk of spina bifida and other birth defects. Women who are pregnant or thinking about becoming pregnant should not start these medications. If you are already taking one of these medications and thinking of becoming pregnant, you should talk to your doctor about alternatives.

In that second group, some antidepressant drugs including Paroxetine (Paxil) and Fluoxetine (Prozac) may increase risk of cardiac defects. If you are starting an antidepressant medication, we would first look at other options. But if you are doing well while taking one of those medications, the risk may not be great enough to change medication.

The third group includes medications not known to increase risk of birth defects. Within that group, the available research includes large numbers of women for some medications and smaller numbers for some. We have more confidence about safety when the numbers are large. For some of the commonly used antidepressants including Sertraline (Zoloft), Escitalopram (Lexapro), and Citalopram (Celexa), we can rely on large studies showing no significant increase in risk. For some of the “atypical” medications including Aripiprazole (Abilify), Olanzapine (Zyprexa), Quetiapine (Seroquel), and Risperidone (Risperdal), we have smaller studies showing no increase in risk—so we would be somewhat more cautious. For both Lithium and Lamotrigine (Lamictal), some older information suggested increased risk of malformations—but more recent and better information does not find any increase. So we would now include those medications in the third group.

If you and your doctor do decide to make some change in your medication, you’ll want to do that gradually. Planning ahead gives you the best chance of a smooth transition (if you need to make a change) and a healthy baby.

About the Doc

About the Doc

Greg Simon, MD, MPH, is a psychiatrist and researcher at  Kaiser Permanente Washington Health Research Institute in Seattle. His research focuses on improving the quality and availability of mental health services for people living with mood disorders, and he has a specific interest in activating consumers to expect and demand more effective mental health care.