Drugs & Medications
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Anxiety Medications During Pregnancy

Henry Vyner, MD, Psychiatrist
Anxiety Medications During Pregnancy

Pregnancy is supposed to be a beautiful time - a time of considerable joy as you await bringing a new life into the world. It's depicted as a stress free time of anticipation, but the reality of pregnancy is that it can be filled with stress, and the hormonal changes alone can alter your body's chemistry and create a considerable amount of anxiety.

Unfortunately, most anxiety medications cannot or should not be taken during pregnancy. Only a few are approved for use while pregnant, and even then it's best to try to find solutions that are not drug related.

Drugs for Anxiety

One very important fact to keep in mind when considering whether or not to take medication for anxiety during a pregnancy is that panic disorder and generalized anxiety disorder do not adversely affect your fetus or baby. You want to use drugs only as a last resort for anxiety. You should strongly consider alternative options. 

An important recent study (Yonkers et al, 2017) of more than 2600 pregnant women has shown that both benzodiazepine and SSRI treatment does increase the risk of adverse maternal and birth outcomes. They found, for example, that if a mother takes a benzodiazepine, it is associated with increased cesarean delivery, low birth weight, and an increased need to use ventilatory support for the newborn. Similarly, they found that SSRI treatment is associated with hypertensive diseases of pregnancy and an increase in preterm births. Dr.Yonkers, the lead author on this study did say however,  that "it should be reassuring that we're not seeing a huge magnitude of an effect here." In other words, if an anxiety problem during pregnancy is serious enough to merit the taking of medications, it might be worth the risk.

The Reason Drugs Are Used

The main reason that drugs are prescribed for pregnant women, however, is because anxiety and stress themselves can affect the pregnancy, and in some cases may also pose a significant risk to the child. Doctors are quicker to prescribe medications because they believe that the risks of some medications are less than the risks of allowing prolonged stress to take place.

If your doctor prescribes an anti-anxiety drug for you during your pregnancy, ask him or her what the risks are. And ask your doctor to refer you to studies that assess the risk of taking the medication that they are recommending. This way you will know to the best of your ability how much of a risk you are taking, and whether or not you want to take it.

Drugs and Pregnancy Side Effects

The medications that are most often used to reduce anxiety in pregnancy fall into two classes: the benzodiazepines (e.g. Valium and Xanax) and the SSRI’s (e.g. Prozac and Zoloft).

Here are the assessments of the risk involved with taking specific benzodiazepines as evaluated by the FDA and the American College of Obstetrics and Gynecology. Each medication is given a grade that tells you what the risk is in taking it. Here is the meaning for each grade: A = controlled studies show no risk; B = no evidence of risk in humans; C = risk cannot be ruled out; D = positive evidence of risk; X = contraindicated in pregnancy.

Alprazolam (Xanax)  =   D

Chordiazepoxide (Librium)  =  D

Clonaepam (Klonopin)  =  D

Diazepam (Valium)  =  D

Lorazepam (Ativan)  =  D

Flurazepam (dalmane)  =  X

Here are the assessments of the risk involved with taking specific SSRI’s as evaluated by the FDA and the American College of Obstetrics and Gynecology:

Fluoxetine (Prozac)  =  C

Paroxetine (Paxil)  =  D

Sertraline (Zoloft)  =  C

Citalopram (Celexa)  =  C

You are definitely putting yourself at some risk by taking a Benzodiazepine or an SSRI during pregnancy. 

How to Decide Whether or Not to Take Medication

Your best basic approach is to try to avoid the risk of taking anti-anxiety medications during your pregnancy by considering other approaches to reducing your anxiety.

If you feel able to do so, consider seeking out alternative non-medicinal solutions. You might try mindfulness, support groups, meditation, therapy and exercise. Before you try any of these approaches, check with your doctor to make sure that there is no danger of causing complications.

If however, you are unable to reduce your anxiety to an acceptable level by pursuing mindfulness, meditation or support groups, then it might make sense to take an anti-anxiety medication. Ask your doctor what is the best medication to take, and again ask to see studies about the medication they prescribe so that you can satisfy yourself that the recommended medication is safe.
 

Article Resources
  1. Armstrong, C. ACOG Guidelines on Psychiatric Medication Use During Pregnancy and Lactation. Am Fam Physician. 2008 Sep 15;78(6):772-778.
  2. Yonkers KA, Gilstad-Hayden K, Forray A, Lipkind HS. Association of Panic Disorder, Generalized Anxiety Disorder, and Benzodiazepine Treatment During Pregnancy With Risk of Adverse Birth Outcomes. JAMA Psychiatry. 2017;74(11):1145–1152. doi:10.1001/jamapsychiatry.2017.2733 
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