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Prescribing

The information on this site is for informational purposes only and does not replace your individualized assessment and clinical judgement.

If your assessment of the patient indicates that medication would be appropriate, the following information is intended to support your practice. If you are unsure, please do not hesitate to contact Ask Masi.

Some patients may have concerns about taking medications during pregnancy and lactation. It is important to explore these concerns and to consider all of the risks and benefits of treating versus not treating with medication.

Key Patient Education Points:

Antidepressant use during pregnancy: Under-treatment or no treatment of perinatal mental health conditions:
  • Does not appear to be linked with birth complications
  • Has been linked with small but inconsistent risk of birth defects, when taken in the first trimester, particularly paroxetine
  • Has been linked with transient (days to weeks) neonatal symptoms (tachypnea, irritability, insomnia)
  • Has inconsistent, overall reassuring, evidence regarding long-term (months to years) neurobehavioral effects on children
  • Has been linked with birth complications
  • Can increase the risk or severity of postpartum depression
  • Can make it harder for moms to take care of themselves and their babies
  • Can make it harder for moms to bond with their babies
  • Can increase risk of mental illness among offspring
  • Has been linked with possible long-term neurobehavioral effects on children


Key Provider Education Points

  • Choose an antidepressant that has worked before. If antidepressant na├»ve, choose antidepressant based on the First Line Treatment Options table with patient preference in consideration. Antidepressants are similar in efficacy and side effect profile.


  • In late pregnancy, you may need to increase the dose above usual therapeutic range (e.g., sertraline [Zoloft] 250mg rather than 50-200mg).


  • If a patient presents with pre-existing mood and/or anxiety disorder and is doing well on an antidepressant, do not switch it during pregnancy or lactation. If patient is not doing well, see the Second Line Treatment Options table.


  • Evidence does not support tapering antidepressants in the third trimester.

  • In general, if an antidepressant has helped during pregnancy, it is best to continue it during lactation.


  • Minimize exposure to both illness and medication:
    • Untreated/inadequately treated illness is an exposure.
    • Use lowest effective doses
    • Minimize switching of medications
    • Monotherapy is preferred, when possible
    • Optimize a single medication before adding or augmenting with another medication.