Teratogenicity

Early data suggested an increase in the risk of some rare malformations, particularly cardiac, with SSRI and SNRI exposure. However, the association has not been consistently confirmed in meta-analyses and may be explained by confounders (eg depression, increased cardiac surveillance with gestational exposure). A cautious interpretation is that gestational exposure may slightly increase the risk of cardiac malformations; paroxetine has most often been implicated. However, do not avoid using an SSRI or SNRI if indicated during pregnancy—see Principles of psychotropic use during pregnancy and Considerations for antidepressant use in pregnancy.

TCAs and mirtazapine have not been associated with malformations but have not been studied to the same extent as SSRIs and SNRIs, so are not thought to be safer and should be used with caution. Agomelatine, mianserin, moclobemide, phenelzine, reboxetine, tranylcypromine and vortioxetine have not adequately studied during pregnancy; use with extreme caution.