If mental health medications, including antidepressants, are part of your life, you may be wondering how they could affect your fertility or pregnancy. Like many medical questions, the answer depends on your unique situation, and you should always consult with your doctor before starting—or stopping—any medications. The good news is that the research about antidepressants in pregnancy and how they affect fertility is reassuring. Here’s what to know about antidepressants and your reproductive health.
Do antidepressants affect fertility?
In many cases, it’s safe to be on an antidepressant while trying to conceive. Especially when we know that stress, anxiety, and depression themselves can negatively impact fertility by messing with hormones like cortisol, contributing to sleep issues, and leading to poor health habits. Treating your stress, anxiety, and depression (even with medication) may actually improve your overall fertility picture.
Do antidepressants affect female fertility?
Most antidepressants don’t appear to have an impact on egg quality (how healthy your eggs are) or ovarian reserve (how many eggs you have left). SSRIs (selective serotonin reuptake inhibitors) like Zoloft, Lexapro, and Prozac, are generally considered safe when it comes to egg health (there’s no evidence that they damage eggs or reduce fertility) and are the most commonly prescribed. But, there is some evidence that these medications can create minor changes in your menstrual cycle, which might make ovulation a bit unpredictable (though it’s typically a temporary symptom early on).
Do antidepressants affect male fertility?
The data is more mixed when it comes to sperm health, but still mostly reassuring. Some studies suggest that SSRIs may affect sperm health parameters like motility, morphology, and DNA fragmentation—but these effects are seen at higher doses, are reversible once the medication is stopped, and aren’t seen in everyone. Most males taking SSRIs can still conceive spontaneously, or with the help of a clinic, especially if overall sperm counts are normal.
Are antidepressants safe for pregnancy?
Absolutely—starting or continuing to take an antidepressant is sometimes the best decision you can make for your health and the health of your baby. Mental health during pregnancy isn’t just important, it’s essential. Untreated depression and anxiety can increase the risk of preterm birth and low birth weight, affect bonding and attachment after birth, and make it harder to care for yourself or contribute to postpartum depression.
What are the safest antidepressants in pregnancy?
Some medications have been studied more extensively and they’re considered low risk when it comes to pregnancy. SSRIs like Zoloft are often a first choice because they’re considered so safe. Prozac, Celexa, and Lexapro can all be safely started during pregnancy, especially if needed in the second or third trimesters, but can be used earlier if needed. If SSRIs are not able to treat symptoms of depression or anxiety, the next option would be SNRIs.
What medications are considered unsafe in pregnancy?
Some medications are best avoided in pregnancy (or at certain points during pregnancy). Paxil has been associated with an increased risk of cardiac defects when taken during the first trimester. Mood stabilizers carry significant risks of neural tube defects and neurodevelopmental delays. Some medications can still be used, but need to be heavily monitored for side effects throughout pregnancy (like atypical antipsychotics because of their association with gestational diabetes and benzodiazepines, which can lead to neonatal withdrawal symptoms).
Underlying mental health conditions like anxiety, depression, and bipolar disorder are linked with poor pregnancy outcomes—the risks of staying on a well-managed and carefully chosen medication often outweigh the risks of stopping (or not starting), when your mental health is on the line.
