Using sedatives and antidepressants in pregnancy

Common sedatives such as Diazepam use in Pregnancy

There is no known harm in one-off use of drugs such as Diazepam. However, long-term use during pregnancy has been associated with defects such as cleft lip and palate, particularly so if taken in the critical first eight weeks. It has been reported that regular use of Diazepam in this critical early phase of pregnancy can increase the risk of cleft lip up to three-fold.

Late pregnancy use, just before delivery, is associated with depression of respiration and very low muscle-tone of the newborn. In fact, this may be so bad that the baby may not cry and may be unable to feed for up to 24 hours after birth. This will require special care and can be extremely worrying to the parents.

Common anti-depressant medication in pregnancy

The older commonly used drugs for depression are the tricyclic antidepressants. The commonly known drugs are Imipramine (Tofranyl®), Amitriptyline (Lentizol®, Triptafen®) and Dosulepin, formerly called Dothiepin (Prothiaden®).

These are not known to cause any birth defects.

Another group of drugs which have been around only for a few years are the SSRIs. The name stands for Serotonin Selective Re-uptake Inhibitors. The most famous SSRI antidepressant is Prozac®. Its generic name is Fluoxetine.

Other SSRIs include Seroxat® (Paroxetine), Lustral® (Sertraline), Cipramil® (Citalopram) and Faverin® (Fluvoxamine).

All these have no known detrimental effect on the fetus in the womb. However, there is a risk of withdrawal for the baby after birth. Paroxetine has also been associated with toxicity in animal studies.

The advice is to avoid them unless necessary. This is because doctors do not have enough experience of these drugs in pregnancy to be sure.

Anti-psychotic medication

The most common anti-psychotic drugs are the group known as phenothiazines. These include chlorpromazine (Largactil®), haloperidol (Serenace®), fluphenazine (Modecate®), and thioridazine (Melleril®). There is no known evidence of birth defects as a result of using these drugs.

Another commonly used anti-psychotic drug is lithium (LI-Liquid®, Priadel®). This is to be avoided in pregnancy at all costs. Lithium is known to cause major heart defects and more than 10% of babies born to mothers using the drugs in pregnancy will be affected.

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Medicines used for anxiety and lack of sleep such as Diazepam, Alprazolam or Xanax (above) and Temazepam or Restoril® (below) may be unsafe if used regularly especially in the early phase of pregnancy. Advice is to avoid.

Temazepam (Restoril) may be unsafe in pregnancy