What are SSRIs, and how do they work? SSRI stands for selective serotonin reuptake inhibitor, and includes medicines like citalopram (Celexa), fluoxetine (Prozac), ecitalopram (Lexapro), sertraline (Zoloft), and paroxetine (Paxil). These medications work by increasing the level of serotonin in the brain. Serotonin is a chemical messenger used by the cells in the brain for communication.
How would this affect my ability to become pregnant? We've known for awhile that SSRIs can decrease libido, but a recent study by Dr. Sjaarda, et al presented at the American Society of Reproductive Medicine, suggests that using any SSRI while trying to conceive decreases the chances of becoming pregnant in a single menstrual cycle by 23%. Additionally, patients specifically taking fluoxetine (Prozac) had an increased risk of pregnancy loss (34% vs 24%) compared with patients who weren’t taking Prozac.
So, should I stop my SSRI right away if I’m trying to conceive? Absolutely not! The decision of whether or not to continue a medication should always be discussed with your provider BEFORE stopping. Not only should these medications generally be tapered prior to stopping, but everyone has a very individual health history, and the level of need for these medications can vary significantly from person to person. Pregnancy at the cost of good mental health probably isn’t going to be worth it.
All medications have their both their benefits and their side effects. For some, those benefits far outweigh the potential side effects, and quite frankly, safe day-to-day functioning may not be possible without a given medication. For others with more mild symptoms, especially if the cause of those symptoms was temporary, their depression might be controlled with nonmedicinal options such as therapy, exercise, good social support, meditation or other coping strategies. In those cases, gradually tapering an SSRI prior to pregnancy may be a good option, or if taking fluoxetine, another medication in the SSRI group may be a better option. That being said, these decisions should always be made in conjunction with your healthcare provider, and if any severe depression symptoms develop during weaning these medications, it is always advised to go directly to the ER for help. For all of those trying to conceive and taking SSRIs, we hope that you are able to make the best decision for you, and, hopefully, your growing family 😊