Pregnancy can be overwhelming. There are the changes in your body, often lots of nausea, and the stress of simply preparing for parenthood. And for women who take medication, either for their mental health or pain relief, another question enters the equation, “Is my prescription safe for my baby?”
Taking an Rx during pregnancy isn’t uncommon—according to the FDA, 50% of pregnant women take at least one medication. But, not all drugs are safe for pregnant and lactating women.
Cymbalta is a serotonin-norepinephrine reuptake inhibitor (SNRI) drug used to treat anxiety and depression, and chronic pain. During pregnancy, depression and anxiety can increase, making it even more critical for women to know their options.
Is it safe to take Cymbalta during pregnancy?
The short answer is: It depends. Like all medications, it’s essential to immediately consult with your doctor if you are or plan to become pregnant. The use of Cymbalta during pregnancy is often decided on a case-by-case basis. “It is generally not used in pregnancy unless the benefits greatly outweigh the risk to the fetus,” according to Kecia Gaither, MD, MPH, an OB-GYN and the director of Perinatal Services at NYC Health + Hospitals/Lincoln.
There is less research on Cymbalta and pregnancy than other antidepressants, such as Zoloft. There is the potential for adverse effects, and it is contraindicated in the third trimester. “If a patient has been taking Cymbalta for anxiety or depression before pregnancy, and it’s working well for them, I’d recommend that they continue taking it,” says Carly Synder, MD, a reproductive and perinatal psychiatrist in private practice in NYC. If there are no other treatment options, including other medications, your healthcare may suggest you keep taking Cymbalta, despite the potential adverse effects. Compromised mental health during pregnancy poses a significant risk to the mother and her unborn child.
With that said, Cymbalta is likely not the first medication your doctor will recommend if you begin experiencing symptoms of depression during pregnancy. Meaning, you should not start using Cymbalta for the first time during pregnancy. Selective serotonin reuptake inhibitors (SSRIs) like Zoloft or Celexa are more commonly prescribed because more research exists demonstrating their safety.
What are the risks of Cymbalta and pregnancy?
Because the data on this drug is limited, the risks are somewhat unknown. The existing research suggests that infants exposed to SNRIs in the third trimester could experience side effects such as: cyanosis, apnea, respiratory distress, seizures, temperature instability, feeding difficulty, hypoglycemia, jitteriness, irritability, constant crying, or tremor. “There have been a few reports of preterm labor, miscarriage, small for gestational age babies, and pregnancy complications such as hypertension—however, whether that’s due to the drug or not is left up to speculation,” Dr. Gaither says.
Antidepressants taken in the third trimester can also present a risk of the baby experiencing temporary withdrawal symptoms for up to a month after delivery. These temporary withdrawal symptoms, known as poor neonatal adaptation syndrome, can include jitteriness, restlessness, irritability, increased muscle tone, and rapid breathing and occur for 25% to 30% of babies born to women on SNRIs and SSRIs. While it sounds scary, Dr. Snyder reassures patients that “it’s completely transient.” However, in some cases it may cause an ICU admission, disrupt parental bonding, or disrupt breastfeeding.
Research doesn’t indicate that discontinuing antidepressant use during the final trimester decreases the likelihood of these symptoms. And tapering off or completely stopping medication puts the mother at risk of sinking back into depression or experiencing heightened anxiety levels during the final months of pregnancy into the postpartum period. If you’re taking Cymbalta and become pregnant, schedule a consultation with a psychiatrist for medication recommendations.
Should dosage change during pregnancy?
Among the many changes a woman’s body goes through during pregnancy is increased blood volume. With those changes, a common assumption might be to increase the dosage of Cymbalta, but Dr. Synder explains that, “in most cases, patients don’t need to adapt their dosage, but sometimes they do. That’s why it’s so important to work with your doctor to find out what works for you.”
Is it safe to breastfeed on Cymbalta?
Like pregnancy, there is limited data on the use of Cymbalta during breastfeeding. You should weigh the potential risks to your infant with your healthcare provider. Given the limited data, many women and their providers may prefer an alternative. However, the available research does indicate that the dose in breast milk is extremely low.
Generally, it is not recommended to start taking Cymbalta for the first time while breastfeeding. Dr. Snyder recommends maintaining consistency between the pregnancy and postpartum period. “If a mother is taking something during pregnancy,” she says, “it’s typically fine during breastfeeding, particularly if the mother is doing well with it.” It’s important to monitor the infant for drowsiness and adequate feeding, weight gain, and developmental milestones, especially if they breastfeed exclusively. And, consult with your doctor if there are ever any concerns.
Remember to prioritize postpartum self-care
Life as a new parent can get overwhelming. But taking care of yourself is the first step in being able to care for your child. And that includes maintaining a consistent schedule with your medication, especially medications taken for mental health. Try a pillbox, use alerts on your phone, or work with your partner to create an accountability system that works for your new schedule as a mom.
If you’re experiencing depression or anxiety during pregnancy, it’s important to remember that you aren’t alone. Talk to your provider and find a solution that will be best for you and your baby.