Is it safe to take Pristiq during pregnancy?

I was rocking my 3-week-old baby boy to a lullaby, when suddenly I burst out crying. After the birth of my first child, I went into depression. Being sad sometimes is normal, but this was different. Subsequently, my healthcare provider prescribed me an antidepressant. 

One in eight women experiences depression. The good news is there are many different medications to treat it. One of these antidepressants is Pristiq (desvenlafaxine), a serotonin-norepinephrine reuptake inhibitor (SNRI). The U.S. Food and Drug Administration (FDA) approved Pristiq in 2008. Since then, some women have been on Pristiq during pregnancy and while breastfeeding. But is this safe?

Can taking Pristiq make it harder to get pregnant?

No research shows that Pristiq makes it harder to get pregnant. “While Pristiq may or may not affect fertility for the woman, it is important to note that antidepressants typically reduce sex drive,” says Chinelo Enwonwu, Pharm.D., a pharmacy manager at CVS in Virginia. “Additionally, Pristiq raises blood pressure which may indirectly contribute to conception problems.” 

Other factors such as age, lifestyle, smoking, alcohol, body mass index (BMI), stress, caffeine, recreational drug use, pesticides, bisphenol a (BPA), heavy metals, and untreated sexually transmitted diseases (STDs), like chlamydia and gonorrhea, affect fertility.

Depression is common in women of childbearing age. Many pregnancies are unplanned and therefore, women can conceive while on antidepressants, like Pristiq. 

Should you stop Pristiq right away if you find out that you are pregnant?

No, don’t stop taking Pristiq right away. Patients must taper off Pristiq slowly or they can suffer from discontinuation syndrome. Discontinuation syndrome may occur with abrupt discontinuation or interruption of antidepressant therapy. Symptoms commonly include nausea, vomiting, diarrhea, headaches, light-headedness, dizziness, decreased appetite, sweating, chills, tremors, fatigue, and sleep disturbances (vivid dreams or insomnia). Less common symptoms include electric shock-like sensations, muscle and joint aches, and balance difficulties. Psychological symptoms may also emerge like anxiety attacks, agitation, irritability, aggressiveness, worsening of mood, mood lability, slowed thinking, confusion, and memory or concentration difficulties. 

If pregnant, you should immediately contact your healthcare provider. “In my practice, SNRIs, like Pristiq, are not my go-to medications,” says Ureh Lekwauwa, MD, a psychiatrist in Winston-Salem, North Carolina. “Most patients on Pristiq have tried and failed other antidepressants. Discontinuing any antidepressant, like Pristiq during pregnancy, can be very risky for both mother and fetus.”

If you take Pristiq while pregnant for more than three weeks, your healthcare provider may gradually taper you off over two to four weeks. If you have taken Pristiq for more than six months, you may have a longer wean. 

Can Pristiq cause a miscarriage?

Miscarriages are common. However, there is no known miscarriage link between Pristiq and pregnancy. 

Is taking Pristiq safe during early pregnancy?

It is unknown if Pristiq is safe during pregnancy. Pristiq is a pregnancy category C drug, which means that studies carried out in animals show adverse effects on the fetus. Unfortunately, there is no adequate study of Pristiq in pregnant women. Therefore, for you to be on Pristiq during pregnancy, the benefits have to outweigh the potential risk posed by the medication. Limited research exists on Pristiq and pregnancy. Notify your healthcare provider immediately if you are taking Pristiq and trying to get pregnant. It may be in your best interest to change psychotropic medications to one more widely studied in pregnant women.  

Is Pristiq safe during late pregnancy?

“The dosing of Pristiq as 50 mg by mouth, once a day, appears to be the safest dose in the general population with the least amount of side effects,” Dr. Enwuowu says. However, your healthcare provider will evaluate your dose of Pristiq during pregnancy and may seriously consider changing medications.

During your third trimester evaluation, your healthcare provider may or may not decide to taper you off Pristiq. During the third trimester, babies exposed to SNRI medications (like Pristiq) may experience more extended hospital stay due to respiratory distress, vomiting, constant crying, seizures, low blood sugars or low temperature, tremors, and feeding issues. These effects might be due to the toxicity of the drug or from withdrawal from Pristiq. 

Additionally, it is unknown if Pristiq causes congenital disabilities or affects labor or delivery.

Is Pristiq safe when breastfeeding?

A modest dose of Pristiq is present in breast milk. Hence, there is still a chance that your child may experience severe side effects. 

It may be safe to take Pristiq while pregnant while under the supervision of a healthcare provider. Other SNRIs like Effexor (venlafaxine) and Cymbalta (duloxetine) may be safe during pregnancy and nursing. The treatment of depression in pregnancy varies from person to person. Your care might involve your obstetrician, primary care physician, psychiatrist, and pediatrician. 

More data on Pristiq and pregnancy is needed. Therefore, if you are pregnant and on Pristiq, sign up with the National Pregnancy Registry for Psychiatric Medications or call 1-844-405-6185. This registry actively collects data to help research the safety of psychotropic medications in pregnancy.