Despite their widespread use, we do not have all of the answers related to the use of antidepressant drugs and pregnancy. There are very large gaps in our understanding of the effects, especially related to more subtle changes that may occur. I will limit my comments to the selective serotonin reuptake inhibitor (SSRI) class of antidepressants. SSRI drugs including Prozac, Paxil, Zoloft, Lexapro, Celexa and others are the most commonly used in the United States. Other classes of antidepressant drugs include the tricyclics, MAO inhibitors and others.

All of the SSRI antidepressants have a warning about use during pregnancy. This warning is based on studies done in rats treated with very large doses of the drug. Abnormalities have been seen in these laboratory animals' offspring. Of course, these tests can only detect physical changes. Changes in the nervous system, especially subtle changes, are impossible to pick up in these studies. All of the SSRI drugs get into the brain, so there is a concern about their effects if they get into the developing brain of a fetus.

We do have some information in humans. Several studies have followed children born to mothers who were taking antidepressants during pregnancy. These limited studies have not identified any problems in intelligence, language skills, or behavior in children who were exposed compared to children who were not exposed. These studies are reassuring, but are few in number and the number of children studied is very small. There does not appear to be any obvious effects of the SSRI antidepressants on the developing brain based on these limited studies.

There is a theoretical concern about the use of alcohol in combination with SSRI antidepressants. All of the SSRI antidepressants carry a warning about use of alcohol. The concern is that alcohol will increase the drowsiness seen with some of the SSRIs. There is also a concern that the SSRI will increase the effects of the alcohol. But the studies that have looked at the combination and its effects on attention and performance did not find any problems.

Pregnant women should avoid drinking alcohol. But in general, I usually advise that alcohol in moderation is acceptable in people taking SSRI antidepressants. One glass of wine is not likely to cause any problems.