Is it safe to take trazodone while pregnant?

Trazodone is a serotonin antagonist and reuptake inhibitor (SARI), a type of antidepressant medication that is FDA approved to treat major depressive disorder. It is also often prescribed off-label to treat other conditions such as sleep disorders, anxiety, substance abuse, eating disorders, Alzheimer’s disease, and fibromyalgia. In other words, there are a lot of different reasons you may be taking this medication when you decide to become pregnant. Like any medication, it’s a good idea to check in with a healthcare provider if you’re considering having a baby or find out that you are expecting. While studies on trazodone don’t link this medication to significant increases in miscarriage, pregnancy loss, or neonatal birth defects, the available data on its safety and pregnancy outcomes is limited.

Keep reading for a closer look at the use of trazodone during pregnancy—including risks, safer alternatives, and other options for managing depression and insomnia during pregnancy.

Can you take trazodone while pregnant?

The use of trazodone is not usually recommended during pregnancy. “Its effects during pregnancy are not well known,” explains Mitchell Kramer, MD, OB-GYN and chairman of the Department of Obstetrics and Gynecology at Huntington Hospital. At the same time, he adds, there is no strong evidence that it causes fetal abnormalities.

Instead, many healthcare providers prescribe selective serotonin reuptake inhibitors (SSRIs), such as Prozac (fluoxetine) or Zoloft (sertraline). “Their effects on pregnancy outcomes are better understood and considered to be safe to use for mood disorders, depression, or anxiety,” Dr. Kramer says.

As with any medication, your healthcare provider will weigh the potential benefits against the potential risks of taking trazodone during pregnancy. “The precise risks associated with trazodone use during pregnancy are still unknown, and additional research is required to provide comprehensive safety profiles,” says Clifford Feldman, MD, board-certified psychiatrist and medical director at Solace Treatment Center. “Maintaining the mother’s mental health while minimizing risks to the fetus necessitates a balanced approach and extensive discussion between the patient and the healthcare provider.”

Risks of taking trazodone while pregnant

Trazodone is a pregnancy category C drug, according to the FDA. That means that there aren’t enough robust studies done on the medication directly in pregnant women, but there were some risks observed in animal studies. Trazadone and its metabolites cross the placenta during pregnancy, demonstrating fetal exposure, but there isn’t information about any fetal effects. Nevertheless, in some cases, the benefits of taking the drug outweigh any unknown risks.

There have been some studies that have demonstrated the negative side effects of trazodone use during pregnancy among animals. For example, congenital anomalies were found among rabbits taking Trazodone. Trazodone use also had adverse side effects on rat fetuses.

At the same time, there have also been some studies in humans that have not found negative side effects during pregnancy. It’s just that these studies are not as rigorous and thorough as they need to be for experts to recommend trazodone during pregnancy.

“While specific studies indicate that trazodone does not significantly increase the risk of congenital malformations, miscarriage, or pregnancy loss, it is still important to exercise caution,” says Dr. Feldman.

Dr. Kramer agrees. “Trazodone crosses the placenta and is found in breast milk,” he explains. However, its effects in utero or during breastfeeding and lactation aren’t clearly understood. “Trazodone should be used in pregnancy if the severity of the behavioral health issue being treated warrants its use and no other treatments are effective enough,” Dr. Kramer advises. If you have been taking trazodone and it has been significantly helpful to your mental health, the benefits may outweigh the risks of continuing it during pregnancy. Before stopping trazodone during pregnancy, it is important you discuss the risks and benefits with your healthcare provider.

What can I take instead of trazodone during pregnancy?

Between 7% and 19% of women experience depression during pregnancy. Left untreated, depression during pregnancy is associated with preterm delivery, lower-than-normal birth weight, poor engagement in prenatal care, and postpartum depression. That’s why it’s important for pregnant women to address their mental health and well-being during pregnancy, including with medication when needed.

Trazodone may not be the safest choice for depression in pregnancy. However, there are other lower-risk medications. According to the American College of Obstetricians and Gynecologists (ACOG), selective serotonin reuptake inhibitors (SSRIs) like Prozac (fluoxetine) and Zoloft (sertraline) are the safest choices for pregnant women and don’t come with increased risks of birth defects.

For sleep problems during pregnancy, Unisom (doxylamine) is a safer choice. Unisom “has significant data for safety in pregnancy and is a good option and also helps treat nausea,” explains Anna Costakis, MD, director of psychiatry residency training at Staten Island University Hospital. Taking over-the-counter magnesium supplements may also be helpful for insomnia in pregnancy, says Dr. Costakis. Though they can cause digestive upset or low blood pressure in some individuals, so use them with caution. Before taking over-the-counter supplements, be sure to discuss them with your healthcare provider and follow their guidance.

Natural remedies for insomnia and depression during pregnancy

In addition to medication, there are natural remedies and lifestyle changes you can try to help manage symptoms of depression or insomnia during pregnancy.

Depression during pregnancy can be managed with therapy, such as cognitive-behavioral therapy (CBT). CBT is “especially effective for depression and insomnia, helping to address negative thought patterns and behaviors,” explains Dr. Feldman. And “regular exercise appropriate for pregnancy can improve mood and facilitate better sleep.”

Certain lifestyle changes can help to manage insomnia during pregnancy, such as:

• Avoiding caffeine after midday
• Using a pregnancy pillow to get comfortable
• Drinking magnesium powder dissolved in water (with approval from your healthcare provider)
• Trying herbal “sleepytime” teas
• Making sure your bedroom is quiet and dark
• Incorporating yoga, stretching, and massage into your evening routine
• Eating a high-protein snack at bedtime
• Using antacids for heartburn and avoiding spicy foods and large meals before bed
• Avoid the use of electronic devices in the bedroom (television, phone, tablet, laptop, etc)

Many people also wonder about using melatonin during pregnancy to help with sleep problems. Unfortunately, there is little data about its safety in pregnancy. “Levels of melatonin are elevated in pregnancy to begin with, so its use for insomnia is limited, and its effects on pregnancy are not well known or studied,” Dr. Kramer explains. If you are taking melatonin during pregnancy, make sure to read labels and disclaimers and only take a dosage recommended by a healthcare professional.

Pregnancy is a time when it’s important to be especially cautious about what medications you use, whether you are in your first or third trimester. It’s also important to be mindful of medication intake during breastfeeding and lactation. You should always consult with your healthcare provider if you have questions about which medication is right for you and whether a supplement or lifestyle change is a healthy choice for you and your newborn.