SSRI stands for Selective Serotonin Reuptake Inhibitors. They are a type of antidepressant medication (which are also used for some other conditions): sertraline, citalopram, and fluoxetine are all common types.
Firstly, it’s important to know that stopping or changing SSRIs during pregnancy can lead to a relapse of depression or anxiety, which carries its own risks for both the mother and baby. HG commonly affects mental health. Do not stop your medications without consulting with your doctor.
There is also no strong evidence to show that SSRIs increase your chances of developing HG, worsening it if you have it, or stop your HG medications from working effectively. However, it is possible that SSRIs could contribute to the processes which cause nausea and vomiting in HG, because:
- Serotonin is released in the gastrointestinal tract and brain, and initiates the vomit reflex.
- As SSRIs increase the levels of serotonin in the body, it is possible that this extra serotonin may trigger serotonin-mediated nausea and vomiting. This may be why nausea is a very common side effect of SSRI antidepressants, reported in 1 in 10 SSRI users.
- It also explains why some anti-sickness medications which work by blocking the interaction between serotonin and its receptor in the body (such as ondansetron) are effective treatments for HG.
- One study reported that pregnant women with HG had significantly higher plasma serotonin levels compared to those who did not have HG or nausea. Although it doesn't tell us whether the higher serotonin levels were directly contributing to HG, it may provide further evidence to suggest that serotonin could play a role.
- Another recent study shows a link between taking SSRIs before pregnancy, and an increased risk of developing HG.
Any decision about using SSRIs in pregnancy should be made after a discussion with your doctor, after weighing the benefits and risks of each option for your health (including your risk of HG AND your mental health) and your future baby’s health. Your options include:
- Staying on your SSRI
- Switching to another medication to treat depression (or other conditions). One option to ask your doctor about is the antidepressant mirtazapine which has some evidence it can reduce vomiting in HG which doesn’t respond well to standard medications. It is currently being tested as a HG treatment in Denmark.
Please also see here for a discussion about taking ondansetron with SSRIs.
Resources for healthcare providers
