1. 2 weeks before pregnancy Harmful drugs taken within the first 2 weeks of pregnancy can cause egg death but are not teratogenic. The use of tricyclic antidepressants (TCAs), fluoxetine, paroxetine, sertraline or fluvoxamine during the first 2 weeks of pregnancy does not increase fetal mortality. 2. First trimester (1) Teratogenicity Drug safety Fetal organs are being formed during the first trimester of pregnancy, and medication taken during this period may cause fetal organ malformations. Large-scale studies have demonstrated that fetal exposure to TCAs, fluoxetine, sertraline, fluvoxamine, citalopram, escitalopram, venlafaxine, mirtazapine, bupropion, trazodone, or nefazodone does not increase the rate of severe teratogenicity. There was also no significant difference in teratogenicity between 5-hydroxytryptamine (5-HT) recycling inhibitors (SRIs) and TCA. Although recent data suggest a moderate increase in fetal teratogenicity in pregnant women taking selective 5-hydroxytryptamine recycling inhibitors (SSRIs), the FDA still classifies antidepressants as Class C pregnancy drugs (except paroxetine). (2) Miscarriage The rate of miscarriage caused by antidepressants is 12.4%, which is 3.7% higher than the basal miscarriage rate ((8.7%), and the relative risk is 1. 45. There is no significant difference between different antidepressants. 3. 7-9 months of pregnancy (1) preterm delivery Most studies have shown that pregnant women taking SRI increases the rate of preterm delivery. (2) Reduced birth mass Preterm delivery tends to reduce birth mass. One study found that the length of time a pregnant woman took an SSRI, or a dual-recovery inhibitor of 5-HT and norepinephrine (SNRI), rather than the point of administration, reduced the length of pregnancy and reduced birth mass. Another retrospective investigation showed that prenatal administration of SSRIs increased seizures and mortality in preterm infants. (3) Long-term mental development Prematurity causes children ① poor academic performance: those born: body mass <1 500 g later have low IQ, poor academic performance, poor attention span, and fewer can go to high school and graduate from high school; ② introversion: women born with body mass <1 500 g are more introverted; ③ depression: those born with body mass <2 500 g have more depressive symptoms and depression than those >2 500 g. (4) Withdrawal syndrome When SSRIs are taken in late pregnancy, 30% of newborns have withdrawal syndrome, while when SSRIs are taken in early pregnancy, only 6%-9% of newborns have withdrawal syndrome. The withdrawal syndrome is the opposite of the pharmacological effect and is mainly characterized by symptoms of hyperarousal (transient extreme irritability, agitation, excessive crying, sleep difficulties, and tachycardia). When clonidine is combined with paroxetine, the withdrawal syndrome is aggravated. (5) Toxic syndrome When SRIs are taken in the 7th -9th months of pregnancy, toxic manifestations are consistent with pharmacological effects and include extrapyramidal symptoms (tremor, spasticity and increased muscle tone), respiratory distress, cyanosis during feeding, xanthogranuloma and hypoglycemia. Occasional neonatal seizures have been seen with clomipramine or venlafaxine during pregnancy, and occasional neonatal paralytic intestinal obstruction and urinary retention have been seen with TCAs, both seen as signs of toxicity. Pregnancy medication notes: 1. Safety: can be replaced with a drug that is safer for reproduction. If the patient is only effective for drugs with limited reproductive safety, they can only be maintained to avoid relapse; 2. single use: as far as possible, no combination of drugs, such as both depression and insomnia, a sedative TCAs can be chosen instead of SSRI, co-trimoxazole or benzodiazepines; 3. incremental dose: the plasma volume increases in pregnancy, the liver and kidney function is enhanced, and the blood concentration of TCAs drops to 65% of the pre-pregnancy level, so at this time The dosage should be increased rather than decreased. Similarly, SSRI should also be increased rather than decreased. However, clinically, doctors will not increase the dosage voluntarily as long as there is no fluctuation of the disease.