Casey Goode Took Zoloft During Her Pregnancy: Is It Safe?

Musician and social media influencer Casey Goode, also known as Quigley, welcomed her first child—a son named Max—in September 2020. 

The newborn spent the first few days in the intensive care unit (NICU). And Goode explained that the infant was withdrawing from the antidepressant Zoloft (sertraline) she took during her pregnancy.

So, are antidepressants safe to take during pregnancy? Here's what you need to know about how, in some cases, taking antidepressants during pregnancy may cause neonatal adaptation syndrome.

Using Antidepressants

Goode, who made it to the final 36 contestants of "American Idol" in 2009, shared her experience in a candid post on Instagram. The singer said she was "finally ready to open up and talk about WHY Max was in the NICU for a week."

First, Goode went back to 2019, when her "anxiety and depression were at an all-time high." She revealed that she felt "nothing mattered," and there wasn't a week where she didn't "full-on cry my eyes out." After having a panic attack at the airport, Goode was referred to a psychiatrist, who prescribed her a low dose of Zoloft. 

Zoloft is a selective serotonin reuptake inhibitor (SSRI). SSRIs are medicines used to treat depression and anxiety by increasing the activity of serotonin. Serotonin is a hormone that plays an essential role in regulating your mood.

When she found out she was pregnant two weeks later, Goode thought about going off her medicine. But after her OB-GYN and psychiatrist told her the low dose wouldn't impact the fetus, she decided to continue taking the Zoloft.

"It was the best decision I've ever made," wrote Goode. "I actually enjoyed my pregnancy. I'd be pregnant over and over again. It was a dramatic contrast to the year before. I truly only had maybe two times during my whole pregnancy where I felt despair or pushed to my breaking point."

Symptoms of Withdrawal in the NICU

After Max was born three weeks early, he went to the NICU. He was given an antibiotic to prevent lung infection. To accelerate his recovery, the healthcare providers recommended formula feeding.

 "Despite my protests, my milk hadn't come in yet... So, I agreed," wrote Goode. "In the next few days, I was told that Max's 'fussiness' was due to symptoms of withdrawal from my Zoloft."

Goode described her mixed emotions that Max had to stay in the NICU because she decided to take antidepressant meds during her pregnancy. 

"I went back and forth from feeling selfish and angry that it was 'on me,'" explained Goode. "I felt a lot of anger at the [healthcare providers] for blaming it on the Zoloft when they really didn't have any hard evidence to back it up. I don't want to sound like I'm blaming them, as I was so thankful for the care they were giving Max. But I did feel a stigma there."

Neonatal adaptation syndrome happens when a newborn exhibits "withdrawal" symptoms after exposure to antidepressants during pregnancy, Elisabeth Netherton, MD, board-certified psychiatrist and neurologist, told Health. 

Neonatal adaptation syndrome symptoms include jitteriness, breastfeeding problems, trouble breathing, and low blood sugar.

The dose and type of medication can affect the likelihood of neonatal adaptation syndrome, Gail Saltz, MD, clinical associate professor of psychiatry at Weill-Cornell Medical College in New York, told Health. 

"A lowest possible dose can decrease the likelihood of withdrawal," said Dr. Saltz. "However, tapering off or stopping meds in the mom just weeks before birth does not seem to decrease the likelihood of withdrawal in the infant."

Medication During Pregnancy and Nursing

Neonatal adaptation syndrome can happen from any antidepressant. Dr. Netherton, who specializes in psychiatric treatment before, during, and after childbirth, stressed that there's no "best" antidepressant during pregnancy. 

"Because drug companies don't do randomized controlled trials of psychotropic medications in [pregnant people], the data we have is imperfect," explained Dr. Netherton.

SSRIs, except for Paxil (paroxetine), are one of the top choices to help treat depression and anxiety in pregnant people. There is a mounting body of safety data about their use in pregnancy compared to other antidepressants.

Levels of transmission in breast milk are another consideration. Some evidence suggests that low doses of SSRIs are not likely to have adverse side effects during breastfeeding. In fact, untreated mental health conditions are more likely to cause difficulties during breastfeeding than medicines. One of the risks of untreated depression and anxiety may include decreased breast milk supply.

"Zoloft tends to have very low rates of transmission for babies who are nursing," said Dr. Netherton. And on that point, breastfeeding could help alleviate the symptoms of neonatal adaptation syndrome.

Research has found that Zoloft is one of the safest choices if a pregnant person needs an antidepressant.

"[Zoloft] can be associated with preterm labor [...], but most studies find it is not associated with any birth defects," added Dr. Saltz. 

Dr. Netherton explained that medication recommendations might change based on specific factors in the pregnant person, like a history of symptoms or responses to particular medications.

In addition to being aware of the risk of neonatal adaptation syndrome, it's essential to realize that untreated depression and anxiety in pregnancy carry significant risks for the fetus. Mental health conditions can impact infant and childhood development, including communication, social skills, and attachment with the parent.

A Quick Review

If you experience symptoms of depression or anxiety and are pregnant, it would be best to consult your healthcare provider about what treatment plan works best for you. When taking antidepressants during pregnancy, there may be benefits and risks. 

"Now I'm home, and I've processed it all... I'm happy with how I handled things," wrote Goode. "I don't feel guilt for being on Zoloft during my pregnancy. I haven't had an ounce of postpartum depression, and I know that is because I have taken the steps I need to keep my body chemically balanced."

Goode finished her Instagram post on a positive, encouraging note.

"I'm writing this to let you know you're not alone if you've gone through any of these thoughts or feelings during your pregnancy or life in general," explained Goode.