Which SNRI has the most safety data regarding use in pregnancy and lactation?

Venlafaxine is considered to have the most safety data for use in pregnancy and lactation among the options provided. This is largely due to the extensive research and clinical experience accumulated over the years regarding its use in these populations. Venlafaxine has been studied in several large cohort studies, which have looked at its effects on both pregnancy outcomes and breastfeeding.

The safety data suggest that venlafaxine does not significantly increase the risk of major congenital malformations or adverse pregnancy outcomes when compared to the general population. Additionally, it has been shown to transfer into breast milk in small amounts, and the limited data available indicates that it is generally well tolerated in breastfeeding infants. This body of evidence contributes to the understanding that venlafaxine may be a suitable option for managing depression or anxiety in pregnant or lactating individuals, providing a balance of efficacy and safety.

In contrast, while other options do have some safety data, they either lack the extensive studies that venlafaxine has or carry different considerations related to their risk profiles during pregnancy and lactation. For instance, while paroxetine is well-studied, there are specific concerns regarding its association with an increased risk of certain birth defects, making it less favorable compared to venlafaxine