Taking Antidepressants During Pregnancy: Risks and Benefits

Why is this a both-sides decision?

It is natural to focus on medication risk during pregnancy, but the other side of the scale is real too. Untreated depression in pregnancy is linked with poorer self-care, difficulty attending prenatal visits, and effects on both parent and baby. The question a prescriber helps you answer is not simply "is the medication risky" but "which path — treated or untreated — carries the lower overall risk for you."

What's known about SSRIs in pregnancy?

SSRIs are among the most studied medications in pregnancy. For most, the absolute risks to the baby are small, and many people continue them. Some specific medications carry more caution than others, and timing in pregnancy can matter. This is exactly the kind of nuance that should come from your own prescriber reviewing your situation, rather than from a general article — the details differ by drug and by person.

To make that less abstract: the effect clinicians weigh most often is poor neonatal adaptation syndrome — jitteriness, or feeding and breathing trouble in the first days of life — which occurs in about one-third of babies exposed later in pregnancy but is usually mild and resolves on its own 4Ref 4Hendson L, et al. (2021).Selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors in pregnancy: Infant and childhood outcomes."Poor neonatal adaptation syndrome (PNAS) occurs in one-third of newborns exposed to SSRIs or SNRIs in utero, and is generally mild and self-limiting"; "Persistent pulmonary hypertension of the newborn and congenital heart defects are rare associations of exposure to SSRIs or SNRIs in utero"; "untreated or incompletely managed depression and anxiety also carry risks for the newborn.". Rarer, more serious associations such as persistent pulmonary hypertension of the newborn have been studied and remain uncommon 4Ref 4Hendson L, et al. (2021).Selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors in pregnancy: Infant and childhood outcomes."Poor neonatal adaptation syndrome (PNAS) occurs in one-third of newborns exposed to SSRIs or SNRIs in utero, and is generally mild and self-limiting"; "Persistent pulmonary hypertension of the newborn and congenital heart defects are rare associations of exposure to SSRIs or SNRIs in utero"; "untreated or incompletely managed depression and anxiety also carry risks for the newborn.". Not all SSRIs behave the same: in a large cohort study, sertraline carried the lowest risk of delayed newborn adaptation among the SSRIs examined, while others showed higher odds 5Ref 5Cornet MC, et al. (2024).Maternal treatment with selective serotonin reuptake inhibitors during pregnancy and delayed neonatal adaptation: a population-based cohort study."All other types of SSRI were associated with increased odds of delayed neonatal adaptation compared with sertraline"; delayed neonatal adaptation occurred in 11.2% of exposed vs 4.4% of unexposed infants, with escitalopram and fluoxetine carrying higher risk than sertraline.. And on the other side of the scale, untreated depression carries its own risks for parent and baby, so "don't treat" is not automatically the safer choice 4Ref 4Hendson L, et al. (2021).Selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors in pregnancy: Infant and childhood outcomes."Poor neonatal adaptation syndrome (PNAS) occurs in one-third of newborns exposed to SSRIs or SNRIs in utero, and is generally mild and self-limiting"; "Persistent pulmonary hypertension of the newborn and congenital heart defects are rare associations of exposure to SSRIs or SNRIs in utero"; "untreated or incompletely managed depression and anxiety also carry risks for the newborn.".

Don't stop abruptly

Stopping an antidepressant suddenly can trigger discontinuation symptoms and, more importantly, a return of depression at a vulnerable time. If you are pregnant or planning to be and take an SSRI, the safest move is to keep taking it as prescribed until you and your prescriber make a plan together. A change, if needed, is usually done gradually and with monitoring.

Protecting wellbeing for you and your baby

Mental health in pregnancy and early parenthood matters well beyond the pregnancy itself. A parent's stability and the early relationship with a child are foundational to that child's lifelong health 1Ref 1Shonkoff JP, Garner AS; Committee on Psychosocial Aspects of Child and Family Health; Committee on Early Childhood, Adoption, and Dependent Care; Section on Developmental and Behavioral Pediatrics (American Academy of Pediatrics) (2012).The Lifelong Effects of Early Childhood Adversity and Toxic Stress.Early parent-child relationships are foundational to a child's lifelong health.2Ref 2American Academy of Pediatrics (Garner AS, Shonkoff JP, et al.) (2012).Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science Into Lifelong Health.Early childhood experiences shape lifelong health, underscoring the value of parental stability.. Treating depression is part of building the safe, nurturing environment that supports both of you 3Ref 3Garner A, Yogman M; Committee on Psychosocial Aspects of Child and Family Health, Section on Developmental and Behavioral Pediatrics, Council on Early Childhood (American Academy of Pediatrics) (2021).Preventing Childhood Toxic Stress: Partnering With Families and Communities to Promote Relational Health.Safe, nurturing relationships and environments buffer stress and build resilience for parent and child. — which is why getting the right care, medication or otherwise, is worth the effort.

When to talk to a prescriber about SSRIs in pregnancy

Because this decision is genuinely individualized, a clinician is essential rather than optional. A prescriber — ideally a psychiatrist or a perinatal mental health specialist working with your OB — can weigh your specific medication's risk profile against your depression history, rule out other contributors like thyroid problems, and choose the safest effective option and dose. They can offer evidence-based therapy such as CBT, which may reduce or replace medication for some people, and they coordinate care across pregnancy, delivery, and the postpartum period when relapse risk is highest.