Antidepressant Use in Pregnancy: What You Need to Know About Safety and Side Effects

Depression During Pregnancy Is Real - and Dangerous

One in seven pregnant people in the U.S. experiences depression. That’s not rare. It’s common. And yet, many still avoid taking antidepressants because they’re scared of harming the baby. The truth? Untreated depression poses a far greater risk to both mother and child than most medications do.

When depression goes unmanaged during pregnancy, the chances of preterm birth go up by 40%. Low birth weight becomes 30% more likely. Preeclampsia risk rises by 25%. The mother is half as likely to show up for prenatal visits. And in the worst cases, depression leads to suicide - the leading cause of pregnancy-related death in the U.S. between 2017 and 2019, according to the CDC.

So when someone asks, “Is it safe to take antidepressants while pregnant?”, the real question should be: “Is it safer to take them - or not?”

SSRIs Are the First Choice - and Here’s Why

Not all antidepressants are the same. For pregnancy, doctors almost always start with SSRIs - selective serotonin reuptake inhibitors. These include sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), and fluoxetine (Prozac). Among them, sertraline is the most studied and the most recommended.

Why sertraline? Because over 20 years of data show it has the lowest risk profile. It doesn’t cross the placenta as easily as others. It’s less likely to cause side effects in the newborn. And most importantly, large studies tracking millions of pregnancies have found no link between sertraline and major birth defects.

That’s not true for paroxetine (Paxil). It’s an SSRI too - but it’s the exception. Studies show it carries a 1.5 to 2 times higher risk of heart defects in babies. If you’re on paroxetine and planning pregnancy, or just found out you’re pregnant, talk to your doctor about switching. Don’t stop cold turkey - switch under supervision.

What About Birth Defects? The Data Doesn’t Support the Fear

Back in the 2000s, early studies suggested SSRIs might raise the risk of birth defects. But those studies didn’t account for one big thing: the depression itself.

Here’s what the latest science shows: when researchers compared women taking SSRIs to women with depression who didn’t take meds, the difference in birth defect rates vanished. One major 2024 review of 29 studies - covering over 5 million pregnancies - found that the initial signal of higher risk disappeared once they controlled for maternal mental health.

The same goes for major congenital anomalies. A 2018 meta-analysis of 28 high-quality studies showed a tiny increase in risk - but only in women without diagnosed depression. When they looked only at women with confirmed depression, the risk was no different than in women not taking any antidepressants.

In other words: the illness, not the medicine, is often the real culprit.

Neonatal Adaptation Syndrome: A Temporary Issue

Some babies exposed to SSRIs in the last trimester may show signs of fussiness, jitteriness, trouble feeding, or mild breathing issues in the first few days after birth. This is called neonatal adaptation syndrome (NAS), or sometimes PNAS (perinatal adaptation syndrome).

It happens in about 30% of exposed newborns. But here’s the key: it’s temporary. It doesn’t cause lasting harm. Symptoms usually clear up within 10 to 14 days. No long-term developmental issues have been linked to it.

And here’s something else: the risk is highest with fluoxetine, because it sticks around in the body longer. Sertraline and citalopram are less likely to cause this. If you’re near your due date and worried, your doctor can adjust your dose or timing to reduce the chance.

What About Long-Term Development?

Parents often worry: “Will my child be different? Will they have autism? Will they struggle in school?”

The largest study to date - the Norwegian Mother, Father and Child Cohort Study - tracked over 44,000 children up to age five. It compared kids exposed to SSRIs in the womb to those who weren’t. No difference in language skills, motor development, behavior, or autism rates.

Other studies in Canada, Sweden, and the U.S. have reached the same conclusion. There’s no evidence that SSRIs cause autism, ADHD, or learning delays.

What does matter? Genetics. Environment. Parental mental health after birth. A mother who is stable, supported, and emotionally available is far more likely to raise a healthy child - regardless of whether she took medication during pregnancy.

The Big Risk: Stopping Your Medication

Many women stop their antidepressants as soon as they find out they’re pregnant. They think they’re protecting the baby. But here’s what happens next:

• 68% of women who stop their meds experience a full depression relapse.
• Only 26% of women who continue their medication relapse.

That’s not a small difference. That’s more than double the risk.

And it’s not just emotional. Relapse means worse prenatal care, more stress hormones, higher blood pressure, and increased risk of preterm labor. It means you’re less likely to eat well, sleep enough, or get the support you need.

A 2025 study in JAMA Network Open found that nearly half of pregnant women stopped refilling their antidepressant prescriptions - but didn’t start therapy or counseling to make up for it. That’s dangerous. Stopping without a plan is like turning off a fire alarm and hoping the house won’t burn down.

What About Other Antidepressants?

SSRIs are the go-to - but sometimes, doctors use other options.

SNRIs like venlafaxine (Effexor) and duloxetine (Cymbalta) are sometimes used if SSRIs don’t work. They’re considered second-line. The data is more limited, but no major red flags have emerged.

Tricyclic antidepressants like nortriptyline and amitriptyline have been around since the 1970s. They’re older, but still safe in pregnancy. They’re rarely used today unless SSRIs fail - mostly because they cause more side effects like dry mouth, drowsiness, or weight gain.

MAOIs? Avoid them. They’re not recommended during pregnancy because of potential interactions and unclear safety data.

And never, ever switch or stop on your own. Talk to your OB-GYN and your psychiatrist together. They need to coordinate your care.

What’s the Best Approach?

There’s no one-size-fits-all. But here’s what experts agree on:

1. If your depression is mild, try therapy first - cognitive behavioral therapy (CBT) works well during pregnancy.
2. If your depression is moderate to severe, or you’ve had relapses before, medication is often the safer choice.
3. Start with sertraline. It’s the most studied and safest.
4. Use the lowest dose that works. You don’t need to be on the highest dose just because you’re pregnant.
5. Don’t stop cold turkey. If you need to change meds, do it slowly under medical supervision.
6. Keep seeing your doctor. Monitor your mood, your baby’s growth, and any side effects.

Many women find that combining medication with therapy and gentle exercise - like walking or prenatal yoga - gives them the best results. You’re not choosing between meds and mental health. You’re choosing both.

The FDA Panel Controversy: Why the Confusion?

In July 2025, an FDA expert panel raised alarms about SSRIs in pregnancy. The media picked it up. Fear spread. Women called their doctors in panic.

But here’s what the panel didn’t say: they didn’t represent the full scope of evidence. Only one of ten panel members emphasized that SSRIs are critical tools to prevent suicide and severe maternal illness.

ACOG, SMFM, and InfantRisk all responded immediately. They called the panel “alarmingly unbalanced.” They reminded everyone that depression kills more pregnant women than hemorrhage or high blood pressure. They warned that fear-driven decisions could cost lives.

The message from every major medical group is clear: don’t let a single panel shake your trust in the science. The evidence hasn’t changed. SSRIs are safe. Untreated depression is not.

Final Thought: Your Mental Health Matters

Being pregnant doesn’t mean you have to suffer in silence. You don’t have to choose between being a good mom and being well. The best thing you can do for your baby is to be emotionally stable, physically cared for, and mentally supported.

Antidepressants aren’t a magic fix. But for many, they’re the bridge back to life - to sleeping, eating, connecting, and feeling like yourself again. And that’s not just good for you. It’s essential for your child.