Recent discussions about the safety of antidepressant use during pregnancy have been sparked by a federal panel’s concerns, but many experts emphasize that untreated depression can pose greater risks to pregnant women and their babies than the medications themselves.
According to the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics, rates of depression among adolescents and adults in the United States have increased by 60% over the past decade. Among pregnant women, it is estimated that 14% to 23% experience depression during pregnancy. The Society for Maternal-Fetal Health Medicine has stated, “Untreated or undertreated depression during pregnancy carries health risks, such as suicide, preterm birth, preeclampsia, and low birth weight.”
Approximately 8% of pregnant women are treated with selective serotonin reuptake inhibitors (SSRIs), a common class of antidepressants. These drugs increase the availability of serotonin in the brain and can help relieve symptoms of depression.
Recently, skepticism about prescribing SSRIs during pregnancy gained attention when Dr. Martin Makary, the new U.S. Commissioner of Food and Drugs, convened an “Expert Panel on SSRIs and Pregnancy.” Most panel members raised concerns about potential risks such as miscarriage, heart defects, autism spectrum disorder, and other problems linked to SSRI use during pregnancy.
The National Curriculum for Reproductive Psychiatry responded by refuting many of these claims and reaffirming the importance of SSRIs as a treatment option for pregnant women with depression.
Dr. Sarah Nagle-Yang from the University of Colorado School of Medicine explained that while there are limitations to research due to historical exclusion of pregnant women from randomized controlled trials, available evidence supports the safety of antidepressants during pregnancy. “I do feel confident to say that these are some of the most extensively studied medications in pregnancy,” she said.
She noted that major medical organizations agree on this point: “There is a clear and robust consensus” from groups like the American College of Obstetrics and Gynecology that antidepressants can be an important part of care for pregnant women diagnosed with anxiety or depression. “When they are clinically indicated, the benefits of SSRI treatment outweigh the low risk associated with these medications,” Nagle-Yang said.
Research into SSRIs during pregnancy often relies on observational or retrospective studies rather than randomized controlled trials. These studies cannot always control for all factors affecting pregnancies but still provide valuable information.
About one-third of women who take antidepressants in late pregnancy may see their newborns experience neonatal adaptation syndrome—symptoms such as increased reactivity or difficulty feeding—which typically resolve within days or weeks without specific treatment.
Regarding persistent pulmonary hypertension in newborns (PPHN), Nagle-Yang cited recent research indicating there “may be” a modestly increased risk—about 1.5 times higher than average—but emphasized PPHN remains rare overall.
A large study published in JAMA Internal Medicine found no link between prenatal exposure to antidepressants and later development issues like autism spectrum disorder or learning disabilities in children. Another study identified differences in certain brain regions among exposed children but called for more research before drawing conclusions about long-term outcomes.
Some critics argue that depression often resolves quickly without medication; however, Nagle-Yang countered this view: “The reality is that depression often does not resolve quickly on its own… only about 10% to 15% of depression cases (subside) spontaneously within three months without treatment.” She stressed that untreated depression increases risks for poor pregnancy outcomes and ongoing mental health challenges.
Women experiencing untreated depression may struggle with self-care during pregnancy—including nutrition and exercise—and face higher rates of preterm births and low birth weights among their infants.
In terms of medication choices, sertraline (Zoloft) is generally considered first-line due to its low transmission into breast milk. Paroxetine (Paxil) has been associated with a small but significant risk for cardiovascular defects if taken early in pregnancy; patients considering paroxetine should discuss options with their provider.
Non-medication strategies like psychotherapy, physical activity, social support networks, and sleep improvement can also help manage depressive symptoms. For those wishing to stop antidepressant use during pregnancy, gradual tapering under medical supervision is recommended to avoid discontinuation syndrome.
Nagle-Yang rarely recommends discontinuing medication for moderate-to-severe cases given elevated postpartum depression risk: “I fully support people thinking through that with their treatment provider.”
She highlighted efforts by organizations such as the National Curriculum in Reproductive Psychiatry to improve training on psychiatric care during reproductive years—a need not yet systematically addressed in general psychiatry education nationwide—and noted increasing opportunities for specialized fellowships focused on reproductive psychiatry at institutions like her own department at University of Colorado School of Medicine.
For women who are pregnant or planning pregnancies while managing depression with SSRIs, Nagle-Yang advised weighing mental health alongside physical health needs: “We would never say to someone with hypothyroidism ‘don’t take your thyroid medication’ during pregnancy… I think SSRIs are very much the same way.”
