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Finding out you're pregnant, or planning to be, can raise a hard question if you take medication for depression or anxiety. You may worry about what a medication could mean for your baby, and also about what could happen if you stop. Deciding about antidepressants during pregnancy is personal, and you don't have to make the choice alone or in a rush.
Key takeaways
- Untreated depression and anxiety in pregnancy carry real risks, so going without medication is not automatically the safest choice.
- SSRIs are among the most studied medications in pregnancy, and research on them has been largely reassuring, with a few exceptions to discuss.
- Major obstetric and psychiatric organizations support considering antidepressants when the benefits outweigh the risks for you.
- If you learn you're pregnant while taking an antidepressant, don't stop suddenly. Call your prescriber first.
- Plan ahead for the postpartum period, when the risk of depression often rises.
If you're struggling right now: If you have thoughts of harming yourself, call or text 988 to reach the Suicide and Crisis Lifeline. Call 911 in an emergency, or text HOME to 741741. You can find more options on our crisis resources page.
Why the choice about antidepressants during pregnancy isn't simple
No option is completely free of risk. Medication has possible risks, and so does untreated illness. That's why this works best as a shared decision. You bring your history and values, your prescriber brings what's known about each medication, and your obstetric clinician fits the plan into your prenatal care.
The risks of untreated depression and anxiety
Depression and anxiety are common during pregnancy, and their effects reach beyond mood. When they go untreated, they can affect:
- How well you sleep, eat and keep up with prenatal visits
- Whether you turn to alcohol, nicotine or other substances to cope
- Pregnancy itself, since research has linked untreated depression to a higher chance of preterm birth and lower birth weight
- Your risk of depression after birth, because depression during pregnancy is one of the strongest predictors of postpartum depression
- Bonding and the early weeks of parenting
- Your safety, in the most serious cases
These risks weigh more heavily if you've had severe depression before.
What's known about antidepressant risks
SSRIs are among the most studied options
Selective serotonin reuptake inhibitors (SSRIs), such as sertraline, citalopram, escitalopram and fluoxetine, have been studied in large numbers of pregnant people over many years. Overall, the research has been reassuring about major birth defects.
Paroxetine is the exception that often comes up. Some studies linked its use early in pregnancy to a small increase in heart defects, so many prescribers prefer a different option for people planning a pregnancy. Still, don't switch on your own, because changing medications carries its own risks.
Other antidepressants, such as SNRIs and bupropion, have been studied less than SSRIs. Your prescriber can explain what's known about yours.
Possible effects on your newborn
Some babies exposed to an SSRI late in pregnancy have short-term symptoms after birth, such as jitteriness, fussiness, feeding trouble or mild breathing problems. These are usually mild and pass within days. When your delivery team knows about your medication, they can watch for them.
Researchers have also looked at a rare newborn lung condition called persistent pulmonary hypertension of the newborn. Findings have been mixed. If there is an added risk, it appears to be small, and it's worth asking your prescriber about.
Questions still being studied
Research continues on possible links with miscarriage, preterm birth and child development. One challenge is that depression itself is tied to some of the same outcomes, which makes it hard to separate the illness from the medication. When studies account for the parent's depression, the links often shrink.
All antidepressants also carry an FDA boxed warning about a higher risk of suicidal thoughts and behaviors in children, teens and young adults, most often early in treatment or after a dose change. If you're a young adult, your prescriber will check in more closely.
What you may have heard recently
SSRIs in pregnancy have received a lot of public attention recently, and you may have come across strong claims. It's understandable if that leaves you feeling unsure.
Major obstetric and psychiatric organizations continue to support considering antidepressants during pregnancy when the benefits outweigh the risks, based on the full body of evidence. Bring what you've read to your appointment. A good prescriber will explain what the research does and doesn't show.
If you're planning a pregnancy
The best time to make a plan is before you conceive. A visit with your psychiatric provider ahead of time can cover:
- How well your current treatment is working and how long you've been stable
- Whether symptoms returned after past attempts to stop medication
- Whether your current medication suits pregnancy, or whether a change makes sense now
- Keeping the number of medications as low as possible while still treating your symptoms well
- Who will be on your care team and how they'll share information
Planning early means any change can happen gradually. The MotherToBaby service also offers free, plain-language information about medications in pregnancy.
If you find out you're pregnant while taking an antidepressant
Many people learn they're pregnant several weeks in. If that's you, start with one simple step: don't stop your medication suddenly. Call your prescriber.
Stopping all at once can cause discontinuation symptoms, and it raises the chance that depression or anxiety returns. By the time most people find out, the baby has already been exposed, so stopping abruptly may remove little risk while adding the risk of relapse. Our post on whether antidepressants are addictive explains why stopping suddenly can make you feel unwell.
Some people do decide with their prescriber to taper off, often when they've been well for a long time and past symptoms were mild. If you go this route, plan for close follow-up.
Coordinating with your OB
Your obstetrician or midwife and your psychiatric provider should work from the same plan. With your permission, they can share information about your medication and symptoms. Pregnancy changes how your body handles some medications, so a dose that worked early on may need adjusting later.
Make sure your delivery team and your baby's pediatrician also know what you take.
Planning for the postpartum period
The weeks and months after birth are a higher-risk time for depression and anxiety, especially if you had symptoms before or during pregnancy. Shifting hormones, broken sleep and the demands of a newborn all add up.
Make a postpartum plan before you deliver. Decide who will check on you, when you'll next see your psychiatric provider and which signs mean you should call.
The National Maternal Mental Health Hotline offers free, confidential support by call or text at 1-833-852-6262 (1-833-TLC-MAMA). Our guide to postpartum depression treatment in Chicago covers signs and options after birth.
Frequently asked questions
Is it safe to take antidepressants during pregnancy?
No medication is completely risk-free in pregnancy, and neither is untreated depression. For many people, an SSRI is a reasonable choice when the benefits outweigh the risks. Your prescriber can help you weigh your own situation.
Should I switch to a different antidepressant before trying to conceive?
Sometimes, but not always. If your current medication works well, switching could mean your baby is exposed to two medications instead of one, along with a higher risk of relapse. Make this decision with your prescriber, ideally months before you try to conceive.
Could I need a different dose later in pregnancy?
Possibly. Pregnancy can change how quickly your body processes some medications, so symptoms may creep back even on the same dose. Your prescriber will watch how you feel and adjust if needed, so don't change the dose on your own.
Can I go without medication if my depression was mild?
For some people, yes, with close monitoring and other support in place, such as skills-based treatment with a trained mental health professional. Have a plan for what you'll do if symptoms return.
Get support for your pregnancy and beyond
You deserve a plan that protects both your mental health and your pregnancy. At Musec Medical, our psychiatrist and psychiatric physician assistants provide women's and perinatal mental health care, working alongside your OB, in person in Chicago and by telehealth anywhere in Illinois. Request an appointment to talk through your options.
