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

When you’re pregnant and struggling with depression, the question isn’t just whether to take an antidepressant-it’s whether not taking one could be more dangerous. It’s a decision no one prepares for. You want to protect your baby, but you also need to survive this. The truth? For many women, staying on antidepressants is the safer choice.

Depression During Pregnancy Is Common-and Dangerous

About 1 in 7 pregnant women in the U.S. experience depression. That’s not rare. It’s not weakness. It’s a medical condition that affects your sleep, appetite, energy, and ability to care for yourself. Left untreated, it doesn’t just make you feel awful-it puts your baby at risk. Studies show untreated depression increases the chance of preterm birth by 40%, low birth weight by 30%, and preeclampsia by 25%. It also cuts your chances of showing up for prenatal visits in half. And worst of all, mental health conditions are the leading cause of pregnancy-related deaths in the U.S., accounting for nearly a quarter of all such deaths between 2017 and 2019.

Not All Antidepressants Are the Same

If medication is needed, doctors don’t just pick any pill. They choose based on safety data. The most commonly prescribed antidepressants during pregnancy are SSRIs-selective serotonin reuptake inhibitors. These include sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), and fluoxetine (Prozac). Among these, sertraline is the top choice. Why? Because it’s been studied the most. The data is clear: it’s associated with the lowest risk of birth defects and complications.

There’s one exception: paroxetine (Paxil). It’s linked to a higher risk of heart defects in babies-1.5 to 2 times higher than other SSRIs. If you’re on paroxetine and planning pregnancy, or if you find out you’re pregnant, your doctor will likely switch you to something safer. Don’t stop cold turkey. Switch under supervision.

What About Birth Defects?

Early studies scared a lot of people. They suggested SSRIs might increase the risk of major birth defects. But those studies didn’t compare apples to apples. They compared women taking antidepressants to women who weren’t. The problem? The women taking meds were often sicker. They had more severe depression, more stress, worse nutrition, less prenatal care. When researchers fixed that bias-comparing women with depression who took meds to women with depression who didn’t-the risk vanished.

A 2024 review of over 5 million pregnancies found that the slight increase in birth defects seen in early studies disappeared once they accounted for the mother’s mental health condition. The same was true for a 2018 analysis of 28 high-quality studies: when only women with diagnosed depression were compared, the risk of major birth defects dropped to nearly zero (OR: 1.04). The medication wasn’t the culprit. The illness was.

Neonatal Adaptation Syndrome: Real, But Temporary

About 1 in 3 babies exposed to SSRIs in the last trimester will show signs of neonatal adaptation syndrome (NAS). That sounds scary. But here’s what it actually means: jitteriness, mild breathing trouble, fussiness, or trouble feeding. These symptoms show up within the first few days after birth and usually go away on their own within two weeks. No long-term harm. No developmental delays. No need for special treatment beyond extra monitoring in the hospital.

This isn’t addiction. It’s a normal physiological response to the sudden drop in medication after birth. Think of it like a baby adjusting to life outside the womb. It’s uncomfortable, but it’s not dangerous.

What About Long-Term Development?

Parents worry: Will my child be different? Will they have autism? ADHD? Learning problems? The answer, based on the best long-term data, is no. A 2022 study tracked nearly 44,000 children from birth to age five. Half were exposed to SSRIs in the womb. The other half weren’t. There was no difference in language skills, motor development, behavior, or IQ scores. Other large studies in Sweden, Norway, and the U.S. reached the same conclusion. SSRI exposure doesn’t change your child’s brain development.

Fluoxetine Has One Slight Caveat

While sertraline is the safest overall, fluoxetine (Prozac) has a small, specific risk: persistent pulmonary hypertension of the newborn (PPHN). That’s when a baby’s lungs don’t adapt properly after birth, making it hard to breathe. The risk is low-about 5 to 6 cases per 1,000 births among SSRI-exposed babies, compared to 2 to 3 per 1,000 in unexposed babies. That’s still less than 1%. But because of this, doctors often avoid fluoxetine as a first choice unless you’ve had success with it in the past.

Stopping Antidepressants Is Riskier Than Staying On

This is the part most women don’t know. If you stop your antidepressant during pregnancy, you have a 68% chance of your depression coming back. If you stay on it, that number drops to 26%. Relapse isn’t just about feeling sad. It’s about not eating right, skipping doctor visits, isolating yourself, and even suicidal thoughts. One 2025 study found that nearly half of pregnant women stopped taking their antidepressants after becoming pregnant. But not one of them increased therapy or counseling to make up for it. That’s a dangerous gap.

What About Other Medications?

SNRIs like venlafaxine (Effexor) and duloxetine (Cymbalta) are sometimes used. They’re not first-line, but they’re considered safe if SSRIs don’t work. Tricyclic antidepressants like nortriptyline are older but still an option for women who haven’t responded to newer drugs. They’ve been around longer, so we have more data on them. They’re not risk-free, but they’re not dangerous either.

What’s the Best Approach?

If you need medication:

• Start with sertraline. It’s the best-studied and safest.
• Use the lowest dose that works. You don’t need to be on the highest dose just because it was prescribed before pregnancy.
• Don’t switch or stop suddenly. Work with your doctor to adjust slowly.
• Combine medication with therapy. Cognitive behavioral therapy (CBT) is proven to help depression in pregnancy and can reduce the dose you need.
• Get your OB and psychiatrist talking. They need to coordinate care. Don’t let one be in the dark about what the other is doing.

The FDA Panel Controversy: Why It Mattered

In July 2025, an FDA expert panel made headlines by suggesting SSRIs might be riskier than we thought. But here’s what didn’t make the news: only one of the ten panel members had direct experience treating pregnant women with depression. The rest were pharmacologists and statisticians-not clinicians. Within hours, ACOG and SMFM pushed back hard. ACOG called the panel “alarmingly unbalanced.” They pointed out that the panel’s message could scare women away from life-saving treatment. And they were right. Panic leads to silence. Silence leads to relapse. Relapse leads to death.

Bottom Line: Treatment Saves Lives

The data is clear. For most women, the risks of untreated depression far outweigh the risks of taking an SSRI like sertraline. Birth defects? Not linked when you control for depression severity. Long-term problems? No evidence. Neonatal symptoms? Temporary and harmless. Stopping? High chance of relapse. Death? Depression is the top cause of pregnancy-related deaths.

You’re not choosing between a healthy baby and a healthy mom. You’re choosing whether to give your baby a mom who can care for them-and whether to give yourself a chance to survive this. If you need medication, it’s not a failure. It’s medicine. And it’s working.