Is it safe to take antidepressants during pregnancy?

Taking antidepressants can be incredibly helpful if you’re struggling with depression, but once you’re pregnant, it’s hard to know if you should keep taking them. But know this: Most experts state taking antidepressants during pregnancy is generally safe. Studies suggest they pose a low risk to the baby, though we know certain medications are less safe than others. If you’re nervous about continuing to take your medications during pregnancy, be sure to discuss it with your doctor, because going off the medications could sometimes be riskier than staying on them. 

Whether a person’s depression preceded pregnancy or set in during the prenatal period—a little-discussed condition known as prenatal depression—antidepressants may help, and it’s important that women are made aware of all the treatment options available to them. 

Related: Prenatal depression is the most under-diagnosed pregnancy complication

That’s because not treating a condition like depression in pregnancy could also be risky as far as health outcomes for both baby and mother. Untreated depression during pregnancy has been linked to issues with fetal development, preterm birth, low birth weight, stillbirth and postpartum depression. 

As many as 1 in 5 perinatal women will experience a mental health event, and it’s important to know that you have options: Talk to your doctor about starting or continuing to take an antidepressant during pregnancy, changing medications, or tapering off—any and all treatment possibilities should be made available to you. Here’s what else you need to know. 

The risk of antidepressant use in pregnancy is low

“Antidepressants are generally safe in both pregnancy and breastfeeding,” notes Tiffany A. Moore Simas, MD, a professor at UMass Chan Medical School who’s part of the American College of Gynecology Committee on Clinical Practice Guidelines for Obstetrics. 

Dr. Simas says there’s some research on the topic, but there’s a lack of randomized trial data (that tends to be the strongest in the science world). A lot of the research is observational. 

Past research has linked antidepressants during pregnancy with epilepsy (among other things like birth defects) in children, though current studies are more reassuring.

“Despite some potential risks, the absolute risk for many of the outcomes is low,” Dr. Simas tells Motherly. 

She cites ACOG’s guidance on psychiatric medications during pregnancy and lactation, which says the risk of SSRI use should be looked at with regard to the risk of a relapse if a person stops treatment. Relapses during pregnancy are more common in people with a history of depressive illness longer than five years and more than four relapses. 

Related: Maggie on having prenatal depression and being afraid to have another baby

Evaluating the risks

Even though the studies won’t give a hard-and-fast, “it’s safe” designation, recent research suggests antidepressants aren’t as risky as we may think—or have been told. 

A May 2022 study in Neurology says taking them during the first trimester won’t raise the chances of epilepsy and seizures in babies.

Researchers examined more than 1.7 million children born in Sweden over a 17-year span. More than 24,000 of them were exposed to antidepressants during the first trimester. Antidepressants included selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs).

The scientists next looked at medical visits for those who had seizures during the first month, or epilepsy in their first few years. Of all the kids, 0.12% had neonatal seizures (very rare) and 0.40% had epilepsy. 

There was a higher prevalence of seizures and epilepsy among those exposed to antidepressants compared to children not exposed. But when they adjusted for factors that could raise the risk of seizures in the babies, the researchers didn’t find a link between antidepressant use during the first trimester and a child’s risk of seizures or epilepsy.

Related: 84% of pregnancy-related deaths in the US are preventable, CDC finds

“While several studies have shown a possible link between antidepressant use by mothers during pregnancy and seizures in newborns and toddlers, our study suggested that antidepressant exposure in the first trimester of pregnancy does not increase the risk of seizures and epilepsy in children,” Ayesha C. Sujan, PhD, a researcher now with Kaiser Permanente, said in a statement.

“This could mean that the slightly elevated risk for such seizures documented in previous studies could be due to other factors such as other diseases or tobacco use during pregnancy,” Dr. Sujan said.

The mothers self-reported their antidepressant use during the first trimester. The authors note that other studies found the strongest ties between seizures and antidepressant use later during pregnancy. 

Another recent JAMA study found no link between antidepressant use in pregnancy and autism, attention-deficit hyperactivity disorder (ADHD), behavioral disorders, developmental speech, language, learning and coordination disorders or intellectual disabilities in children of 145,000 pregnant women who took the medications. 

A note from Motherly: Antidepressants during pregnancy

Trying to decide if you should stay on your current antidepressant—and currently expecting or planning to be soon? 

“The discussion should not and cannot focus on the risks of medication treatment versus no medication only,” Dr. Simas says. “The risk/benefit discussion must comprehensively focus on the risk of treated disease versus untreated disease, because mental health conditions have significant risks for the pregnant person and the offspring.”

One thing many women try to consider when making the choice is trying to anticipate how their mental health will be after the baby arrives. We already know that past (or current) mental health issues can play a part in the onset of postpartum depression, so it’s helpful to be proactive.

If you have questions and concerns about starting or stopping antidepressants in pregnancy, your first best step should be to speak with your birth care provider and prescribing physician. 

Related: How motherhood myths impacted my struggle with depression

Sources

Ghaedrahmati M, et al. Postpartum depression risk factors: A narrative review. 2017. Journal of Education Health Promotion. doi:10.4103/jehp.jehp_9_16.

Mao Y, et al. Prenatal exposure to antidepressants and risk of epilepsy in childhood. Pharmacoepidemiol Drug Safety. 2016. doi:10.1002/pds.4072.

Mayo Clinic: Antidepressants: Safe during pregnancy? January 2022.

Reefhuis J, et al. Specific SSRIs and birth defects: bayesian analysis to interpret new data in the context of previous reports. 2015. BMJ. doi:10.1136/bmj.h3190.

Suarez EA, et al. Association of antidepressant use during pregnancy with risk of neurodevelopmental disorders in children. 2022. JAMA Internal Medicine. doi:10.1001/jamainternmed.2022.4268

Uguz F. The use of antidepressant medications during pregnancy and the risk of neonatal seizures: a systematic review. 2019. Journal of Clinical Psychopharmacology. doi:10.1097/JCP.0000000000001093. 

Wiggs K, et al. Maternal serotonergic antidepressant use in pregnancy and risk of seizures in children. 2022. Neurology. doi:10.1212/WNL.0000000000200516.