Antidepressants and Pregnancy: What You Need to Know to Make Informed Choices
Deciding whether to continue antidepressants during pregnancy can feel overwhelming. It's important to know that millions of women have used antidepressants during pregnancy. Selective Serotonin Reuptake Inhibitors (SSRIs), which are first line medications for depression and anxiety, are among the most commonly used psychiatric medications during pregnancy. This means we have a large amount of data to help guide decision-making. The information we have today on SSRIs is based largely on observational studies, which provide valuable guidance despite certain limitations. With the help of your doctor, you can navigate this decision through a careful risk-risk discussion by weighing the risks of untreated illness against the potential risks of medication.
Understanding the Risks
Untreated depression or anxiety during pregnancy can have serious consequences for both mother and baby. Risks include:
Worsening depression or anxiety symptoms
Decreased prenatal care
Suicidal thoughts or behaviors
Impaired functioning in daily life
Higher likelihood of C-section
Increased risk of preterm labor
Low birth weight
Impaired emotional and social bonding between parent and child
Potential developmental concerns in the child
Lower rates of breastfeeding among mothers with untreated depression
The impact of untreated mental illness is significant and often outweighs the potential risks of medication in many cases.
When it comes to antidepressant use during pregnancy, much of the focus is on SSRIs. Current research often groups SSRIs together, so individual medication differences may not always be clear. Potential risks associated with SSRI use during pregnancy include:
Small but increased risk of postpartum hemorrhage
Higher likelihood of C-section delivery
Increased risk of preterm labor
Neonatal adaptation syndrome (temporary symptoms like jitteriness or difficulty feeding)
Low birth weight
Notice that some of the risks of untreated illness and medication use overlap. For example, both untreated depression and SSRI use have been associated with risks like preterm labor, low birth weight, and higher rates of C-section. This overlap highlights why it's so important to work closely with your provider to thoughtfully weigh the risks and benefits.
Long-term neurodevelopmental data on children exposed to SSRIs is still somewhat limited, but the research available so far is reassuring. Importantly, SSRIs have not been associated with an increased risk of congenital abnormalities beyond the baseline risk seen in the general population (which is approximately 3–5%).
Breastfeeding and SSRIs
If you are considering breastfeeding while taking an SSRI, it’s reassuring to know that most SSRIs are transferred into breastmilk in low amounts. Based on current research, most SSRIs are generally considered compatible with breastfeeding. Many professional organizations, including the American Academy of Pediatrics and the American Psychiatric Association, support the use of SSRIs during lactation when clinically needed.
Ultimately, the best decision on what medications are recommended in pregnancy for you involves consulting with your doctor, psychiatrist, or reproductive mental health specialist. It's important to review your mental health history, including severity, past episodes, and medication response. If you're planning a pregnancy, consider a preconception consultation. Weigh the pros and cons carefully with expert guidance, and develop a personalized monitoring plan for your mental health during and after pregnancy.
There is no "perfect" choice, only the best choice for your unique situation. Remember, you deserve to feel supported, healthy, and empowered throughout your pregnancy journey. With thoughtful planning and professional support, many women continue antidepressants during pregnancy and go on to have healthy pregnancies and thriving mental health.
If you're pregnant, planning pregnancy, or concerned about your mental health, don't navigate it alone. Reach out to a qualified provider who understands reproductive psychiatry and the nuances of these important decisions.