Is It Safe to Stay on or Start an Antidepressant During Pregnancy?

For many people, taking an antidepressant during pregnancy can be a reasonable choice, because untreated depression carries its own risks for both parent and baby. Research on individual medicines is mixed, and the decision depends on your history, how severe your depression has been, and which drug you take. Do not stop on your own. This article explains how clinicians weigh the options, what newborns may experience, and which symptoms need urgent help.

Is an antidepressant during pregnancy safe? The honest answer

No medicine is risk-free in pregnancy, and no untreated illness is either. That is why the question is rarely "safe or unsafe." Clinicians ask which choice carries the better balance of benefit and risk for you and your baby. For many people that balance favors continuing a medicine that has kept them well. For others it favors a different drug, a talking therapy, or a combination.

MedlinePlus (NIH) notes that medicines taken in pregnancy can affect the baby, and that you should talk with your health care provider before starting, stopping or changing any of them. That advice applies to antidepressants as much as to anything else. If you want a broader look at over-the-counter and common prescription choices, see our article on which medications are safe to take during pregnancy. This page stays focused on antidepressants.

Why untreated depression matters in pregnancy

Depression is more than a low mood. MedlinePlus describes depression as a medical illness that can affect sleep, appetite, energy, concentration and the ability to function. During pregnancy, those changes can make it harder to eat well, rest, attend prenatal visits, or ask for help.

Depression that goes untreated has been associated with poorer self-care and with a higher chance of depression continuing after delivery. Researchers are still sorting out how much of any effect on the baby comes from the illness itself, from stress, or from other factors that travel with it. Several factors contribute, and the exact mechanisms are not fully understood.

This is the reason many guidelines treat the question as a balance and not as a simple "avoid medicines" rule. An international review of perinatal depression guidelines, published in PubMed Central (NIH), Guidelines on treatment of perinatal depression with antidepressants, compares how different countries approach this decision. It describes recommendations that generally call for an individualized plan instead of one answer for everyone.

What is known, and not known, about the risks of the medicine

Antidepressants fall into several families, including SSRIs (such as sertraline and fluoxetine), SNRIs (such as venlafaxine and duloxetine), and others such as bupropion. MedlinePlus explains how antidepressants work and lists side effects that apply to adults generally. Pregnancy adds questions about the baby.

Here is how the evidence is usually described, in plain terms:

• Birth defects and miscarriage. Studies have looked for links, and results differ from one medicine to another and from one study to the next. It is hard to separate the effect of a drug from the effect of the depression it treats. Your clinician can tell you what is known about the specific medicine you take.
• Paroxetine. Some guidelines advise extra caution about this particular SSRI in early pregnancy, which is one reason clinicians sometimes discuss switching before conception or early in pregnancy. Whether a switch makes sense for you is a decision for your prescriber, because changing medicines can itself risk a relapse.
• Newborn adjustment. Babies exposed to some antidepressants late in pregnancy may show short-term signs after birth, such as jitteriness, feeding difficulty, irritability, or breathing trouble. These are often mild and often pass, but they are the reason your delivery team should know about your medicine in advance.
• Rare lung condition in newborns. Some studies have raised the possibility of a small added chance of a serious newborn breathing problem called persistent pulmonary hypertension with SSRI use later in pregnancy. The evidence is debated and any added chance appears to be small. Ask your obstetric clinician how it applies to you.
• Long-term child development. Research continues, and results are not consistent enough to give a firm answer.

Because randomized trials in pregnancy are limited for ethical reasons, most of what we know comes from observational studies. That is a real limitation, and honest clinicians will say so.

Staying on, starting, or switching: how the decision often looks

This table describes common considerations, not a recommendation for you. Your own history decides the plan.

Why stopping on your own can backfire

Many people feel pressure to stop a medicine the moment a pregnancy test turns positive. Stopping suddenly can bring discontinuation symptoms such as dizziness, nausea, irritability, trouble sleeping, and "electric shock" sensations. It can also allow depression to return. Relapse in pregnancy can arrive when you are least able to cope with it.

If you want to taper, ask your prescriber to plan it with you. Do not change the dose or timing of a prescription on your own. We explain this further in our article on what happens if you stop an antidepressant suddenly.

The boxed warning and who it applies to

Antidepressant labels carry a boxed warning, the most serious type, about a higher chance of suicidal thoughts and behavior in children, teens and young adults, particularly when starting a medicine or changing the dose. Many pregnant people are within the age group the warning covers, so it is relevant here.

The warning is not a reason to avoid treatment. It is a reason for close follow-up, especially in the first weeks and after any dose change. Family members or a partner can help by watching for new agitation, worsening mood, or talk of hopelessness. MedlinePlus has information on suicide warning signs and where to get help. If you are in crisis, call or text 988, the Suicide and Crisis Lifeline.

Other medicines, supplements and serotonin syndrome

Antidepressants can interact with other products. Serotonin syndrome is a rare but serious reaction in which too much serotonin activity builds up. It is more likely when several serotonin-affecting products are combined, such as certain migraine medicines, some pain medicines, St. John's wort, or a recent dose increase. Symptoms can include agitation, sweating, tremor, diarrhea, fast heartbeat, muscle stiffness, high fever, confusion, and seizures. Severe cases need emergency care.

Tell your prescriber and pharmacist about everything you use, including supplements and herbal products. MedlinePlus Medicines offers general guidance on using medicines safely and reading labels. For common pain relief, see our article on whether Tylenol is safe during pregnancy.

Planning for delivery and the first weeks

Share your medicine with your obstetric clinician and the team that will care for your baby. Doing so lets them watch for the short-term newborn signs described above and respond if needed. Some people continue the medicine through delivery, because stopping late in pregnancy can cause relapse near the time the risk of postpartum depression rises.

Feeding choices also deserve a conversation. Some antidepressants pass into breast milk in small amounts, and experience differs from one medicine to another. Your clinician or pharmacist can review the specific drug with you.

Depression after birth is common enough that it deserves a plan. Our article on postpartum depression versus the baby blues explains how to tell them apart, and MedlinePlus covers postpartum depression in more detail.

Questions to bring to your appointment

• How severe has my depression been, and how likely is it to return if I change my medicine?
• What is known about the specific drug I take, and is a different one worth considering?
• Would talking therapy be appropriate alone or alongside medicine?
• What should the delivery team and my baby's clinician watch for?
• How often should we check in, and who do I call if my mood changes?
• How does this plan fit with breastfeeding?

Writing your answers down before the visit helps when you are tired or anxious. A decision made together, with your history in front of you, tends to be a better decision than one made from fear.

Other treatments that may be part of the plan

Medicine is one tool. Cognitive behavioral therapy and interpersonal therapy are talking treatments that clinicians often use for depression in pregnancy. Regular sleep, movement your obstetric clinician has approved, and support from family or a peer group can also help. Outcomes vary, and some people need medicine as well. Severe depression, or depression with psychosis or thoughts of suicide, needs prompt specialist attention.

When to Seek Medical Care