Antidepressants During Pregnancy: What’s a Mom to Do?

Updated 8.18.25

I get it. None of us wants to take a medication while we’re pregnant unless we feel we absolutely must – and only if we know it’s been proven completely safe for use in pregnancy. We’re all about trying to protect our babies from potential ‘toxins’. We go organic to avoid unnecessary chemicals in our foods, we switch to glass water bottles to avoid BPA, we stop drinking wine and cut way back on – or stop – drinking coffee. So the last thing we want is to expose our babies to possibly unsafe medications!

But the reality is that about one in five pregnant and postpartum women in the United States experience a perinatal mood and anxiety disorder (PMAD), an umbrella term that includes depression, anxiety, bipolar disorder, post-traumatic stress disorder, obsessive-compulsive disorder, and postpartum psychosis. And a stunning 75% of women of women dealing with mental health issues during and after pregnancy go untreated. 

And perhaps I should say one in five pregnant and postpartum women that we know of, since the actual number is much higher. For so many women this remains a hidden motherhood struggle.  Many don’t seek care at all because few women want to admit that they are less than happy when they are pregnant. After all, we’re supposed to be bathing in that joyous pregnancy glow, while basking in knowing we’re becoming mothers. And perhaps that is true for many women. But for many women, experiencing depression or other tough feelings during pregnancy leads to feelings of shame – so stigmatized are these matters.

Also, too many of  us are accustomed to dismiss our moods and suffering, to power through, and even when we eager to do something about our suffering – we’d largely sacrifice everything for the sake of our children—including our own health and safety i it means avoiding an possibly risks for our babies – no matter how small those are. No pregnant woman wants to put her baby at risk—and who can blame us? Further, most doctors – and even many midwives –  don’t consistently screen for PMADs during pregnancy (or postpartum), 

Add to this the confusion around the safety of antidepressants in pregnancy – and we end up with far too many mothers – and the families struggling, too, in limbo, not getting the help they need. 

The Risk of Untreated PMADs

Lack of care for maternal mental illness is no small matter. Maternal mental health challenges are a  leading cause of pregnancy-related death in the United States. Untreated PMADs can contribute to real risks for mothers—including worsening symptoms, complications like preeclampsia or preterm labor, and, in severe cases, safety concerns. Babies can also be affected when a parent’s suffering goes unaddressed.

Here’s what we know about the potential impact:

On Mothers

• Untreated, mental health problems in pregnancy can worsen, leading to more severe depression, anxiety, panic, or obsessive thoughts – and is also a predisposing factor for postpartum mental health challenges.
• Physical health may also suffer, with increased risks of pregnancy complications like preeclampsia, preterm labor, and difficult deliveries.
• Daily functioning and relationships are often strained. Women may feel isolated, disconnected from their partners, or unable to fully engage in work and life.
• In severe cases, untreated PMADs increase the risk of self-harm or suicide.

On Babies

• Untreated PMADs are linked with preterm birth, low birth weight, and growth restriction.
• Babies may show altered stress responses and can face developmental and behavioral challenges later in life.
• Bonding may be harder when mothers are overwhelmed, impacting infant attachment and security—though with support, healing is always possible.

When you’re struggling with depression or anxiety in pregnancy, white-knuckling it isn’t a virtue; it’s a load you don’t have to carry – and certainly not alone! Treatment—whether therapy, social support, or medication—can help you sleep, eat, keep up with prenatal care, and stay connected to the people who love you. Those are not luxuries; they’re the foundations of healthy pregnancy and early bonding. Here’s a gentle reframe: getting help is part of caring for your baby. 

Give Yourself Permission Not to Suffer

When you’re struggling with depression or anxiety in pregnancy, white-knuckling it isn’t a virtue; it’s a load you don’t have to carry. Treatment—whether therapy, lifestyle supports, or medication—can help you sleep, eat, keep up with prenatal care, and stay connected to the people who love you. Those are not luxuries; they’re the foundations of healthy pregnancy and early bonding. Here’s a gentle reframe: getting help is part of caring for your baby. 

Choosing care is an act of protection, not only for you, but for your baby and your family. You’re not failing—you’re doing what good parents do: seeking what’s best for your child by taking care of yourself. So perhaps  we need to let ourselves off the hook for sometimes needing help — even if that help comes from a prescription. 

If you are one of the many moms facing mental health challenges, please know that you’re not alone, and I understand how gutting the choice to take a medication can be. I’m here to guide you through it by sharing what we know (and what we don’t) about antidepressant use during pregnancy. 

But Dr. Aviva, Are Antidepressants During Pregnancy Safe?

The long answer is that there is still a lot we need to learn about the safety of antidepressants in pregnancy, but this doesn’t mean they cannot be used, despite concerns raised by a recent FDA panel which was biased and inaccurate. 

In fact, there’s a lot we don’t know about most medications used in pregnancy. About while about 90% of women report taking some type of medicine during pregnancy, and 70% take at least one prescription medicine, including in the first trimester, fewer than 10% of medicines approved since 1980 have enough information to determine their safety during pregnancy. This is because pregnant women are often not included in studies that determine the safety of new medicines.

But the short answer is, yes, if you are using antidepressants in pregnancy according to the most current recommendations, then they can be a game-changer – and even a lifesaver for you- and can be quite safe for your baby. 

Here’s what we know. 

The most commonly recommended medications for depression and anxiety in pregnancy are SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (Selective Norepinephrine Reuptake Inhibitors). These are considered the primary options in pregnancy. Most other categories—like mood stabilizers and tricyclics—are generally avoided due to higher concerns for congenital malformations.

Large studies including hundreds of thousands of pregnant women have not shown harm to mothers from using SSRIs during pregnancy, and the consensus among experts and organizations like the American College of Obstetricians and Gynecologists (ACOG) and and the National Curriculum in Reproductive Psychiatry Society for Maternal-Fetal Medicine is that untreated maternal mental health disorders put women and their babies at greater risk of adverse outcomes than antidepressants prescribed and used appropriately. In other words, when symptoms are significant, treatment—including medication—can be the safer choice overall.

Still, like any medication, there are potential risks: a moderately increased risk of preterm birth and low birth weight and a slightly increased risk of preeclampsia and postpartum hemorrhage. So using them safely and wisely, with skilled guidance, is key. 

The Safest Use of Antidepressants in Pregnancy

If you have decided you need to use an antidepressant, this may not have been an easy choice for you.  Trust that if you have do need one, you are making the best choice for you and your baby. 

To rmaximize your benefits while reducing risks linked to antidepressant exposure in pregnancy:

• Choose time-tested options.  Choose a medication that is known to result in the lowest fetal/neonatal exposure whenever possible. Zoloft (sertraline) has typically been the first line medication recommended during pregnancy. However, in a large 2020 study, Lexapro (escitalopram) was associated with the lowest number of birth defects so may be a better choice. Your doctor can help you determine which of these is best for you. Venlafaxine was associated with the highest number of defects and there is limited literature on venlafaxine use during pregnancy, so I recommend avoiding it at this time.
• Dose thoughtfully: Use the most effective dose: One significant problem is not dosing adequately in hopes of mitigating exposure. In reality, this could lead to undertreatment and persistent symptoms while one is still being exposed to the medication! So the more effective approach is to increase dosing to effectiveness.
• Avoid newly released antidepressants while pregnant Choose only from those that have been time-tested in pregnant women.
• If tapering is appropriate, work with your healthcare provider to reduce gradually—about 10% per week—and stop at the lowest dose that keeps you well. Note that lowering or switching can sometimes trigger rebound symptoms that are harder to control. Adjust gradually, and don’t try to do this alone.
• Combine supports: Add in non-supplement, non-pharmacologic treatments such as light therapy, yoga, and CBT, all of which have been found to be effective for supporting mental health during pregnancy. These non-supplement treatments won’t interfere with your medication and may allow you to effectively lower your dose.

This is not about “being on a drug” versus “being natural.” It’s about stability. A steady mood, regular sleep, consistent nutrition, and engagement with prenatal care are all part of a healthy pregnancy. If medication helps you have more of that, it can be a profoundly supportive choice.

What if I’m Already Taking Medication?

If you became pregnant while on an antidepressant, set up time with your midwife or OB to review risks and benefits of your medication. But if you’re already on a medication generally preferred for pregnancy and are past the first trimester, the evidence is clear that it is the wisest choice to stay at the dose that’s keeping you well. Lowering or switching can sometimes trigger rebound symptoms that are harder to control. If a change is needed, make a plan with your clinician and adjust gradually.

Do I Need Medication? 

If you’re experiencing PMAD symptoms, the most important thing you can do is seek help from a care-provider skilled in working with pregnant women facing these symptoms. This could be your obsetrician, family physician, midwife, or a perinatal therapist or psychiatrist. Ideally, they will assess your symptoms using a validated questionnaire. If medication is indicated, they can help you get the prescription and support you need. 

If you’re on the fence or prefer not to use medication, I get it. But do this: Consider if any of the following feel true for you:

• Your depression is moderate and interfering with experiencing joy, sleeping, eating, or other important aspects of self care or quality of life. 
• Your depression is severe, you’ve had frequent relapses, or you don’t feel able to wait to see whether natural approaches work.
• You’ve tried non-drug strategies and they haven’t helped enough.
• You feel more confident in medication than in natural therapies.
• You understand there can be risks to medication in pregnancy, but  you also understand that untreated maternal mental health issues can carry even greater risks.

If you answered yes to any of the above, an antidepressant may be the best choice for you right now. If you answered no to all, have no thoughts of self-harm, and have a solid support network, starting with non-pharmacologic strategies may be appropriate, but I still urge you to talk with your healthcare provider to make sure that’s the case. .

Are There Safe, Effective Non-Drug Options?

I want to be clear: For many women with maternal mental health conditions, medication may be absolutely necessary for managing symptoms. For some women, non-pharmacologic approaches are enough. 

These include:

• Cognitive Behavioral Therapy (CBT) and other forms of counseling
• Omega-3 fatty acids
• Light therapy
• SAM-e (S-adenosyl methionine)
• Yoga and mindfulness-based practices

If your symptoms are mild, you’re not experiencing thoughts of self-harm, and you have strong support, it’s reasonable to try these first. (See: Depression in Pregnancy: 10 Ways to Beat the Blues Without Medication.) However, most of these are not strongly evidence based, these supplements have not been tested for use in pregnancy, and they are generally not adequate for moderate depression, and rarely enough for more severe symptoms. 

Taking Care of You Is Taking Care of Your Baby

As women, we’re conditioned to put our babies first. But one of the most protective things you can do for your baby is to protect you—your mood, your sleep, your nourishment, your sense of connection. Needing help does not mean you’re weak; it means you’re wise. Whether your path includes therapy, lifestyle changes, medication, or all of the above, choosing care is an act of love.

If you’re struggling, please know you’re not alone. Reach out—to your midwife, OB, primary care clinician, or a mental health professional. With the right support, you can feel better, and your baby will benefit from a healthier, more resourced you.

I hope this article has brought you deep peace of mind and a good plan for getting the help and support that you so deserve to have.  If you’ve found it helpful, please consider sharing it with a mama who you feel needs it, and the healthcare practitioners you know, so they too, can be more educated about this issue.