SSRIs and Antidepressants During Pregnancy: What You Need to Know About Risks and Benefits

When you’re pregnant and struggling with depression or anxiety, the question isn’t just should I take medication? It’s what happens if I don’t? For many women, this isn’t a theoretical debate-it’s a daily reality. Around 1 in 7 pregnant women experience depression or anxiety severe enough to need treatment. And while the idea of taking antidepressants while pregnant can feel scary, the real danger might be doing nothing at all.

The Real Risk of Untreated Depression

It’s easy to focus on the possible side effects of SSRIs, but what’s often forgotten is how dangerous untreated depression can be during pregnancy. In the U.S., suicide is the leading cause of pregnancy-related death, accounting for about 20% of all maternal deaths. That’s not a rare tragedy-it’s a consistent pattern backed by CDC data from 2022. Women with untreated depression are also far more likely to have preterm babies, give birth to infants with low birth weight, or struggle to bond with their newborns. Studies show that up to 25% of women with untreated depression turn to alcohol or drugs during pregnancy, compared to just 8% of those who are treated.

And it doesn’t end at birth. If you’re depressed during pregnancy, you’re more than twice as likely to develop postpartum depression. One study found that 14.5% of women with untreated antenatal depression developed postpartum depression-versus only 4.8% of those who received treatment. That’s not just about feeling sad. It’s about missing feedings, not responding to your baby’s cries, or feeling so overwhelmed you can’t get out of bed. These aren’t small things. They shape a child’s early development.

What Are SSRIs, and Which Ones Are Used?

SSRIs-Selective Serotonin Reuptake Inhibitors-are the most commonly prescribed antidepressants during pregnancy. They work by increasing serotonin levels in the brain, which helps regulate mood. The first SSRI, fluoxetine (Prozac), hit the market in 1987. Since then, several others have become standard options: sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), and fluoxetine.

One SSRI, paroxetine (Paxil), is generally avoided during the first trimester because it’s linked to a slightly higher risk of heart defects in the baby. The absolute risk is still low-rising from about 0.5% to 0.7-1.0%-but it’s enough that doctors recommend switching away from it before or early in pregnancy if possible.

Sertraline is now considered the first-line choice. Why? Because it crosses the placenta less predictably than others, has the lowest reported risk of newborn complications, and has the most safety data from large studies. One 2021 study found that about 60-70% of the mother’s dose reaches the baby, but the levels in the baby’s blood are nearly the same as the mother’s-meaning it doesn’t build up dangerously. That’s a good sign.

The Big Fear: Birth Defects and PPHN

The most common worry is whether SSRIs cause birth defects. Large studies of nearly 2 million births in Nordic countries and the U.S. found no meaningful increase in major birth defects. The rate of serious congenital anomalies was 2.5% in babies not exposed to SSRIs and 2.8% in those who were. That’s not a meaningful difference.

One specific concern is Persistent Pulmonary Hypertension of the Newborn (PPHN), a rare but serious lung condition. In the general population, it affects 1-2 out of every 1,000 babies. With SSRI use in the third trimester, that number rises to 3-6 per 1,000. That sounds alarming-but remember, even with SSRI use, the risk is still less than 1%. And when researchers controlled for how severe the mother’s depression was, the link became even weaker. In fact, untreated depression itself increases the risk of PPHN.

Other concerns-like preterm birth or low birth weight-are also tricky. Studies show slightly higher rates in women taking SSRIs. But here’s the catch: women who take SSRIs often have more severe depression, and depression alone increases those risks. When researchers compared women with depression who took SSRIs to women with depression who didn’t, the difference vanished. That’s called “confounding by indication”-and it’s why many earlier studies got it wrong.

What About Long-Term Development?

This is where things get messy. Some studies suggest children exposed to SSRIs in the womb might have a slightly higher risk of autism or anxiety later in life. One 2022 study in JAMA Pediatrics found a 1.3-fold increase in autism risk. But another major study in The Lancet, which accounted for family history and genetics, found no link at all. The difference? The Lancet study looked at siblings-some exposed, some not-and found the risk was the same. That suggests genetics or environment, not the medication, may be the real driver.

There’s also new data from Columbia University showing that by age 15, children exposed to SSRIs in utero had a 28% rate of depression-nearly double the 12% rate in children whose mothers had depression but didn’t take medication. That’s concerning. But experts point out: those children’s mothers likely had more severe, chronic depression. And depression is hereditary. So is it the drug-or the illness?

The NIH’s 2023 review concluded: “The risks of untreated perinatal depression far outweigh the potential risks of SSRIs.” That’s the core truth. If you’re struggling, staying on medication isn’t just about you-it’s about giving your child the best possible start.

What Should You Do?

There’s no one-size-fits-all answer. But here’s what the top medical groups agree on:

• If you’re already on an SSRI and doing well, don’t stop. Stopping increases your chance of relapse by more than four times.
• Sertraline is the safest and most recommended option. Start low (25-50 mg), and increase only if needed.
• Avoid paroxetine in the first trimester.
• Don’t switch medications unless absolutely necessary. Switching can trigger withdrawal or relapse.
• Use the lowest effective dose. More isn’t better.

If you’re thinking about stopping, talk to your doctor first. Abruptly stopping SSRIs can cause dizziness, nausea, brain zaps, and severe mood swings. One study found 73% of women who quit cold turkey had withdrawal symptoms. A slow taper over 4-6 weeks, with weekly depression check-ins, is the safe way.

Monitoring and Support

If you’re on an SSRI during pregnancy, your doctor should monitor you closely. That means checking blood pressure regularly (SSRIs can slightly increase risk of gestational hypertension), watching for signs of preterm labor, and screening for depression using tools like the PHQ-9. After birth, your baby may show signs of neonatal adaptation syndrome-jitteriness, irritability, feeding trouble. It’s common (affects about 30% of exposed newborns) and usually clears up within two weeks. It’s not an addiction. It’s a temporary adjustment.

For long-term peace of mind, some experts now recommend annual mental health check-ups for children exposed to SSRIs in utero, starting at age 12. Use the PHQ-9 with a lower threshold (score of 5 or higher) since kids don’t always show depression the way adults do.

The Bottom Line

The fear of taking antidepressants during pregnancy is real. But so is the risk of not treating depression. The data is clear: for women with moderate to severe depression, the benefits of continuing SSRIs outweigh the risks. Sertraline is the safest choice. Stopping cold turkey is dangerous. And untreated depression doesn’t just hurt you-it affects your baby’s health, development, and future.

You’re not choosing between a perfect pregnancy and a risky medication. You’re choosing between two hard paths-and the safer one is the one that keeps you well enough to care for your child. Talk to your OB-GYN, your psychiatrist, and your partner. Make a plan. You’re not alone in this. And you’re not being selfish for wanting to feel better.