Antidepressants During Pregnancy, Breastfeeding, and Trying to Conceive

About 18% of women in the U.S. use antidepressants regularly. By far the most common antidepressants are the selective serotonin reuptake inhibitor (SSRI) class, making up about three-quarters of prescriptions. The period of trying to conceive through postpartum can be times of significant stress and mental health challenges, making the question of the use of SSRIs during these periods a salient one for many people.

However, people often find that there aren’t easy answers to the most basic questions: Does my SSRI affect my fertility? Should I keep taking it during pregnancy? What about during breastfeeding? More troubling, when these questions are discussed, the language can quickly turn to phrases like, Well, you can take it if you really feel like you need it. This approach reinforces the idea of maternal sacrifice being a key way we show love for our children. The message comes across as: only if you’re really selfish would you put your mental health needs above some possible risk to the infant.

A lot of people are enormously helped by SSRIs. It can be hard, though, to move forward with the choice to take these medications without understanding better the data behind the possible risks to the child. I am going to run through that data today — what there is of it — and then return to this question of framing the choice.

A note: this discussion focuses on SSRIs. There is significantly less research on other classes of antidepressants, although the research we do have echoes the conclusions from the SSRI data.

SSRIs while trying to conceive

There are two main concerns here: potential risks to the fetus and impacts on fertility.

Considering first the risks to the fetus, there is little reason to stop using antidepressants while trying to conceive. First, as I get into below, the evidence on pregnancy is mixed, and for many people, it will make sense to continue taking their medications during pregnancy. Second, the half-life of these medications is short, meaning that if you stopped taking them when you found out you were pregnant, the exposure of the fetus would be minimal.

As for conception, there is some evidence that fertility is lower for women on antidepressants, but this is very hard to interpret causally since it is impossible to separate the effects from the impact of depression. Having depression may affect sexual behavior or be correlated with other factors that might make conception less likely.

In other words, the data is on your side if you continue to take SSRIs while trying to conceive.

SSRIs in pregnancy

Studying the impacts of SSRIs in pregnancy is challenging, due in part to the lack of randomized controlled trials. Our ideal approach would be to recruit a sample of pregnant people who were candidates for antidepressants, randomize whether they were treated with medication, and then observe outcomes for their children.

This experiment is likely to be infeasible for both ethical and practical reasons. On the ethical side, one could argue that it is unethical either to expose infants to SSRIs or to withhold them from pregnant people for research purposes. Also, generally, we do not like to experiment on pregnant women, which is a broader issue for drug access. Practically, it is not likely to be an experiment that many women are going to be interested in participating in. Whatever the reason, we do not have evidence like this.

In the absence of this type of evidence, we must make use of observational studies that look for differences in birth outcomes or other childhood experiences based on prenatal antidepressant exposure. A good aspect of these studies is that they tend to be extremely large. The data resources of many European countries make it possible to link together information on medical exams, drug treatments, and birth outcomes for entire populations.

The major issue with studying this problem, though, is that it is hard to separate the impact of mental health issues from the impact of antidepressants. This is important because, from an individual standpoint, if you need an antidepressant, the choice you face is to have untreated depression/anxiety or treated depression/anxiety. Researchers want to try to isolate the impact of treatment. But since antidepressant usage is correlated with other characteristics, our correlation-versus-causality problem is significant.

What are the major concerns?

There are four major concerns with antidepressant use in pregnancy: (1) a risk for the child to develop autism or ADHD, (2) birth defects or higher mortality risks for infants, (3) birth and postpartum complications for the mother, and (4) shorter-term newborn complications, possibly related to withdrawal.

Autism and ADHD

There is a correlation between antidepressant use in pregnancy and a child developing autism and ADHD. However, in the best data, we can see this relationship does not seem to be driven by the antidepressant usage.

A 2026 meta-analysis used data from 37 studies with almost 25 million pregnancies. At first, the results look concerning. When the authors compare children who were exposed during pregnancy to those who were not, they do find a higher rate of these neurodevelopmental issues in exposed children.

But when they dug deeper, this doesn’t hold up. First, when they accounted for differences across families, the effect became much smaller and was no longer statistically significant. Second, the same effect showed up when looking at mothers taking antidepressants before pregnancy, as well as fathers’ antidepressant use. Both tests clearly indicate that the underlying characteristics of families are driving these differences, not the antidepressant itself. Overall, our best evidence does not support a causal link here.

Birth defects

Among the most studied questions is the impact of SSRIs on birth defects — and the evidence is reassuring. Studies that compare people with untreated depression to those who take SSRIs don’t show an increased risk, nor do studies that use a sibling-comparison design (which control for shared family factors).

Although some studies show elevated risks of cardiovascular issues in infants, the better studies of this — those that are able to adjust for more variables — do not. There is similarly no good evidence that antidepressant use impacts stillbirth, miscarriage, or infant death.

Maternal complications

In the case of maternal complications, there are two categories that seem to show elevated risk. One is postpartum hemorrhage (PPH) — heavy postpartum bleeding, which needs medical attention. A large registry study in Sweden showed a higher risk of PPH among those who took SSRIs, even relative to women with untreated depression. The second issue is preterm birth; a meta-analysis of data on preterm birth shows an elevation in risk.

In both cases, it is important to note that the effects are small in absolute terms; there appears to be about a 1.5 percentage point increase in the PPH risk, for example. These effects also appear only when using SSRIs close to delivery, not with use earlier in pregnancy.

Newborn risks

When we turn to the newborn, the primary concerns are the possibility of elevated NICU admission, respiratory issues, and a serious condition called persistent pulmonary hypertension. The best evidence on these comes from registry-based data in Sweden. The study covers about 740,000 infants, of whom 2.4% were exposed to SSRIs during gestation. The authors find that infants who are exposed to SSRIs, especially in later pregnancy, have a higher risk of NICU admission, respiratory issues, and pulmonary hypertension.

This paper, though scary, has very notable limitations. In particular, the comparison is of exposed and unexposed infants, but not between infants of mothers with depression who are treated versus untreated. Mothers who take SSRIs are, on average, older, more likely to be obese, and more likely to smoke; they are also more likely to have diabetes, gestational diabetes, hypertension, or preeclampsia; use opioids or other neurotropic drugs or sedatives; and have a cesarean section.

These differences in demographics are large and the effects of SSRIs are much smaller when the authors adjust for them. This leads to a concern that if they could see more information about these women, the effects would be even smaller. To give you a sense of how small these effects are: In the case of persistent pulmonary hypertension, the authors estimate that it occurs at a rate of three in 1,000 among non-exposed newborns. Using their most controlled estimates, they would estimate an increase of less than one per 1,000 as a result of SSRI exposure.

A final note is that in other data from the UK, focusing on preterm birth specifically, the authors find that although there is a correlation between SSRI use and preterm birth, it seems to be driven entirely by a higher risk among women with depression, not by whether they are treated or not. Pulling this all together, it is hard to fully reject these concerns, but they are very small.

Navigating the decision

The most convincing risk in the data is maternal hemorrhage. The most concerning data is on the early newborn results, but that is the least convincing evidence. But actually, stepping back, none of this evidence is ironclad.

My sense is that the lack of certainty here, and the complexity of the problem, is what leads us to the language of “Well, if you feel like you need it … ” In a distorted way, this is trying to capture the idea of tradeoffs.

Antidepressants in pregnancy provide tremendous benefits to people who need them. They also may carry some small risks. Because of these small risks, we wouldn’t simply encourage everyone to take an SSRI during pregnancy (or otherwise). We’d encourage people to take them if the benefits outweigh these small risks. “If you need it” is a poorly phrased way to say “consider the benefits.”

As with any tradeoff of this type, my view is that the decision is best made with the full picture of data. This data should also inform what we do to monitor.

For example, we could say some version of “This medicine may carry some small elevated risks if you continue to take it during pregnancy. This includes a small increase in the risk of postpartum hemorrhage and possibly some small risks to your baby right after they are born. We should be aware of these risks when we think about delivery, and you should be aware of them when considering whether or not to take it.”

My point in putting it this way is to say that there is some tradeoff, at least based on the best data we have. The fact that there is a tradeoff, though, doesn’t mean that SSRIs should be discontinued. For most people — maybe not all — the tradeoff is likely to favor continuing their SSRI prescription. If you are in the boat of deciding this, I hope the data will help.

A few specific questions:

My doctor told me to take Zoloft because there is more data on it. Is this true?

It is true that since Zoloft is the most popular first-line SSRI, there is the most data on it. However, the expert discussion of this is very clear that the information we have doesn’t suggest any difference in risk profile across different SSRIs. Moreover, getting back to benefits, people often respond differently to different SSRIs. If you are starting an SSRI during pregnancy, you’ll probably be started on Zoloft. But there is no reason to switch.

Should I move to a smaller dose?

None of the large-scale data we have compares across doses (and it would be hard to learn from that even if it did, since dose and depression severity are likely to be correlated). There is a logic to the idea that lower doses would lower risk, but they also may lower benefits. A general rule of taking the lowest dose that is effective holds, both for pregnant and nonpregnant individuals.

What if I stop later in pregnancy?

The study of newborn complications in Sweden is able to separate early versus late SSRI use, and it finds no elevated risk for use early in pregnancy. I would be reluctant to draw too many conclusions from this, given the issues with the comparison group. Again, though, there are good reasons not to stop that need to be considered.

SSRIs while breastfeeding

This is easier. Antidepressants are passed through breast milk, but we have little or no evidence of negative impacts on infants. There are, of course, reports of infants who are fussy after nursing when mom is taking an antidepressant, but also, infants are fussy a lot.

On the flip side, postpartum depression and anxiety can impact early parenting in significant ways. The huge benefits of treating depression and anxiety, combined with the very reassuring evidence on risks, make this choice a clear one.

The bottom line

• The evidence does not support a causal link between SSRIs and autism, ADHD, or birth defects. The correlations we observe appear to be driven by underlying maternal characteristics rather than the medication itself.
• Real but small risks exist: a slight increase in postpartum hemorrhage and possibly some short-term newborn complications, particularly with later-pregnancy use. These are worth knowing about and monitoring for, not reasons to avoid treatment.
• For most people, the benefits of treating depression and anxiety during pregnancy outweigh the risks. “Only take it if you really need it” is a poor framing — the better question is whether the benefits outweigh the small risks, and for most people they do.
• During breastfeeding, the evidence is even more reassuring. While the medications do pass through the milk, there’s little to no evidence that this has a negative impact on infants.

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