If you’re feeling depressed during pregnancy, you’re not alone. Studies estimate that approximately 9-16% of pregnant women experience depression, with some research suggesting rates as high as 20%. That means potentially two out of three pregnant women in America have experienced at least some symptoms of depression during their pregnancy.
Finding yourself struggling emotionally during what’s “supposed to be” a joyful time can feel isolating and confusing. This is true whether you’re planning to parent your baby or considering adoption. Both paths come with complex emotions, and depression during pregnancy is a real, valid medical condition that deserves support. Most importantly, it’s treatable.
The Question Many Expectant Mothers Ask: Are Antidepressants Safe During Pregnancy?
This is one of the most common and important questions pregnant women and their doctors face together. The answer isn’t simply “yes” or “no”—it’s complex and requires careful consideration of your individual situation.
What Current Research Tells Us
The good news is that decades of research have provided increasingly reassuring data about antidepressant use during pregnancy. Most antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) and older medications like tricyclic antidepressants, are generally considered safe and carry a very low risk to your developing baby.
Here’s what you should know:
Antidepressants don’t cause major birth defects. Multiple studies have found no increased risk of major congenital malformations with the most commonly prescribed antidepressants. All pregnant women have approximately a 3% baseline risk of having a baby with any type of birth defect—and antidepressant use doesn’t significantly change this number.
Some antidepressants have more safety data than others. Sertraline (Zoloft) is often considered a first-line choice because it has decades of use during pregnancy and extensive safety data. Other SSRIs like citalopram (Celexa) also have reassuring safety profiles. Medications like venlafaxine (Effexor), duloxetine (Cymbalta), and bupropion (Wellbutrin) also have growing evidence supporting their safety.
Two medications deserve special caution. Research consistently shows that fluoxetine (Prozac) and paroxetine (Paxil) may carry slightly higher risks than other SSRIs. The American College of Obstetricians and Gynecologists recommends avoiding paroxetine during pregnancy when possible.
Understanding Potential Risks
While the overall safety profile is reassuring, it’s important to understand potential effects:
Neonatal Adaptation Syndrome: About 30% of babies whose mothers take SSRIs may experience temporary symptoms after birth, including increased jitteriness, irritability, or mild breathing difficulties. These symptoms typically resolve on their own and can also occur in babies whose mothers didn’t take antidepressants.
Rare complications: Some studies have linked SSRI use to a very rare condition called persistent pulmonary hypertension of the newborn (PPHN). However, the absolute risk increase is extremely small—around 1% or less—and more recent research suggests the risk may be even lower than initially thought.
Every pregnancy is unique, which is why your healthcare provider will consider your specific medical history, the severity of your depression, and which medication has worked best for you.
The Risk of Untreated Depression
Here’s what’s crucial to understand: untreated depression during pregnancy also carries significant risks—for both you and your baby. When depression goes untreated during pregnancy, research shows increased risks of:
- Preterm birth and low birth weight
- Poor prenatal care and missed appointments
- Unhealthy behaviors like poor nutrition, smoking, or substance use
- Preeclampsia and other pregnancy complications
- Difficulty bonding with your baby after birth
- Postpartum depression
- In severe cases, thoughts of self-harm or suicide
Depression isn’t just feeling sad. It affects your ability to take care of yourself and make healthy choices for your pregnancy. For many women, the benefits of treating depression significantly outweigh the small potential risks of medication.
Making the Decision That’s Right for You
The decision about whether to take antidepressants during pregnancy should be made along with your healthcare team, including your obstetrician and a mental health professional. Consider these factors:
How severe your depression is: If you have mild depression that’s well-controlled, your doctor might suggest trying non-medication approaches first. These might include lifestyle changes such as regular exercise and a healthy diet, psychotherapy, or mind-body practices like yoga and meditation.
However, moderate to severe depression usually needs medication to help you feel better.
Your treatment history: If you’ve been stable on a particular antidepressant, switching medications “just because you’re pregnant” may not be the best approach. Switching can cause unnecessary stress, take time to be effective, and there’s no guarantee the new medication will work as well.
Your previous episodes: Women with a history of severe depression who stop their medication have a high risk of relapse during pregnancy, which can have serious effects.
Your support system and situation: Your family situation, stress levels, other children who depend on you, and available support all factor into the decision.
Alternative Approaches
For some women with mild to moderate depression, or in combination with medication, these approaches may help:
- Psychotherapy: Cognitive behavioral therapy (CBT) and interpersonal therapy have strong evidence for treating depression during pregnancy
- Lifestyle changes: Regular exercise, good sleep hygiene, healthy nutrition, and adequate sunlight exposure
- Social support: Connecting with supportive friends, family, or pregnancy support groups
- Prenatal yoga and mindfulness: Stress-reduction techniques designed specifically for pregnancy
- Electroconvulsive therapy (ECT): For severe depression unresponsive to other treatments, ECT is considered safe and effective during pregnancy
Finding Support and Getting Help
If you’re experiencing depression during pregnancy, here are important steps to take:
- Talk to your doctor about your feelings and symptoms. Be honest about your symptoms; there’s no shame in needing help.
- Consider a consultation with a reproductive psychiatrist who specializes in mental health during pregnancy and can provide expert guidance.
- Surround yourself with positive, supportive people, especially those who’ve experienced similar challenges and can offer understanding without judgment.
- Don’t make medication decisions on your own. Never start or stop antidepressants without discussing it with your doctor first.
- Know the warning signs that require immediate attention: thoughts of harming yourself or your baby, inability to care for yourself, severe hopelessness, or withdrawal from all activities.
- Use screening tools like the Edinburgh Depression Scale to help you and your provider track your symptoms over time.
Can You Take Antidepressants While Pregnant?
Depression during pregnancy is common, treatable, and nothing to be ashamed of. For many women, antidepressants are not only safe to use during pregnancy. They’re essential for maintaining health and wellbeing during this vulnerable time.
The question isn’t simply whether antidepressants are safe, but rather: what’s the best way to keep both you and your baby healthy? For many women, that answer includes medication as part of a complete treatment approach.
Your mental health matters: not just for your own wellbeing, but for your baby’s health and development too. A healthy, stable mother is one of the best things you can provide for your growing baby.
Remember: you deserve to feel good during your pregnancy, and there’s no need to suffer in silence. With the right support and treatment, you can manage depression and have a healthy pregnancy.
If you’re considering placing your baby for adoption, please know that you can access licensed counseling and peer support services at no cost to help you navigate your options and feelings during this time.
This article is for informational purposes only and should not replace professional medical advice. Always consult with your healthcare provider about your specific situation and treatment options.
Editor’s Note: This article was originally published on February 28, 2014, and has since been updated.