Are Antidepressants Safe During Pregnancy?

Antidepressants are one of the most common and effective treatments for managing depression — and according to the American College of Obstetricians and Gynecologists (ACOG), about 1 in 10 women experience depression during pregnancy.

“It’s so important to feel mentally well during pregnancy,” says Dr. Diana Isaacs, an endocrine clinical pharmacist. “When you feel good, you're more likely to take care of yourself — and that’s crucial for a healthy pregnancy and fetal development.”

Here’s what you need to know about antidepressants, pregnancy, and the safest choices if medication is part of your care.

Why Treating Depression During Pregnancy Matters

Pregnancy affects every woman differently. Some may notice their depression eases, while others find their symptoms get worse — and for some, depression may begin for the first time during pregnancy.

Leaving depression untreated during pregnancy can lead to risks for both the mother and baby, including:

• Poor fetal growth

• Preterm birth

• Low birth weight

• Health issues after birth

• Higher risk of postpartum depression

  
  

“Depression can make it harder to keep up with prenatal care, eat well, exercise, or attend appointments,” says Dr. Isaacs. “That has a direct impact on both mother and baby.”

Should You Stop Taking Medication if You’re Pregnant?

If you’re pregnant — or planning to be — it’s essential to talk to your healthcare provider before starting, stopping, or changing any medications.

While any medication taken during pregnancy can potentially reach the fetus, many antidepressants have been studied and appear to be safe. Experts don’t conduct randomised trials on pregnant women, but long-term observational data has shown encouraging results, especially for certain medications.

The Safest Antidepressants in Pregnancy

The safest and most widely used class of antidepressants in pregnancy are Selective Serotonin Reuptake Inhibitors (SSRIs) — particularly sertraline (Zoloft®).

“These medications have been used for many years, so we have more data on their safety in pregnancy,” Dr. Isaacs explains. “For most women, the benefits of treating depression with an SSRI outweigh the potential risks.”

Antidepressants to Avoid During Pregnancy

There are a few medications that may carry higher risks and are generally avoided during pregnancy:

• Paroxetine: This SSRI has been linked to a small increase in risk for heart defects in babies.

• Tricyclic antidepressants: Older medications in this group have been associated with certain birth defects, particularly involving the baby’s head and neck.

“Thankfully, these medications are less commonly used today — even in non-pregnant people,” Dr. Isaacs adds.

Do Antidepressants Increase the Risk of Gestational Diabetes?

Some studies suggest certain antidepressants might increase the risk of gestational diabetes, but SSRIs have not been linked to a higher risk.

In fact, Dr. Isaacs notes that untreated depression may raise the risk instead, since it can affect lifestyle factors like diet, physical activity, and weight gain.

Non-Medication Options for Managing Depression

If your symptoms improve naturally during pregnancy or if you and your provider decide medication isn’t the best route, there are several alternative treatments:

• Therapy: Talk therapy (like CBT) can help you understand and manage symptoms.

• Lifestyle changes: Exercise, proper sleep, healthy eating, and sunlight exposure can all support mental health.

• Electroconvulsive therapy (ECT): For severe depression, ECT is a safe and effective option during pregnancy and may be recommended when other treatments don’t work.

  
  

“Some women manage their symptoms without medication,” says Dr. Isaacs. “But for others, medication may be the best and safest option — and that’s okay.”

Talking to Your Provider

Dr. Isaacs encourages open, honest conversations with your care team. "The decision to take antidepressants during pregnancy is very personal. It should be made in partnership with your healthcare provider, considering all the risks and benefits.”

Some women may explore going off antidepressants before pregnancy, or tapering in the third trimester to reduce the chance of neonatal withdrawal — although the risk of serious effects is very low.

You Deserve Support

If you’re pregnant and struggling with depression, help is available. Talk to your provider, lean on your support system, and know you’re not alone.