{"id":84740,"date":"2025-08-11T07:41:08","date_gmt":"2025-08-11T13:41:08","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=84740"},"modified":"2025-09-24T08:36:46","modified_gmt":"2025-09-24T14:36:46","slug":"the-truth-about-antidepressants-during-pregnancy","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/the-truth-about-antidepressants-during-pregnancy\/","title":{"rendered":"The truth about taking antidepressants during pregnancy"},"content":{"rendered":"
<\/div>
\"A
A federal panel recently raised concerns about the use of antidepressants during pregnancy. But untreated depression poses greater risks to pregnant women than antidepressants. Photo: Getty Images.<\/figcaption><\/figure>\n

If the United States were a coal mine, the rising number of people suffering from depression would be the canary warning of increasing danger.<\/p>\n

The U.S. Centers for Disease Control and Prevention\u2019s National Center for Health Statistics reported last spring that the frequency of depression in adolescents and adults rose 60%<\/a> over the past decade.<\/p>\n

Many pregnant women are among that growing group. By one estimate, depression will burden 14% to 23%<\/a> of women during their pregnancies. It is important that they receive treatment, not only for themselves but for the health of their babies. As the Society for Maternal-Fetal Health Medicine<\/a> recently put it, \u201cUntreated or undertreated depression during pregnancy\u00a0carries health risks, such as suicide, preterm birth,\u00a0preeclampsia, and low birth\u00a0weight.\u201d<\/p>\n

About 8%<\/a> of pregnant women receive treatment with a class of antidepressant drugs called selective serotonin reuptake inhibitors (SSRIs). These drugs block the reabsorption of the neurotransmitter serotonin. That blockage makes serotonin more available to support communication between neurons in key regions of the brain. This, in turn, can help to relieve symptoms of depression.<\/p>\n

SSRIs don\u2019t banish depression, but studies<\/a> show they can help to relieve it. Some people question the safety of prescribing antidepressants for pregnant women.<\/p>\n

These skeptics got a boost late last month when the new U.S. Commissioner of Food and Drugs, Dr. Martin Makary, convened an \u201cExpert Panel on SSRIs and Pregnancy<\/a>.\u201d Most of the panel members raised questions about the dangers for pregnant women who take SSRIs and their children. In their view, the risks include miscarriage and heart defects, autism spectrum disorder and other problems.<\/p>\n

The National Curriculum for Reproductive Psychiatry issued a statement<\/a> after the panel session that strongly disagreed with and refuted many of these claims and reiterated the importance of SSRIs as one important tool for treating depression in pregnant women.<\/p>\n

To learn more about this debate, we spoke with Dr. Sarah Nagle-Yang<\/a>, an associate professor at the University of Colorado School of Medicine<\/a> on the Anschutz Medical Campus<\/a>. Nagle-Yang is also the psychiatry department\u2019s vice chair for quality, executive director of Colorado Women’s Behavioral Health and Wellness<\/a>, and co-chair of the National Curriculum for Reproductive Psychiatry.<\/p>\n

What does research tell us about the use of antidepressant medications during pregnancy?<\/strong><\/h2>\n

There are limitations to the data gathered on the subject, Nagle-Yang said. The biggest obstacle: pregnant women have historically been excluded from randomized controlled studies of all medications. That means there are no head-to-head comparisons between women who take antidepressants during pregnancy and those who don\u2019t.<\/p>\n

\"Dr.
Dr. Sarah Nagle-Yang says the benefits and risks of SSRIs to treat depression in pregnant women have been extensively studied. Photo: University of Colorado School of Medicine.<\/figcaption><\/figure>\n

Even so, Nagle-Yang said there’s plenty of evidence that antidepressants are safe during pregnancy.<\/p>\n

\u201cI do feel confident to say that these are some of the most extensively studied medications in pregnancy.\u201d<\/p>\n

The statement by the National Curriculum in Reproductive Psychiatry that followed the FDA\u2019s \u201cexpert panel\u201d discussion on antidepressants and pregnancy affirmed Nagle-Yang’s views.<\/p>\n

What are the conclusions of the research about the use of antidepressants during pregnancy?<\/strong><\/h2>\n

\u201cThere is a clear and robust consensus\u201d from the American College of Obstetrics and Gynecology<\/a> and other scientific organizations that antidepressant medications can be an important part of the overall plan of care to treat pregnant women who are diagnosed with anxiety and depression, Nagle-Yang said.<\/p>\n

\u201cWhen they are clinically indicated, the benefits of SSRI treatment outweigh the low risk associated with these medications,\u201d Nagle-Yang said.<\/p>\n

How have these antidepressant medications been studied?\u00a0<\/strong><\/h2>\n

Researchers have relied on observational studies of what happens to women during their pregnancies in real time or retrospective studies that attempt to look back and analyze what happened to the women and their children during and after pregnancy, Nagle-Yang said.<\/p>\n

These kinds of studies can yield valuable information, she said. But they can\u2019t fully control for the many factors that may affect a pregnancy, such as the severity of a patient\u2019s depression; other complications, like gestational diabetes; smoking; or patients who stopped taking their medications partway through pregnancy.<\/p>\n

What are the evidence-based risks of taking antidepressants during pregnancy?<\/strong><\/h2>\n

The medical literature shows that about one-third of women who take antidepressants during the second half of their pregnancies show symptoms of a condition called neonatal adaptation syndrome<\/a>.<\/p>\n

\u201cWhat that sometimes looks like is babies that are more reactive than others or maybe have a harder time soothing or initiating feeding,\u201d Nagle-Yang said. \u201cTypically this lasts a couple of days or a couple of weeks.\u201d<\/p>\n

In those cases, mothers and their babies don\u2019t need any particular treatment other than good care, she added.<\/p>\n

Another question is whether taking antidepressants during pregnancy increases the risk of persistent pulmonary hypertension of the newborn<\/a>, or PPHN. It\u2019s a serious condition that restricts the flow of blood to the baby\u2019s lungs.<\/p>\n

Nagle-Yang said the most recent research shows there \u201cmay be\u201d a modest increased risk \u2014 about 1.5 times \u2014 from the average for all pregnant women, which is about one to three live births per 1,000. Even with that increase in risk, PPHN is still \u201ca very rare condition,\u201d Nagle-Yang said.<\/p>\n

She emphasized that she always discusses the risks of taking SSRIs with her patients. However, she also talks with them about the risks of not treating or undertreating their depression.<\/p>\n

Are there studies that analyze the impacts on children who were exposed to antidepressants in utero?<\/strong><\/h2>\n

Yes. A large recent study reported in JAMA Internal Medicine<\/em><\/a> found that children whose mothers took antidepressants during pregnancy were not at risk for issues that surfaced later such as autism spectrum disorder, learning disabilities or attention-deficit\/hyperactivity disorder.<\/p>\n

Another study<\/a> pointed to differences in regions of the brain that help to regulate emotions among children who were exposed to SSRIs before birth. Nagle-Yang called the study \u201cwell-conducted\u201d and said it called for additional research.<\/p>\n

She noted, however, that \u201ca key limitation is that we don\u2019t know how women who continued SSRIs during pregnancy differed from those who stopped.\u201d Researchers also need more information about the severity of a patient\u2019s mental illness and other conditions that might influence their child\u2019s brain development.<\/p>\n

Another crucial point is that changes in the brain structure won\u2019t necessarily affect a child\u2019s social or emotional development, Nagle-Yang said.<\/p>\n

\u201cWhile both SSRIs and untreated depression\u00a0likely influence fetal brain development, current evidence \u2013 though imperfect \u2013 doesn\u2019t suggest that SSRI exposure leads to consistent or lasting differences in developmental outcomes,\u00a0like motor, language, cognition or emotional functioning, across studies and timepoints,\u201d she said.<\/p>\n

Some critics say that the symptoms of depression subside in many cases within five or six weeks. If that is true, would limited use of antidepressants during pregnancy make sense?<\/strong><\/h2>\n

No. \u201cThe reality is that depression often does not resolve quickly on its own,\u201d Nagle-Yang said. \u201cThe best available evidence suggests that only about 10% to 15%<\/a> of depression cases (subside) spontaneously within three months without treatment.\u201d<\/p>\n

A far greater concern is that untreated depression increases the risk of poor pregnancy outcomes and chronic mental health issues, Nagle-Yang said.<\/p>\n

\u201cThat\u2019s particularly concerning during pregnancy, when both the parent and baby\u2019s well-being are at stake.\u201d<\/p>\n

What are the risks of untreated depression and other mental health disorders during pregnancy?<\/strong><\/h2>\n

Beginning with menstruation and continuing through menopause, women experience depression that is linked to fluctuations in reproductive hormones, Nagle-Yang said. These hormones, which are steroids that bind to receptors in the brain, directly affect mood.<\/p>\n

\u201cThe data tell us that there is a subset of women who are especially vulnerable to fluctuations in these reproductive hormones,\u201d Nagle-Yang said. The most dramatic fluctuations occur during the postpartum period, a high-risk time that increases the danger of debilitating depression, negative behaviors like substance use, and suicide.<\/p>\n

\u201cThe biggest risk factor for postpartum depression is untreated depression during pregnancy,\u201d Nagle-Yang said.<\/p>\n

She added that women experiencing depression during pregnancy may find it difficult to keep themselves and their unborn babies healthy with good nutrition and exercise.<\/p>\n

\u201cThe good news is that if you get treatment for your depression during pregnancy, it puts you in a good place going into the postpartum period,\u201d Nagle-Yang said. \u201cIt\u2019s the biggest thing you can do if you are someone with depression.\u201d<\/p>\n

Can untreated depression affect newborns?<\/strong><\/h2>\n

Yes. \u201cYour body is affected by your depression and anxiety,\u201d Nagle-Yang said. \u201cWe see that in increased rates of preterm births and low birth weights among individuals with depression during pregnancy.\u201d<\/p>\n

Are some antidepressants safer or riskier than others?<\/strong><\/h2>\n

As a class, antidepressants are \u201cpretty similar,\u201d Nagle-Yang said. Sertraline (Zoloft) is generally considered the first-line treatment because it has a low transmission to breast milk.<\/p>\n

Some studies have linked paroxetine (Paxil) to \u201ca small but significant\u201d risk of cardiovascular defects in babies exposed to the drug during the first trimester of pregnancy, she said.<\/p>\n

\u201cIf someone is on paroxetine and thinking about pregnancy, it\u2019s a discussion to have,\u201d Nagle-Yang said. \u201cIt\u2019s not a complete contraindication, but it is a different conversation than with other SSRIs.\u201d<\/p>\n

Are there other strategies for a woman who doesn\u2019t want to take medications but would like help with depression?<\/strong><\/h2>\n

Yes. It\u2019s never an \u201ceither-or\u201d proposition to take antidepressant medications or not, Nagle-Yang said. Women may decide, after speaking with their doctors, that they don\u2019t want or need medications to address their depression. There are other options to relieve symptoms, including psychotherapy, physical activity and connections with friends, family and coworkers, she said.<\/p>\n

These steps can also help to improve sleep, which is another important part of relieving symptoms of depression, Nagle-Yang said.<\/p>\n

Is it okay to stop using antidepressants during pregnancy?<\/strong><\/h2>\n

It can be safe to stop using antidepressants during pregnancy, but it’s best not to stop taking the medications abruptly, Nagle-Yang said. People who stop taking SSRIs suddenly are at risk for antidepressant discontinuation syndrome<\/a>, which can cause flu-like symptoms, nausea, insomnia and other issues. A patient who wants to come off the medications should work with their provider to taper their use gradually, she said.<\/p>\n

Ultimately, the decision on medications is personal for each patient and dependent on multiple factors, including how severe their depression is and the factors that protect their emotional wellness, such as a strong support system and access to other therapies, Nagle-Yang said.<\/p>\n

\u201cI fully support people thinking through that with their treatment provider,\u201d Nagle-Yang said.<\/p>\n

She cautioned, however, that she rarely recommends that women with moderate to severe depression discontinue taking their medications, particularly with the added risk of postpartum depression looming.<\/p>\n

What can the medical profession do to improve understanding of the benefits and risks of SSRIs to treat depression in pregnant women? <\/strong><\/h2>\n

The National Curriculum in Reproductive Planning has helped to amass considerable information and education<\/a> to help providers identify and treat psychiatric disorders in pregnant women, Nagle-Yang said.<\/p>\n

\u201cYet this education has not been systematically included in the training of general psychiatry,\u201d she noted. \u201cThat is part of what this organization is trying to address, because we think that every psychiatrist should be able to take care of women across their lifespan.\u201d<\/p>\n

The Accreditation Council for Graduate Medical Education does not recognize reproductive psychiatry as a subspecialty, Nagle-Yang said. However, as of November 2022, there were 16 psychiatry fellowship programs<\/a> focused on women\u2019s mental health and\/or reproductive psychiatry.<\/p>\n

In addition, the Department of Psychiatry at the University of Colorado School of Medicine now offers a one-year fellowship<\/a> in reproductive psychiatry.<\/p>\n

\u201cI think we are slowly but surely building more capacity for training programs around the country,\u201d Nagle-Yang said.<\/p>\n

What expert advice about taking antidepressants would you give to women who are pregnant or considering becoming pregnant?<\/strong><\/h2>\n

Nagle-Yang reiterated that studies of the safety and effectiveness of SSRIs during pregnancy are extensive and added that women should consider their mental and physical health inextricably linked.<\/p>\n

\u201cWe would never say to someone with hypothyroidism, \u2018don\u2019t take your thyroid medication\u2019 during pregnancy. They have an illness and need treatment,\u201d she said. \u201cWe understand that that would not be in the best interest of the pregnancy. I think SSRIs are very much the same way.\u201d<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

If the United States were a coal mine, the rising number of people suffering from depression would be the canary warning of increasing danger. The U.S. Centers for Disease Control and Prevention\u2019s National Center for Health Statistics reported last spring that the frequency of depression in adolescents and adults rose 60% over the past decade. […]<\/p>\n","protected":false},"author":2143,"featured_media":75652,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[6,8],"tags":[9261,113,112,63,4802,309,4010,4009,212],"class_list":["post-84740","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-healthy-living","category-news","tag-autism","tag-behavioral-health","tag-mental-health","tag-pharmacy","tag-poudre-valley-prenatal-program","tag-pregnancy","tag-pregnancy-childbirth-and-newborn-care","tag-prenatal-care","tag-womens-care"],"acf":[],"yoast_head":"\nThe truth about antidepressants during pregnancy - 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