Antidepressants During Pregnancy

Written and Fact-Checked by: Jenna Carberg

Can You Take Antidepressants While Pregnant?

Yes, for most people. The American College of Obstetricians and Gynecologists (ACOG) recommends SSRI antidepressants as the first-line medication for depression and anxiety during pregnancy, and recommends against stopping mental health medication just because you are pregnant or breastfeeding. It also notes that the absolute risks of antidepressants in pregnancy appear to be low for almost all psychiatric medications.

That does not mean there are no risks. It means the decision is a comparison between two sets of risks, the medication’s and those of untreated depression, rather than a choice between risk and safety. This page walks through what the research actually shows, in absolute numbers, so you can have that conversation with your prescriber.

One honest caveat up front: no randomized trials have tested antidepressants in pregnancy. Everything below comes from large observational studies, and ACOG grades its own recommendations as based on low-quality evidence.

Which Antidepressant Is Safest in Pregnancy?

There is no single proven safest antidepressant. ACOG’s guidance is:

  • If an antidepressant has worked for you before, that medication should usually be the choice, from any class.
  • If you have never taken one, sertraline (Zoloft) or escitalopram (Lexapro) are reasonable first choices. Sertraline is often preferred because it has the most extensive reassuring safety research.

Drug-by-drug guides: Zoloft, Lexapro, Wellbutrin and Prozac.

Birth Defects

About 3 in every 100 babies are born with a birth defect regardless of medication. The question is whether antidepressants add to that.

  • In a Nordic study of 2.3 million births, 3.7% of SSRI-exposed babies had a birth defect compared with 3.1% of unexposed babies. When researchers compared siblings, which cancels out family and genetic factors, the difference essentially disappeared, pointing against the medication as the cause.
  • In a U.S. study of nearly 950,000 pregnancies, heart defects occurred in about 90 per 10,000 exposed babies and 72 per 10,000 unexposed. But among women who all had depression, with full adjustment, the risk was nearly identical.
  • A meta-analysis of more than 9 million births found that when the comparison was limited to women with a psychiatric diagnosis, SSRIs were not linked to a significant increase in major birth defects or heart defects.

The main exception is paroxetine (Paxil), which has been linked to a small increase in heart defects and is not among ACOG’s preferred choices.

PPHN: The “Six-Fold” Risk Is Outdated

Persistent pulmonary hypertension of the newborn (PPHN) is a rare but serious lung condition. You may read that SSRIs raise the risk six-fold. That figure came from a small 2006 study.

  • A 2015 study of 3.8 million pregnancies found PPHN in about 21 per 10,000 unexposed babies and about 32 per 10,000 exposed babies, and concluded the risk increase was much more modest than earlier studies suggested.
  • ACOG estimates the absolute risk at about 1 to 2 additional cases per 1,000 births.
  • MotherToBaby puts the overall chance at under 1% even if the association is real.

In 2011, the FDA advised clinicians not to change their practice of treating depression in pregnancy because of PPHN concerns.

Newborn Adaptation Symptoms

Some babies exposed to antidepressants late in pregnancy have temporary symptoms after birth, such as jitteriness, irritability, feeding trouble or breathing that is faster than usual.

  • Most studies put this at 10% to 30% of exposed babies.
  • Symptoms usually appear in the first few days and resolve within two weeks. Most are mild; some babies need extra monitoring.
  • Fluoxetine and paroxetine have been linked to it more often.
  • Tapering or stopping before delivery is not recommended. ACOG notes it does not reduce these symptoms and raises the risk of relapse.

Miscarriage and Preterm Birth

  • Miscarriage: studies disagree. Compared with women who have depression but take no medication, SSRIs were not significantly linked to pregnancy loss in data summarized by ACOG.
  • Preterm birth: in a Swedish study of 1.6 million children, the sibling comparison still showed a small increase in preterm birth but none in babies being born small. It is hard to separate the medication from the depression itself, because untreated depression is also linked to preterm birth.

Autism and ADHD

This is one of the most common fears, and the best evidence is reassuring. A 2026 meta-analysis of 37 studies reached a similar conclusion; see what the largest review shows. In a U.S. study of 3.2 million pregnancies that compared siblings, antidepressant exposure was not linked to autism or ADHD, and the authors concluded that antidepressant use in pregnancy itself does not increase the risk. A large Swedish sibling analysis reached the same conclusion. Earlier links appear to be explained by the underlying depression and genetics.

The Risks of Untreated Depression

  • In a study of women with a history of major depression, 68% of those who stopped their antidepressant during pregnancy relapsed, compared with 26% of those who continued. Pregnancy does not protect against depression.
  • A 2026 Kaiser Permanente study of 6,552 patients found that stopping antidepressants during pregnancy was linked to more postpartum depression.
  • Depression in pregnancy is linked to higher rates of preterm birth and low birth weight.
  • Untreated depression can lead to poor self-care, missed prenatal care, substance use, postpartum depression and difficulty bonding.
  • Suicide is a leading preventable contributor to maternal deaths in the United States.

Do not stop an antidepressant suddenly on your own. Stopping abruptly can cause withdrawal symptoms and relapse. If you want to change or stop, plan it with your prescriber. For mild to moderate depression, therapy is also a first-line option; see depression during pregnancy.

What Happened to Pregnancy Categories?

You may see Zoloft or Lexapro described as “Category C.” Those letter grades no longer exist.

  • The FDA’s Pregnancy and Lactation Labeling Rule, effective June 30, 2015, removed the A, B, C, D and X categories from drug labels, because the FDA found them confusing and overly simplistic.
  • Labels now contain a written risk summary, clinical considerations and the underlying data for pregnancy and breastfeeding.
  • Zoloft, Lexapro, Prozac and Wellbutrin were all Category C. The letter was based largely on animal studies and a lack of human trials, and it never ranked these drugs against each other.

Anxiety Medications During Pregnancy

  • SSRIs are also first-line for anxiety in pregnancy, with sertraline or escitalopram as reasonable first choices.
  • Benzodiazepines (such as lorazepam or clonazepam) should be avoided or used sparingly, according to ACOG. Their safety profile is relatively reassuring for birth defects, and older links to cleft palate have not held up in recent studies, but late-pregnancy use can cause newborn sedation, low muscle tone and NICU admission. Alprazolam (Xanax) should be avoided because of its high addiction and withdrawal risk.
  • Hydroxyzine can be used as an add-on, especially for sleep. Data are limited, and a few newborn withdrawal cases have been reported with use close to delivery.
  • Buspirone has very little pregnancy data, so it is not known whether it is safe.

Antidepressants and Breastfeeding

ACOG recommends against stopping medication because of breastfeeding alone, and says people taking SSRIs or SNRIs can continue breastfeeding. If a medication kept you stable during pregnancy, it generally should not be changed after birth, because the baby’s exposure in pregnancy was far greater than exposure through breast milk. See each drug page for its breastfeeding data.

Talking to Your Prescriber

  • What has worked for me before, and should I stay on it?
  • What is my risk of relapse if I stop?
  • Is my dose the lowest one that keeps me well?
  • What should the pediatric team watch for after birth?
  • What is my plan for the postpartum period, when risk is highest?

Find a perinatal mental health therapist

If you are having thoughts of harming yourself, call or text 988, or call or text the National Maternal Mental Health Hotline at 1-833-TLC-MAMA (1-833-852-6262).

Frequently Asked Questions

What is the safest antidepressant during pregnancy?

There is no single safest one. ACOG says a medication that has worked for you before is usually the best choice; if you have never taken one, sertraline or escitalopram are reasonable first options.

Do antidepressants cause birth defects?

The largest studies, when they account for depression itself or compare siblings, have not found a meaningful increase. The background risk of about 3% applies either way. Paroxetine is a partial exception.

Should I stop my antidepressant when I find out I’m pregnant?

Not without talking to your prescriber. ACOG recommends against stopping because of pregnancy alone, and stopping is linked to a much higher chance of relapse.

Will my baby have withdrawal?

Some babies have mild, temporary symptoms that usually resolve within two weeks. Tapering before delivery is not recommended.

Do antidepressants in pregnancy cause autism?

Large sibling-comparison studies have not found a link.

What pregnancy category are antidepressants?

Pregnancy letter categories were removed from drug labels in 2015. Zoloft, Lexapro, Prozac and Wellbutrin were all formerly Category C, which never meant one was riskier than another.

Are anxiety medications safe during pregnancy?

SSRIs are the first-line choice for anxiety. Benzodiazepines should be avoided or used sparingly, and data on buspirone are very limited.

PostpartumDepression.org Team
Written by:

Jenna Carberg was diagnosed with postpartum depression following the birth of her daughter in 2016. It was a healthy birth but in the following days, Jenna's mood changed quickly. Doctors suggested that it might be the "baby blues", but her husband Chris suggested she seek a second opinion. Jenna was diagnosed with postpartum depression and began a journey that lasted 9 long months with significant ups and downs. Jenna's mental health care and her experiences became a passion for her to share with the world. She and her husband Chris founded PostpartumDepression.org as a support website designed to help women suffering in silence and their loved ones.

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