Is it safe to take antidepressants while pregnant?

Meeting your mental health needs as a parent benefits you and your children — including when that means taking antidepressants during pregnancy.

I tell my pregnant patients struggling with anxiety or depression what I tell myself as a mother of four: Put your needs at the top of the list, because you can't pour from an empty cup.

When pregnant people don’t prioritize their mental health needs, this can negatively affect the infant’s health. Research has shown maternal anxiety and depression are associated with poor infant attachment. For example, mothers with depression reduce eye contact and struggle more to breastfeed.

Knowing how a parent’s mental health can affect the baby empowers my patients to accept the help they need and know how much their health matters.

Understanding the prevalence of depression in pregnancy

Depression and anxiety are common during pregnancy and postpartum. About 25% of women experience significant depression or anxiety during pregnancy. That means between you and three friends, there’s a chance one of you experienced depression or anxiety during pregnancy or postpartum.

Between 20% and 80% of women experience “baby blues” postpartum, which is a limited period of crying, irritability or feeling overwhelmed between delivery and 10 days after birth. When these feelings continue beyond two weeks and worsen, this may be a sign of postpartum depression.

Women who experience previous episodes of depression and anxiety have an increased risk of developing depression or anxiety during pregnancy. A lack of social support, a challenging life change, like the loss of a loved one or a pregnancy complication, and issues with a partner can all affect someone’s likelihood of developing depression during pregnancy.

Signs of needing antidepressants during pregnancy

Therapy is the recommended treatment for mild to moderate depression — including during pregnancy. In general, selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant that helps increase serotonin levels in the brain to improve mood and reduce anxiety, aren't always effective above placebo in treating mild and moderate depression.

For severe depression, antidepressant treatment combined with therapy is the gold standard of treatment — including during pregnancy and postpartum.

When a patient is depressed, it’s my job to figure out where on the scale the depression or anxiety rates. Signs of severe depression include the following:

• Disinterest in food
• Intrusive and distressing negative thoughts that affect your ability to function
• Feelings of hopelessness
• Feeling detached from yourself and your life
• Feeling exhausted but unable to sleep because of racing thoughts
• Feeling like it's not worth getting out of bed in the mornings
• Difficulty with activities of daily living
• Self-harm
• Thoughts of wanting to end your life

If you are experiencing any of these symptoms, speak to your physician or an established psychiatrist, as well as your partner and supportive loved ones.

Is it safe to take antidepressants during pregnancy?

There's no evidence that antidepressants lead to an increased risk of birth defects.

One risk of taking antidepressants during pregnancy that I discuss with my patients is neonatal withdrawal syndrome. In the same way you might not feel well if you quit taking your antidepressant cold turkey, your baby may experience discomfort from withdrawing from the antidepressant after delivery.

That said, in my decade-plus of prescribing antidepressants to pregnant people, I've never had a patient whose infant needed to go to the NICU or needed a higher level of care because of antidepressant withdrawal.

Simply cuddling your baby is usually enough to comfort an infant who might be experiencing any withdrawal symptoms from antidepressants.

Another increased but rare risk of taking antidepressants during pregnancy is persistent pulmonary hypertension of a newborn (PPHN). This is an extremely rare lung condition that I’ve also never seen in my 11 years of practice.

I absolutely feel comfortable prescribing antidepressants for those experiencing significant depression or anxiety during pregnancy. I've seen countless pregnant patients improve and thrive with antidepressant treatment.

Do antidepressants affect a baby's brain?

Pregnant people experiencing depression or anxiety can feel stuck between a rock and a hard place. While they may worry about how medication may affect the infant, depression or severe anxiety during pregnancy increases an infant's risk of developing depression, anxiety or autism spectrum disorder.

This is why I tell patients you shouldn’t “white knuckle” your way through depression or anxiety in the hope that your baby will be better off. Emerging evidence shows that treating your depression is not harmful to your developing baby, and we know that a mother who is not depressed is best equipped to help her baby.

When prioritizing your health during pregnancy, remember that you and your baby are on the same team. What benefits you often benefits your child’s outcomes and health.

Antidepressants and postpartum depression

Depression or anxiety symptoms during pregnancy are highly predictive of significant postpartum depression and anxiety. Research has shown that a starting dose of antidepressants beginning at 36 weeks helps prevent postpartum depression and postpartum anxiety.

For this reason, when patients have a history of postpartum depression or symptoms of depression and anxiety during pregnancy, I proactively prescribe antidepressants. In my 11 years of this standard of care, only one of these patients developed postpartum depression or anxiety.

Therapy and healthy habits to help reduce symptoms of depression

The decision to treat a patient with antidepressants is not automatic, which comforts my patients. Together, we monitor their symptoms closely and try behavioral interventions like therapy, exercise, sleep hygiene and proper nutrition.

Besides pharmaceutical intervention and therapy, anything that reduces your stress helps alleviate symptoms of depression and anxiety — especially during pregnancy. In my own life, I take stress reduction so seriously that I take a slightly longer route to work because the traffic pattern is less stressful. It takes a few more minutes, but reducing stress is simply the safer, easier option.

Look for small ways to reduce stress in your own life, such as ordering groceries online, getting help around the house or avoiding heavy traffic.

Don’t underestimate the power of healthy habits that help you feel better throughout pregnancy and also help reduce stress.

Here are a few healthy habits I recommend to patients at all times for a sound mind and sound body, but especially during pregnancy:

• Keep exercising: Exercise, like running, that releases endorphins and reduces stress is important at any time — and especially during pregnancy. Of course, you should follow the guidance of your Ob/Gyn, but if you can safely continue exercise that you loved before pregnancy, keep it up while pregnant.
• Stay nourished: Prioritize balanced meals to maintain your energy levels throughout the day. If you can tolerate eating protein while pregnant, it will help you feel full and provide essential nutrients for you and your baby.
• Stay hydrated: When you're overwhelmed, hydration is often the first thing you neglect. Keep a water bottle with you and drink regularly to stay hydrated for your well-being and your baby’s health.
• Prioritize sleep: Adequate sleep reduces the risk of depression and anxiety and can also lead to better health outcomes. Make rest a priority, whether you get a full night’s sleep or take naps.
• Learn to meditate: Making time to quiet your mind through practicing meditation or even deep breathing is a powerful tool for stress relief. If you’re new to meditation, there are many apps and online resources to guide you through mindfulness practices.

Whenever I'm on an airplane, I smile when a stewardess tells parents to secure their oxygen masks before their children. It’s a metaphor that applies to my personal lived experience, as well as my research and professional practice. Children are always better off when their parents are okay.