Antidepressants and SSRIs During Pregnancy

Antidepressants and SSRIs During Pregnancy

Product Recommendations

L Methylfolate 15 mg - A Mood-Boosting Supplement

Methylfolate 15 mg

$76.00

  • Professional Strength - Ask Your Doctor
  • High-Dose L Methylfolate 15 Mg for Natural Mood Support²
  • 3rd-Party Tested for Purity, Potency & Safety
  • 90 Vegan, Non-GMO, Chewable Mint Tablets
Katie Stone - Naturopath

Written By:

Katie Stone - Naturopath
Kari Asadorian - BSN, RN

Medical Reviewer:

Kari Asadorian - BSN, RN
Dr. Nare Simonyan - PhD Pharmaceutical Science

Edited By:

Dr. Nare Simonyan - PhD Pharmaceutical Science
Last updated:

Pregnancy and Depression

An estimated 10% of pregnant women are affected by a mental health disorder, mainly depression.1 Perinatal depression is a serious disorder that can occur during the period from conception through several months after childbirth.2


Symptoms of antenatal depression can include depressed mood, loss of interest or pleasure in activities, feelings of worthlessness or guilt, slowed movement or agitation, impaired thinking or concentration, and recurrent thoughts of death.3


Depression during pregnancy can have serious consequences for both the mother and the baby. Observational data suggest a higher risk of delayed fetal development, low birth weight, miscarriage, and preterm labor or delivery. The mother may also be at higher risk of anemia, diabetes, hypertensive disorders (including preeclampsia), and postpartum depression.4 Some research also suggests that children born to mothers with depression are more prone to developmental delays and behavioural issues. A child’s health and growth continue to be affected if the mother also has postpartum depression.5


The risk of women with untreated prenatal depression developing post-partum depression is 50-62%.6

Antidepressants and SSRIs During Pregnancy

Research into the use of antidepressants in pregnancy is somewhat limited and risks are not certain. However, authors have noted that although selective serotonin reuptake inhibitors (SSRIs) in pregnancy may pose some risk to the developing fetus, the risk associated with untreated depression may be greater.7

Risks of SSRIs During Pregnancy

SSRIs are the most common antidepressants used to treat anxiety and depressive disorders during pregnancy. All SSRIs cross the placenta.


A 2023 review reported that taking SSRIs in pregnancy found ‘small’ risks of pre‑eclampsia, postpartum hemorrhage, preterm delivery, and persistent pulmonary hypertension of the newborn. There appeared to be no clear increase in diagnosed neurodevelopmental disorders overall, but mixed evidence suggesting a possible increased risk of adverse cognitive outcomes and affective disorders later in life.8


A 2023 consensus guideline of 17 meta-analyses reported that most evidence regarding the use of SSRIs, SNRIs, TCAs, atypical antidepressants, benzodiazepines, and Z‑drugs and risks in pregnancy is largely inconsistent, with some studies showing significant risk and others none. The panel found that current studies did not suggest SSRIs significantly increased risk of congenital malformations or persistent pulmonary hypertension, but that evidence is still limited.9

Another 2023 review concluded low absolute risk of clinically relevant negative outcomes with SSRI use in pregnancy when compared to untreated perinatal depression.10


SSRIs do not appear to increase the risk of stillbirth and are not thought to be major teratogens (drugs that cause structural or functional congenital disabilities). 

Longer-term developmental outcomes with antidepressants have not yet been confirmed. 

A 2022 review of 14 sibling-control studies examined evidence of adverse effects of taking antidepressants in pregnancy, including preterm birth, small for gestational age, neonatal size, birth defects, autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), behavioral problems, neurodevelopmental deficits, and scholastic attainment. The review concluded there were few statistically significant differences between siblings who were and were not exposed to SSRIs, and these were generally small with doubtful clinical significance.11


Mothers taking an SSRI during pregnancy and postpartum may have more difficulty breastfeeding.12

Benefits of SSRIs During Pregnancy

Generally, the use of SSRIs during pregnancy can be effective in treating moderate-to-severe maternal depression and anxiety, but this is strictly on a risk-benefit balance, and should be prescribed on a case-by-case basis.


Untreated antenatal depression can have significant adverse effects on the fetus and the mother.13 Relapse rates are higher in pregnant women who discontinue their medication than those who continue, especially if they have a history of depression.14

Some research shows that psychiatric conditions - but not use of SSRIs during pregnancy - are associated with increased risk of neurodevelopmental disorders in offspring.15

Guidelines for Prescribing SSRIs During Pregnancy

Clinicians are currently recommended to assess risks vs benefits when prescribing antidepressants in pregnancy. 

  • Abruptly ceasing medication is not recommended. Major guidelines suggest assessing the mother’s health history, risk of relapse risk, and preferences. For some women, reducing medication slowly or switching to non‑pharmacological options may be considered, while others may need to continue their medication.
  • Pregnant women affected by depression symptoms but not currently taking antidepressants may be advised to seek out non-pharmacological options, depending on the severity of the symptoms. 
  • Clinician guidelines recommend prescribing the lowest effective dose of antidepressant and regularly monitoring the mother’s mental health. Dosage may be increased if the SSRI appears to be effective and tolerated, and the patient feels a higher dose would be more helpful.

Which Antidepressants are Safe to Take During Pregnancy?

  • Sertraline/Zoloft is considered the antidepressant of choice for use in pregnancy and lactation. It may be continued throughout pregnancy and while breastfeeding if benefits outweigh potential risks.
  • Other antidepressants that may be continued throughout pregnancy (if benefits outweigh potential risks) include Citalopram/Celexa, and Duloxetine/Cymbalta. Mirtazapine may be continued but with caution during breastfeeding.

Antidepressants to Avoid During Pregnancy

Fluoxetine has a long half‑life and higher concentrations are found in breastmilk. It may still be used but is not universally recommended in pregnancy.16

Paroxetine has been historically associated with a small increased risk of heart defects, and many guidelines recommend avoiding starting it in pregnancy. However, it may be continued if the mother’s health is stable and cessation poses risks.17

Some SSRIs may cause drowsiness in the mother, which can make bed-sharing unsafe and affect night feeding.

Stopping Antidepressants (or SSRIs) During Pregnancy & the Consequences

Discontinuing antidepressants during pregnancy can result in relapse of depression, which poses significant risks for both the mother and fetus, including the potential for withdrawal symptoms.

Women with a history of depression have higher risk of developing antenatal and postnatal depression, and women who experience depression during pregnancy also have a higher risk for postnatal depression.18 These data reflect the likelihood of symptom recurrence during pregnancy and post-partum.


A 2026 cohort study found that around half of women previously taking antidepressants discontinued treatment during preconception and pregnancy, yet a third of these women restarted treatment in the year after childbirth. 

Only 7% of women who had not taken antidepressants before started treatment after childbirth, while 64% of women taking antidepressants during conception/pregnancy continued taking them in the year after childbirth.19

Methylfolate and Pregnancy Depression

Several studies have shown that people with low levels of folate are at higher risk of developing depression, and also that antidepressants may be less effective.

The MTHFR enzyme is required for the conversion of dietary folate to its active form, methylfolate. 

Methylfolate is the methyl donor in numerous processes, including the methylation of homocysteine to form methionine and S-adenosylmethionine (SAMe), which is then required for the synthesis of neurotransmitters such as serotonin. People with MTHFR mutations are less efficient in processing folate and folic acid to methylfolate, which may lead to lower neurotransmitter production and increased risk of depression. 

Supplementation with methylfolate has been shown to improve symptoms of depression either when taken alone or in combination with an antidepressant.20

Methylfolate has been referred to as a better alternative to folic acid due to its ability to pass the blood brain barrier and bypass the MTHFR impairment.

Patients taking methylfolate alongside SSRIs are found to have significantly better treatment response and fewer side effects.21

Although studies involving methylfolate for treating depression in pregnancy are limited, one study found that supplementation with a prescription prenatal/postnatal product containing 7 mg L-methylfolate, 1 mg folic acid and 2.5 mg folinic acid resulted in significant improvement in depression symptoms.22


A 2024 study involving 88 pregnant women with depression showed improvement after 12 weeks of supplementation with a multivitamin formula that contained methylfolate alongside other vitamins and minerals, plus some herbal extracts.23

Antidepressants and SSRIs During Pregnancy

Key takeaways

  • Icon Depression in pregnancy is not uncommon, and can have serious consequences for both the baby and mother.
  • Icon Taking SSRIs during pregnancy may have some risks, but untreated depression is also dangerous to the fetus and the mother.
  • Icon Methylfolate may be a suitable alternative or adjunct to antidepressants during pregnancy.

Product Recommendations

L Methylfolate 15 mg - A Mood-Boosting Supplement

L Methylfolate 15 mg - A Mood-Boosting Supplement

$76.00

  • Professional Strength - Ask Your Doctor
  • High-Dose L Methylfolate 15 Mg for Natural Mood Support²
  • 3rd-Party Tested for Purity, Potency & Safety
  • 90 Vegan, Non-GMO, Chewable Mint Tablets

Frequently Asked Questions about SSRIs During Pregnancy

Can you take antidepressants during pregnancy?

Yes, antidepressants can be taken during pregnancy, but the type of antidepressant and its effects on both the mother and the fetus must be assessed on a case-by-case basis.

Which SSRI is safest in pregnancy?

Sertraline/Zoloft is generally considered the antidepressant of choice during pregnancy and lactation as it appears to have minimal impact on heart function and low risk of interaction with other medications. Other antidepressants that may be continued throughout pregnancy (if benefits outweigh potential risks) include Citalopram/Celexa, and Duloxetine/Cymbalta.

Why can't you take SSRIs while pregnant?

Antidepressants can be taken during pregnancy, and may be a better option than stopping treatment. The type of antidepressant and its effects on both the mother and the fetus must be assessed on a case-by-case basis.

What are the risks of taking SSRIs during pregnancy?

Evidence regarding risks of taking SSRIs during pregnancy is limited. Current research indicates some SSRIs may increase risks for preterm birth and low birth weight, and pulmonary hypertension. However, similar risks are also associated with untreated depression.

Do SSRIs cross the placenta?

Yes, SSRIs cross the placenta and enter the fetal circulation.

Do SSRIs increase the risk of miscarriage?

Research from 2022 has indicated a possible link between prenatal exposure to antidepressants and miscarriage, but further studies are warranted to evaluate the risk of miscarriage among pregnant women who need these medications.

Do SSRIs affect fetal brain development?

Some small studies have suggested that prenatal SSRI exposure may be associated with reduced brain matter volume in children, but this may be restored in early adolescence.24 Other studies have suggested that prenatal SSRI exposure and brain structure may have some small adverse effects, but further research is pending.25

References

  1. World Health Organization; "Mental Health, Brain Health and Substance Use"; mhGAP Intervention Guide - Version 2.0; 2019 June

    https://www.who.int/teams/mental-health-and-substance-use/promotion-prevention/maternal-mental-health

  2. Marsha Wilcox, Beth Ann McGee, Dawn F Ionescu, Marie Leonte, Lauren LaCross, Jenna Reps, Kevin Wildenhaus; "Perinatal depressive symptoms often start in the prenatal rather than postpartum period: results from a longitudinal study"; Archives of women's mental health; 2020 Feb

    https://pmc.ncbi.nlm.nih.gov/articles/PMC7929945/

  3. Kingi K Mochache; "Depression During Pregnancy And Preterm Birth; A Prospective Cohort Study Carried Out Among Women Attending Antenatal Clinic At Pumwani Maternity Hospital."; University Of Nairobi; 2016

    https://erepository.uonbi.ac.ke/handle/11295/100375

  4. Vitalba Gallitelli, Rita Franco, Sofia Guidi, Ludovica Puri, Marco Parasiliti, Annalisa Vidiri, Georgios Eleftheriou, Federica Perelli, Anna Franca Cavaliere; "Depression Treatment in Pregnancy: Is It Safe, or Is It Not?"; Int. J. Environ. Res. Public Health; 2024

    https://www.mdpi.com/1660-4601/21/4/404

  5. Sarah Benatar, Caitlin Cross-Barnet, Emily Johnston, Ian Hill; "Prenatal Depression: Assessment and Outcomes among Medicaid Participants"; The Journal of Behavioral Health Services & Research; 2020 Feb

    https://link.springer.com/article/10.1007/s11414-020-09689-2

  6. Vitalba Gallitelli, Rita Franco, Sofia Guidi, Ludovica Puri, Marco Parasiliti, Annalisa Vidiri, Georgios Eleftheriou, Federica Perelli, Anna Franca Cavaliere; "Depression Treatment in Pregnancy: Is It Safe, or Is It Not?"; Int. J. Environ. Res. Public Health; 2024

    https://www.mdpi.com/1660-4601/21/4/404

  7. Georgios Eleftheriou, Riccardo Zandonella Callegher, Raffaella Butera, Marco De Santis, Anna Franca Cavaliere, Sarah Vecchio, Alessandra Pistelli, Giovanna Mangili, Emi Bondi, Lorenzo Somaini, Mariapina Gallo, Matteo Balestrieri, Umberto Albert; "Consensus Panel Recommendations for the Pharmacological Management of Pregnant Women with Depressive Disorders"; Int J Environ Res Public Health.; 2023 Aug

    https://pmc.ncbi.nlm.nih.gov/articles/PMC10454549/

  8. Lindsay G Lebin, Andrew M Novick; "Selective Serotonin Reuptake Inhibitors (SSRIs) in Pregnancy: An Updated Review on Risks to Mother, Fetus, and Child"; Curr Psychiatry Rep.; 2023 Oct

    https://pmc.ncbi.nlm.nih.gov/articles/PMC10590209/#S8

  9. Georgios Eleftheriou, Riccardo Zandonella Callegher, Raffaella Butera, Marco De Santis, Anna Franca Cavaliere, Sarah Vecchio, Alessandra Pistelli, Giovanna Mangili, Emi Bondi, Lorenzo Somaini, Mariapina Gallo, Matteo Balestrieri, Umberto Albert; "Consensus Panel Recommendations for the Pharmacological Management of Pregnant Women with Depressive Disorders"; Int J Environ Res Public Health.; 2023 Aug

    https://pmc.ncbi.nlm.nih.gov/articles/PMC10454549/#sec7-ijerph-20-06565

  10. Lindsay G Lebin, Andrew M Novick; "Selective Serotonin Reuptake Inhibitors (SSRIs) in Pregnancy: An Updated Review on Risks to Mother, Fetus, and Child"; Curr Psychiatry Rep.; 2023 Oct

    https://pmc.ncbi.nlm.nih.gov/articles/PMC10590209/

  11. Frank M C Besag, Michael J Vasey; "Should Antidepressants be Avoided in Pregnancy?"; Drug Saf.; 2022 Dec

    https://pmc.ncbi.nlm.nih.gov/articles/PMC9829627/

  12. National Institute of Child Health and Human Development; "Fluoxetine"; Drugs and Lactation Database (LactMed®) [Internet]; 2006

    https://www.ncbi.nlm.nih.gov/books/NBK501186

  13. Lindsay G Lebin, Andrew M Novick; "Selective Serotonin Reuptake Inhibitors (SSRIs) in Pregnancy: An Updated Review on Risks to Mother, Fetus, and Child"; Curr Psychiatry Rep.; 2023 Oct

    https://pmc.ncbi.nlm.nih.gov/articles/PMC10590209/

  14. Lee S Cohen, Lori L Altshuler, Bernard L Harlow, Ruta Nonacs, D Jeffrey Newport, Adele C Viguera, Rita Suri, Vivien K Burt, Victoria Hendrick, Alison M Reminick, Ada Loughead, Allison F Vitonis, Zachary N Stowe; "Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment"; JAMA; 2006 Feb

    https://pubmed.ncbi.nlm.nih.gov/16449615/

  15. Jennifer L Ames, Christine Ladd-Acosta, M Daniele Fallin, Yinge Qian, Laura A Schieve, Carolyn DiGuiseppi, Li-Ching Lee, Eric P Kasten, Guoli Zhou, Jennifer Pinto-Martin, Ellen Howerton, Christopher L Eaton, Lisa A Croen; "Maternal Psychiatric Conditions, Treatment with SSRIs, and Neurodevelopmental Disorders"; Biological psychiatry; 2022 Aug

    https://pmc.ncbi.nlm.nih.gov/articles/PMC8504533/

  16. National Institute of Child Health and Human Development; "Fluoxetine"; Drugs and Lactation Database (LactMed®) [Internet]; 2006

    https://www.ncbi.nlm.nih.gov/books/NBK501186

  17. Organization of Teratology Information Specialists (OTIS); "Paroxetine"; MotherToBaby | Fact Sheets [Internet]; 2025 Apr

    https://www.ncbi.nlm.nih.gov/books/NBK582896/

  18. Nasrin Jahan, Terry R Went, Waleed Sultan, Alisha Sapkota, Hajra Khurshid, Israa A Qureshi, Michael Alfonso; "Untreated Depression During Pregnancy and Its Effect on Pregnancy Outcomes: A Systematic Review"; Cureus; 2021 Aug

    https://pmc.ncbi.nlm.nih.gov/articles/PMC8448270/

  19. Ella J Marson, Irene Petersen, Sonia Saxena, Patricia Schartau, Holly Christina Smith; "Continuation and discontinuation of antidepressant treatment before, during and after pregnancy: a cohort study"; Arch Womens Ment Health.; 2026 Mar

    https://pmc.ncbi.nlm.nih.gov/articles/PMC12971859/#Sec16

  20. Afifa Siddique, Muhammad Masood Khokhar, Akbar Waheed, Uzma Naeem, Shahzad Akhtar Aziz; "Effect of combination therapy of methylfolate with antidepressants in patients with depressive disorder"; BMC pharmacology & toxicology; 2025 Jan

    https://pmc.ncbi.nlm.nih.gov/articles/PMC11752948

  21. Cara T Hoepner, Roger S McIntyre, George I Papakostas; "Impact of Supplementation and Nutritional Interventions on Pathogenic Processes of Mood Disorders: A Review of the Evidence"; Nutrients; 2021 Feb

    https://pmc.ncbi.nlm.nih.gov/articles/PMC7996954/

  22. Marlene P Freeman, Gina M Savella, Taylor R Church, Lina Góez-Mogollón, Alexandra Z Sosinsky, Olivia B Noe, Anjali Kaimal, Lee S Cohen; "A prenatal supplement with methylfolate for the treatment and prevention of depression in women trying to conceive and during pregnancy"; Annals of clinical psychiatry; 2019 Feb

    https://pubmed.ncbi.nlm.nih.gov/30699214/

  23. Hayley A Bradley, Elena Moltchanova, Roger T Mulder, Lesley Dixon, Jacki Henderson, Julia J Rucklidge; "Efficacy and safety of a mineral and vitamin treatment on symptoms of antenatal depression: 12-week fully blinded randomised placebo-controlled trial (NUTRIMUM)"; BJPsych Open; 2024 Jun

    https://pmc.ncbi.nlm.nih.gov/articles/PMC11363078

  24. Dogukan Koc, Henning Tiemeier, Bruno H Stricker, Ryan L Muetzel, Manon Hillegers, Hanan El Marroun; "Prenatal Antidepressant Exposure and Offspring Brain Morphologic Trajectory"; JAMA Psychiatry; 2023 Aug

    https://pmc.ncbi.nlm.nih.gov/articles/PMC10469300

  25. Allison L Moreau, Michaela Voss, Isabella Hansen, Sarah E Paul, Deanna M Barch, Cynthia E Rogers, Ryan Bogdan; "Prenatal Selective Serotonin Reuptake Inhibitor Exposure, Depression, and Brain Morphology in Middle Childhood: Results From the ABCD Study"; Biological psychiatry global open science; 2022 Feb

    https://pmc.ncbi.nlm.nih.gov/articles/PMC10140451/

Katie Stone - Naturopath

About the Author

Katie is a qualified Naturopath (BNatMed) and freelance writer from New Zealand. She specializes in all things health and wellness, particularly dietary supplements and nutrition. Katie is also a dedicated runner and has completed more half-marathons than she can count!

Related Articles

Trusted by Experts. Backed by Science.

Trusted professionals crafting original content backed by verified research. Since 2012, Methyl-Life® has been dedicated to providing evidence-based education to help individuals better understand methylation and nutritional wellness.

  • Expert-authored education

    Expert-authored education

    Every article and guide is written or reviewed by professionals specializing in methylation science and nutritional biochemistry.

  • Research-verified information

    Research-verified information

    Our content references peer-reviewed studies and verified data, ensuring accuracy, integrity, and real-world relevance.

  • Educational leadership since 2012

    Educational leadership since 2012

    A founder-led team collaborating with clinicians, researchers, and health writers to make complex science accessible and actionable.

  • Transparent and trustworthy

    Transparent and trustworthy

    All educational materials undergo internal review for scientific accuracy, compliance, and clarity before publication.

Blog Categories

Table of Contents