What We Know About Antidepressant Use in Pregnancy

  • A recent mouse study suggests that antidepressants used during pregnancy can affect brain development in utero.
  • Experts say that most antidepressants can be used safely during pregnancy. Withholding medication may cause more serious health problems depending on the severity and duration of mental illness.
  • Mindfulness, yoga, and exercise are also effective treatments for depression.

According to a new study, taking antidepressants while pregnant may have an impact on brain development and increase the risk of developing mental disorders in later life.

The findings were published February 16 in Nature Communications. Trusted Source.

Researchers studied the effects of a chemical named fluoxetine in mice.

Fluoxetine increases the level of serotonin within the brain. It is commonly used in SSRI medications like Prozac or Sarafem, which treat depression and perinatal depressive disorders. Researchers studied how serotonin affects the prefrontal cortex in a developing fetus, specifically the effects of serotonin deficiency or surplus on brain development.

The results showed that serotonin has an impact on brain function and how neuronal connections change and adapt. This, in turn, affects how the brain learns.

“This is a fascinating study of postnatal development, but how this applies to the brains of humans remains to be seen,” said Dr. Michael Cackovic, a maternal-fetal medicine doctor at Bridgeport Hospital.

Cackovic was not involved in the study.

Cackovic explained that the brain develops most in the first two to three years of life, and 90% occurs before kindergarten. It would, therefore, make sense to give “pups”; this medication at an early age could cause problems.

SSRIs are transmitted from mother to child during pregnancy.

Researchers studied the effects of serotonin in a part of the developing brain known as the prefrontal cortex when it was exposed to fluoxetine.

Fluoxetine is absorbed not only into the breast milk but also into the placenta.

Dr. Jay Gingrich is a professor of developmental psychology at Columbia University Vagelos College of Physicians and Surgeons. Several studies examined the mental and physical health outcomes of children who were exposed to SSRIs while in utero. Serotonin receptors, pathways, and their functions have been highly conserved throughout evolution (across species). Therefore, it was assumed that the findings from rodents would be relevant to human brain development.

Gingrich added: “It’s difficult to prove unambiguously, but studies have shown increased rates of anxiety, depression, and adjustment disorders as children age into adolescence.” Some studies have shown an increase in autism rates, but they haven’t controlled for the mental health of mothers.

He added that the risk of exposure from breast milk should be much lower than that through placental passage. This shouldn’t discourage mothers from breastfeeding during this time or from resuming SSRI usage.

Experts say that these findings do not mean women who want to get pregnant should immediately stop taking SSRIs.

Dr. Katherine Campbell, associate professor of obstetrics and reproductive sciences at Yale School of Medicine, said: “There are a lot of studies that support the use of SSRIs during pregnancy to help a person achieve remission from depression or anxiety. Katherine Campbell is an associate professor of reproductive sciences and obstetrics at Yale School of Medicine.

Campbell, who was not involved in the study, clarified that babies can experience symptoms if a mother is taking SSRIs during pregnancy.

Campbell stated that withdrawal symptoms can begin after birth in babies born to parents taking fluoxetine or other SSRIs. Withdrawal symptoms include irritability and jitteriness. Newer SSRIs that do not cross the placenta or enter breast milk at high concentrations are available.

Can antidepressants be taken during pregnancy?

Mental health disorders can also be a risk when taking SSRIs during pregnancy. Experts have pointed out that untreated mental illnesses can have serious and established consequences for maternal and infant health.

For example, Ariadna Forray, Yale School of Medicine associate professor of psychiatry and director at the Center for Wellbeing of Women and Mothers, Psychiatry. Yale Medical Director, ACCESS Mental Health for Moms.

Forray did not participate in the study.

Gingrich stated that “the irony is both untreated maternal depressive disorder and antidepressant use increase the risk of anxiety and depression disorders in children later in life.” This problem has made it difficult to determine whether SSRIs used during pregnancy are a net benefit to the child or if we are exacerbating trends that were expected based on maternal history.

If you are pregnant while taking SSRIs, you should speak to your doctor about whether it makes sense to stop the medication.

It is difficult to stop medication during pregnancy in many cases due to the severity of the symptoms of the mother.

We have worked in this field for the past 20 years to try to give clinicians and patients a better risk-benefit analysis to inform their decisions. Gingrich said that this work will continue.

Other Treatment Options for Depression

If you want to avoid SSRIs, other non-pharmacological treatments can be explored after speaking to your psychiatrist and doctor.

Forray said that “evidence-based treatments include cognitive behavioral therapy, interpersonal psychotherapy, and mindfulness.” Support groups, yoga, meditation, and exercise are also helpful additions to the evidence-based treatment.

Gingrich also explained that “there are several effective psychological therapies for depressive disorders during pregnancy, and in the period following childbirth (IPT,CBT), and there are non-SSRI medications which are specifically indicated for postpartum depression (e.g. Zurzuvae, or zuranolone).” The US must improve access to and reimbursement for non-pharmacologic treatments. This is often a barrier to getting the right psychotherapy for an expectant mother.


A new mouse study suggests that antidepressant usage during pregnancy could affect brain development. Further research is required.

Experts agree that the majority of antidepressants can be used safely during pregnancy. Withholding medication during pregnancy can cause greater health risks to the pregnant woman and her child.

There are many other options to treat depression symptoms besides medication. There are many ways to treat depression, including cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), support groups, mindfulness and yoga, as well as exercise.


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