Can I keep taking an SSRI during pregnancy?
Penny cited the following
3 peer-reviewed research articles
7 professionally-backed sources
4 articles from healthcare institutions
Overview
Continuing a selective serotonin reuptake inhibitor (SSRI) during pregnancy is generally considered safe for most people, and is supported by major medical organizations. The decision to continue or adjust SSRI treatment should be made in partnership with your OB/GYN or psychiatrist, weighing the benefits of treating depression or anxiety against any potential risks to the fetus. Untreated depression or anxiety during pregnancy can itself lead to significant risks for both the parent and baby.
Key Points
SSRIs and Pregnancy Safety
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General Safety: Most SSRIs do not increase the risk of birth defects or major congenital anomalies. Large studies and clinical guidelines consistently find no significant increase in congenital malformations, fetal growth problems, or long-term developmental issues with SSRI use in pregnancy, compared to the general population.
1ArticleAntidepressants and Pregnancy: What to Know | Johns Hopkins MedicineHowever, stopping your medication ... antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), during pregnancy may worry about whether the medications can cause birth defects....→
Johns Hopkins Medicine
2ArticleSMFM Statement on SSRIs and Pregnancy - Society for Maternal-Fetal MedicineSMFM strongly supports the use of SSRIs to treat depression during pregnancy.→Society for Maternal-Fetal Medicine
3ArticleWeighing the Evidence: Response to the FDA’s Recent Panel on Antidepressant Use in Pregnancy. - MGH Center for Women's Mental HealthThe recent FDA expert panel focused largely on the risks of SSRIs during pregnancy but ignored or diminished the risks associated with untreated depression in the mother. On Monday, the US Food and Drug Administration convened an expert panel to discuss the use and safety of selective serotonergic ...→MGH Center for Women's Mental Health - Women's Mental Health Across the Life Cycle
4ArticleSelective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors in pregnancy: Infant and childhood outcomes | Canadian Paediatric SocietyPerinatal Services BC. Perinatal services BC antidepressant use during pregnancy: Considerations for the newborn exposed to SSRIs/SNRIs, May 2013: www.perinatalservicesbc.ca/Documents/Guidelines-Standards/Newborn/AntidepressantUseExposedNewbornGuideline.pdf (Accessed July 8, 2020)→cps.ca
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Risks of Untreated Depression: Untreated depression or anxiety during pregnancy is associated with higher risks of preterm birth, low birth weight, poor prenatal care, substance use, impaired bonding, and even suicide. Discontinuing antidepressants can lead to relapse of depression, which itself poses risks to both the parent and baby.
1ArticleAntidepressants and Pregnancy: What to Know | Johns Hopkins MedicineHowever, stopping your medication ... antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), during pregnancy may worry about whether the medications can cause birth defects....→2ArticleSMFM Statement on SSRIs and Pregnancy - Society for Maternal-Fetal MedicineSMFM strongly supports the use of SSRIs to treat depression during pregnancy.→3ArticleWeighing the Evidence: Response to the FDA’s Recent Panel on Antidepressant Use in Pregnancy. - MGH Center for Women's Mental HealthThe recent FDA expert panel focused largely on the risks of SSRIs during pregnancy but ignored or diminished the risks associated with untreated depression in the mother. On Monday, the US Food and Drug Administration convened an expert panel to discuss the use and safety of selective serotonergic ...→5ArticleACOG Statement on the Benefit of Access to SSRIs During Pregnancy | ACOG“It is dangerous to minimize the real effects from mental health conditions during pregnancy and postpartum. For the sake of our patients, ACOG continues to assert that all treatment options should be available for people struggling with their mental health during pregnancy.”→
American College of Obstetricians and Gynecologists
6ArticleAntidepressant Use During Pregnancy: Current Controversies and Treatment Strategies - PMCClinical Guidelines for Treatment of Depression During Pregnancy ... Antidepressant use during pregnancy is often necessary in order to prevent maternal psychiatric illness. Discontinuation of antidepressants during or shortly before pregnancy has been associated with a high rate of relapse ...→PubMed Central
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Neonatal Adaptation Syndrome: About 20–30% of babies exposed to SSRIs in late pregnancy may experience mild, temporary symptoms after birth (such as jitteriness, irritability, or breathing difficulties). These symptoms are usually short-lived and resolve without intervention.
1ArticleAntidepressants and Pregnancy: What to Know | Johns Hopkins MedicineHowever, stopping your medication ... antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), during pregnancy may worry about whether the medications can cause birth defects....→4ArticleSelective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors in pregnancy: Infant and childhood outcomes | Canadian Paediatric SocietyPerinatal Services BC. Perinatal services BC antidepressant use during pregnancy: Considerations for the newborn exposed to SSRIs/SNRIs, May 2013: www.perinatalservicesbc.ca/Documents/Guidelines-Standards/Newborn/AntidepressantUseExposedNewbornGuideline.pdf (Accessed July 8, 2020)→7Articleprescribing SSRIs/SNRIs in pregnancy and lactationGeneral advice when prescribing SSRIs/SNRIs in pregnancy and lactation. It is important that mums/ parents are supported to stay healthy in the perinatal period to reduce the risk of more→
NHS Somerset
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Persistent Pulmonary Hypertension of the Newborn (PPHN): Some studies have suggested a very small increased risk of PPHN (a rare lung condition) with SSRI use in late pregnancy, but the absolute risk is low (about 0.3%, or 3 in 1,000 births), and more recent, larger studies have not confirmed a strong association.
3ArticleWeighing the Evidence: Response to the FDA’s Recent Panel on Antidepressant Use in Pregnancy. - MGH Center for Women's Mental HealthThe recent FDA expert panel focused largely on the risks of SSRIs during pregnancy but ignored or diminished the risks associated with untreated depression in the mother. On Monday, the US Food and Drug Administration convened an expert panel to discuss the use and safety of selective serotonergic ...→4ArticleSelective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors in pregnancy: Infant and childhood outcomes | Canadian Paediatric SocietyPerinatal Services BC. Perinatal services BC antidepressant use during pregnancy: Considerations for the newborn exposed to SSRIs/SNRIs, May 2013: www.perinatalservicesbc.ca/Documents/Guidelines-Standards/Newborn/AntidepressantUseExposedNewbornGuideline.pdf (Accessed July 8, 2020)→8ArticleFDA Drug Safety Communication: Selective serotonin reuptake inhibitor (SSRI) antidepressant use during pregnancy and reports of a rare heart and lung condition in newborn babies | FDASafety Announcement Additional Information for Patients Additional Information for Healthcare Professionals Data Summary · [12-14-2011] The U.S. Food and Drug Administration (FDA) is updating the public on the use of selective serotonin reuptake inhibitor (SSRI) antidepressants by women during pregnancy ...→
U.S. Food and Drug Administration
Differences Between SSRIs
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Paroxetine (Paxil): This SSRI has been linked to a slightly higher risk of certain birth defects, especially heart defects, when used in the first trimester. Most guidelines recommend avoiding paroxetine during pregnancy if possible, or switching to another SSRI if already taking it.
4ArticleSelective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors in pregnancy: Infant and childhood outcomes | Canadian Paediatric SocietyPerinatal Services BC. Perinatal services BC antidepressant use during pregnancy: Considerations for the newborn exposed to SSRIs/SNRIs, May 2013: www.perinatalservicesbc.ca/Documents/Guidelines-Standards/Newborn/AntidepressantUseExposedNewbornGuideline.pdf (Accessed July 8, 2020)→9ArticleACOG Guidelines on Psychiatric Medication Use During Pregnancy and Lactation | AAFPThe American College of Obstetricians and Gynecologists (ACOG) has released guidelines on psychiatric medication used by women during pregnancy and lactation. The use of psychotropic medications in these women is a concern because of the risks of adverse perinatal and postnatal outcomes.→
American Academy of Family Physicians
10ArticleAntidepressant Use During Pregnancy | InfantRisk CenterSerotonin Norepinephrine Reuptake ... minimal side effects and have been relatively well studied. It should be noted, however, that not all SSRIs are equally safe during pregnancy, and that ......→infantrisk.com
11ArticleAntidepressant Use During Pregnancy | AAFP(Strength of Recommendation [SOR]: B, based on limited-quality, patient-oriented evidence.) The use of SSRIs or TCAs during pregnancy may increase the risk of preterm birth, low birth weight, respiratory distress, and neonatal convulsions, without obvious subsequent adverse neurodevelopmental ...→ -
Sertraline (Zoloft) and Citalopram (Celexa): These are often preferred during pregnancy due to extensive safety data and low levels in breast milk. However, all SSRIs are considered relatively safe, and the best choice is often the one that has worked well for you in the past.
7Articleprescribing SSRIs/SNRIs in pregnancy and lactationGeneral advice when prescribing SSRIs/SNRIs in pregnancy and lactation. It is important that mums/ parents are supported to stay healthy in the perinatal period to reduce the risk of more→10ArticleAntidepressant Use During Pregnancy | InfantRisk CenterSerotonin Norepinephrine Reuptake ... minimal side effects and have been relatively well studied. It should be noted, however, that not all SSRIs are equally safe during pregnancy, and that ......→11ArticleAntidepressant Use During Pregnancy | AAFP(Strength of Recommendation [SOR]: B, based on limited-quality, patient-oriented evidence.) The use of SSRIs or TCAs during pregnancy may increase the risk of preterm birth, low birth weight, respiratory distress, and neonatal convulsions, without obvious subsequent adverse neurodevelopmental ...→12ArticleEssential Reads: What is the Best Antidepressant to Use During Pregnancy? - MGH Center for Women's Mental HealthThe reality is that most of the antidepressants taken by women today are relatively safe and carry a very low risk to the developing fetus. What separates one antidepressant from another is that some medications have more data to support their reproductive safety than others.→
What the Guidelines Say
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Major Medical Organizations: The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) both support the use of SSRIs for depression and anxiety during pregnancy when clinically indicated. They emphasize the importance of individualized care and shared decision-making.
2ArticleSMFM Statement on SSRIs and Pregnancy - Society for Maternal-Fetal MedicineSMFM strongly supports the use of SSRIs to treat depression during pregnancy.→4ArticleSelective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors in pregnancy: Infant and childhood outcomes | Canadian Paediatric SocietyPerinatal Services BC. Perinatal services BC antidepressant use during pregnancy: Considerations for the newborn exposed to SSRIs/SNRIs, May 2013: www.perinatalservicesbc.ca/Documents/Guidelines-Standards/Newborn/AntidepressantUseExposedNewbornGuideline.pdf (Accessed July 8, 2020)→5ArticleACOG Statement on the Benefit of Access to SSRIs During Pregnancy | ACOG“It is dangerous to minimize the real effects from mental health conditions during pregnancy and postpartum. For the sake of our patients, ACOG continues to assert that all treatment options should be available for people struggling with their mental health during pregnancy.”→
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No Abrupt Stopping: Stopping SSRIs suddenly can cause withdrawal symptoms and increase the risk of depression relapse. Any changes to medication should be discussed with your healthcare provider.
5ArticleACOG Statement on the Benefit of Access to SSRIs During Pregnancy | ACOG“It is dangerous to minimize the real effects from mental health conditions during pregnancy and postpartum. For the sake of our patients, ACOG continues to assert that all treatment options should be available for people struggling with their mental health during pregnancy.”→8ArticleFDA Drug Safety Communication: Selective serotonin reuptake inhibitor (SSRI) antidepressant use during pregnancy and reports of a rare heart and lung condition in newborn babies | FDASafety Announcement Additional Information for Patients Additional Information for Healthcare Professionals Data Summary · [12-14-2011] The U.S. Food and Drug Administration (FDA) is updating the public on the use of selective serotonin reuptake inhibitor (SSRI) antidepressants by women during pregnancy ...→9ArticleACOG Guidelines on Psychiatric Medication Use During Pregnancy and Lactation | AAFPThe American College of Obstetricians and Gynecologists (ACOG) has released guidelines on psychiatric medication used by women during pregnancy and lactation. The use of psychotropic medications in these women is a concern because of the risks of adverse perinatal and postnatal outcomes.→
Research Limitations and Considerations
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Observational Data: Most evidence comes from observational studies, not randomized controlled trials, due to ethical constraints. This means some risks may be over- or underestimated, especially since people who need medication may have more severe illness to begin with.
3ArticleWeighing the Evidence: Response to the FDA’s Recent Panel on Antidepressant Use in Pregnancy. - MGH Center for Women's Mental HealthThe recent FDA expert panel focused largely on the risks of SSRIs during pregnancy but ignored or diminished the risks associated with untreated depression in the mother. On Monday, the US Food and Drug Administration convened an expert panel to discuss the use and safety of selective serotonergic ...→13ArticleSelective Serotonin Reuptake Inhibitors (SSRIs) in Pregnancy: An Updated Review on Risks to Mother, Fetus, and Child - PMCOne large cohort study found that ... in pregnancy (or those who take a higher dose of medication) may have more severe illness compared to those that discontinue medication. As such, both confounding by indication and illness severity can complicate interpretation of observational studies. Due to these limitations, ongoing characterization of the reproductive safety profile of SSRIs remains an ...→14ArticleSafety of psychotropic medications in pregnancy: an umbrella review | Molecular PsychiatryWeighing risks and benefits of the use of psychotropic medicationsduringpregnancy remains a challenge worldwide. We systematically assessed the strength of associations between psychotropic medication use in pregnant people with mental disorders and various adverse health outcomes in both ...→
Nature
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Balancing Risks: The potential risks of SSRIs are generally outweighed by the risks of untreated depression or anxiety during pregnancy. Most people who continue SSRIs during pregnancy have healthy babies.
1ArticleAntidepressants and Pregnancy: What to Know | Johns Hopkins MedicineHowever, stopping your medication ... antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), during pregnancy may worry about whether the medications can cause birth defects....→2ArticleSMFM Statement on SSRIs and Pregnancy - Society for Maternal-Fetal MedicineSMFM strongly supports the use of SSRIs to treat depression during pregnancy.→4ArticleSelective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors in pregnancy: Infant and childhood outcomes | Canadian Paediatric SocietyPerinatal Services BC. Perinatal services BC antidepressant use during pregnancy: Considerations for the newborn exposed to SSRIs/SNRIs, May 2013: www.perinatalservicesbc.ca/Documents/Guidelines-Standards/Newborn/AntidepressantUseExposedNewbornGuideline.pdf (Accessed July 8, 2020)→5ArticleACOG Statement on the Benefit of Access to SSRIs During Pregnancy | ACOG“It is dangerous to minimize the real effects from mental health conditions during pregnancy and postpartum. For the sake of our patients, ACOG continues to assert that all treatment options should be available for people struggling with their mental health during pregnancy.”→7Articleprescribing SSRIs/SNRIs in pregnancy and lactationGeneral advice when prescribing SSRIs/SNRIs in pregnancy and lactation. It is important that mums/ parents are supported to stay healthy in the perinatal period to reduce the risk of more→
Summary
Continuing an SSRI during pregnancy is supported by current evidence and clinical guidelines, as untreated depression or anxiety can pose significant risks to both parent and baby. Most SSRIs are considered safe, with paroxetine being the main exception due to a slightly higher risk of birth defects. The decision should be made together with your OB/GYN or psychiatrist, who can work with you on your personal course of care. Do not stop or change your medication without medical guidance, as this can increase the risk of relapse and withdrawal symptoms. Most people who take SSRIs during pregnancy have healthy pregnancies and babies.
1
Article
Antidepressants and Pregnancy: What to Know | Johns Hopkins Medicine
However, stopping your medication ... antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), during pregnancy may worry about whether the medications can cause birth defects....
2
Article
SMFM Statement on SSRIs and Pregnancy - Society for Maternal-Fetal Medicine
SMFM strongly supports the use of SSRIs to treat depression during pregnancy.
4
Article
Selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors in pregnancy: Infant and childhood outcomes | Canadian Paediatric Society
Perinatal Services BC. Perinatal services BC antidepressant use during pregnancy: Considerations for the newborn exposed to SSRIs/SNRIs, May 2013: www.perinatalservicesbc.ca/Documents/Guidelines-Standards/Newborn/AntidepressantUseExposedNewbornGuideline.pdf (Accessed July 8, 2020)
5
Article
ACOG Statement on the Benefit of Access to SSRIs During Pregnancy | ACOG
“It is dangerous to minimize the real effects from mental health conditions during pregnancy and postpartum. For the sake of our patients, ACOG continues to assert that all treatment options should be available for people struggling with their mental health during pregnancy.”
7
Article
prescribing SSRIs/SNRIs in pregnancy and lactation
General advice when prescribing SSRIs/SNRIs in pregnancy and lactation. It is important that mums/ parents are supported to stay healthy in the perinatal period to reduce the risk of more