When you’re pregnant and struggling with depression or anxiety, the question isn’t just whether to take an SSRI-it’s whether not taking one might be riskier. Every year, 1 in 7 pregnant women in the U.S. experiences a major depressive episode. For many, the weight of untreated illness-fatigue, hopelessness, panic attacks, even thoughts of self-harm-is heavier than the fear of medication. So what does the science actually say about SSRIs like sertraline, citalopram, or fluoxetine during pregnancy? Let’s cut through the noise.
Why SSRIs Are Commonly Used in Pregnancy
SSRIs, or selective serotonin reuptake inhibitors, were designed to help balance brain chemistry by increasing serotonin levels. They’re not just for severe depression. Many women take them for anxiety, OCD, or panic disorders that flare up during pregnancy. The first SSRI, fluoxetine (Prozac), hit the market in 1987. Since then, millions of pregnant women have used them-and the data has slowly caught up. The real reason doctors recommend them isn’t because they’re perfect. It’s because untreated depression is far more dangerous. According to CDC data from 2022, suicide accounts for 20% of all pregnancy-related deaths in the U.S. That’s more than hemorrhage or preeclampsia. Untreated depression also increases the risk of preterm birth by more than double, and it’s the strongest predictor of postpartum depression. One study found that 14.5% of women with untreated antenatal depression develop postpartum depression-compared to just 4.8% of those who stayed on treatment.The Biggest Risks: What the Data Shows
No medication is risk-free. But when we look at the numbers, the risks are small-and often misunderstood. One concern is persistent pulmonary hypertension of the newborn (PPHN). This rare but serious lung condition affects about 1-2 in 1,000 babies overall. With SSRI use in the third trimester, that number rises to 3-6 in 1,000. That sounds scary, but let’s put it in perspective: even with increased exposure, the absolute risk is still under 1%. Most babies with PPHN recover fully with treatment. Another issue is preterm birth. Some studies show a 1.4-fold increase in preterm delivery among women taking SSRIs. But here’s the key: when researchers adjust for how severe the depression was to begin with, that risk drops almost to zero. In other words, it’s not the medication-it’s the illness-that’s pushing labor early. Low birth weight and low Apgar scores are also slightly more common, but again, these differences vanish when you compare women with depression who took SSRIs to those with depression who didn’t. The real difference? Between women with depression (treated or not) and women without depression at all.Paroxetine Is the Exception
Not all SSRIs are created equal. Paroxetine (Paxil) is the only one with a clear, consistent link to birth defects-specifically heart septal defects. Studies show it increases the absolute risk from about 0.5% to 0.7-1.0%. That’s still low, but it’s enough for guidelines to say: avoid it in the first trimester if possible. If you’re on paroxetine and planning pregnancy, talk to your doctor about switching. Sertraline, citalopram, and escitalopram don’t carry that same risk.Sertraline Is the First-Line Choice
Why is sertraline (Zoloft) recommended first? Because it crosses the placenta less than other SSRIs. Studies show cord blood levels are nearly equal to maternal levels-meaning less drug reaches the baby. It’s also the safest when it comes to PPHN risk among SSRIs. Dosing is straightforward: start at 25-50 mg daily, increase slowly if needed, up to 150-200 mg. Most women do well on the lower end. Fluoxetine (Prozac) is a second-line option. It stays in the body longer, which can be helpful for women who miss doses-but it also means it lingers in the newborn. That’s why some doctors avoid it near delivery, especially if the baby might be sensitive to withdrawal symptoms.
What About Long-Term Effects on the Child?
This is where things get messy. Some studies suggest children exposed to SSRIs in utero might have slightly higher rates of anxiety or depression by age 15. One Columbia University study found 28% of exposed children developed depression by adolescence, compared to 12% of children whose mothers had depression but didn’t take SSRIs. But here’s the catch: those mothers were likely more severely ill. And when researchers compared exposed children to siblings who weren’t exposed, the difference disappeared. A 2021 Lancet study looked at families with genetic risk for autism and found no increased risk from SSRIs. Other large studies-including one tracking 1.8 million births in Nordic countries-found no link between SSRIs and autism when they controlled for family history and maternal mental health severity. The bottom line? There’s no smoking gun. The data doesn’t prove SSRIs cause long-term harm. But it also doesn’t prove they’re completely harmless. That’s why experts say: if you need them, use them. But if you don’t, don’t start them just because you can.What Happens If You Stop?
Stopping SSRIs cold turkey during pregnancy is one of the riskiest choices you can make. A 2022 JAMA Psychiatry trial showed that 92% of women who stopped their medication relapsed into depression-compared to only 21% who stayed on it. Relapse isn’t just about feeling sad. It means skipping prenatal visits, not eating well, using alcohol or drugs, and even neglecting the baby after birth. Abruptly quitting can also cause withdrawal symptoms: dizziness (42%), nausea (38%), and what patients call “brain zaps” (29%). These aren’t imaginary. They’re real, uncomfortable, and can last for weeks. If you’re thinking about stopping, work with your doctor on a slow taper over 4-6 weeks. Test your mood weekly with the PHQ-9 questionnaire. If your score climbs above 10, you’re likely relapsing.What About Breastfeeding?
SSRIs are generally safe while breastfeeding. Sertraline passes into breast milk in the smallest amounts. Most babies show no signs of exposure. Fluoxetine is the worst offender here-it builds up in breast milk over time. If you’re breastfeeding, sertraline or citalopram are preferred. A 2023 review found no evidence of developmental delays, sleep problems, or feeding issues in babies exposed to SSRIs through breast milk. The American Academy of Pediatrics lists SSRIs as compatible with breastfeeding. If your baby seems unusually fussy or sleepy, talk to your pediatrician-but don’t assume it’s the medication without checking.
What Should You Do?
There’s no one-size-fits-all answer. But here’s what the experts agree on:- If you have moderate to severe depression or anxiety, continuing an SSRI is usually safer than stopping.
- Use sertraline as your first choice. Avoid paroxetine.
- Take the lowest effective dose. Don’t increase unless necessary.
- Don’t switch medications mid-pregnancy unless there’s a clear reason.
- Monitor your mood weekly. Use the PHQ-9. If your score goes above 10, reach out.
- If you’re breastfeeding, stick with sertraline or citalopram.
The Bigger Picture
The FDA’s labeling rules changed in 2015 to stop using vague categories like “Category C” and instead give clear, data-driven summaries. That’s why you now see phrases like “no substantial evidence of increased major birth defects” instead of “may be harmful.” The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine both say the same thing: untreated mental illness poses a greater threat to mother and baby than SSRIs. In July 2025, ACOG publicly criticized an FDA panel for ignoring the benefits of SSRIs, calling their approach “alarmingly unbalanced.” Meanwhile, the NIH is launching a $15 million study in 2025 to track 10,000 mother-child pairs over 15 years. We’ll know more in a decade. But right now, the evidence is clear enough to make a decision.Final Thoughts
You’re not choosing between a perfect, risk-free option and a dangerous one. You’re choosing between two imperfect paths: managing your mental health with medication, or risking the consequences of untreated illness. For most women, the scale tips heavily toward continuing treatment. If you’re scared, that’s normal. Talk to your OB, your psychiatrist, your therapist. Ask for the numbers. Ask for the studies. Don’t let fear or guilt make the decision for you. Your mental health matters. Your baby’s health matters. And sometimes, taking a pill is the most loving thing you can do-for yourself, and for them.Are SSRIs safe to take during pregnancy?
Yes, for most women with moderate to severe depression or anxiety, SSRIs are considered safe during pregnancy. Large studies involving over 1.8 million births show no significant increase in major birth defects with SSRIs like sertraline, citalopram, or escitalopram. The biggest risk is from untreated depression, which increases chances of preterm birth, low birth weight, and suicide. Sertraline is the preferred choice due to the lowest risk profile.
Can SSRIs cause autism or developmental delays in babies?
Current evidence does not support a clear link between SSRIs and autism or developmental delays. Some early studies suggested a small increased risk, but those didn’t account for family history or severity of maternal depression. When researchers compared children exposed to SSRIs with their unexposed siblings, no difference in autism rates was found. The 2021 Lancet study and a 2020 JAMA Psychiatry analysis of 1.8 million births found no significant association after adjusting for confounding factors.
Is sertraline better than other SSRIs in pregnancy?
Yes, sertraline is the most recommended SSRI during pregnancy. It has the lowest placental transfer rate, meaning less of the drug reaches the baby. It’s also linked to the lowest risk of persistent pulmonary hypertension of the newborn (PPHN) among SSRIs. Studies show it’s effective for both depression and anxiety, and it’s considered safe for breastfeeding. Most guidelines, including ACOG and SMFM, list sertraline as first-line treatment.
What happens if I stop my SSRI during pregnancy?
Stopping SSRIs abruptly during pregnancy greatly increases the risk of depressive relapse-up to 92% in some studies. Relapse can lead to poor prenatal care, substance use, preterm birth, and postpartum depression. Withdrawal symptoms like dizziness, nausea, and “brain zaps” affect up to 73% of women who quit cold turkey. If you want to stop, work with your doctor on a slow taper over 4-6 weeks and monitor your mood weekly using the PHQ-9.
Can I breastfeed while taking SSRIs?
Yes, most SSRIs are safe during breastfeeding. Sertraline passes into breast milk in the smallest amounts and is the most commonly recommended. Citalopram and escitalopram are also considered low-risk. Fluoxetine stays in the body longer and can build up in the baby’s system, so it’s usually avoided if possible. Studies show no increased risk of developmental delays, sleep problems, or feeding issues in babies exposed to SSRIs through breast milk.
Asia Roveda
November 26, 2025 AT 18:24Let’s be real-any woman who takes SSRIs while pregnant is just lazy and wants an easy way out. You think your feelings matter more than your baby’s health? The data’s clear: these drugs mess with brain development. And don’t even get me started on how hospitals push this stuff like it’s vitamin D. Wake up, sheeple.
My cousin took Zoloft and her kid still can’t focus at 7. Coincidence? I think not.
Micaela Yarman
November 27, 2025 AT 00:37It is of paramount importance to recognize that the clinical management of perinatal mood disorders must be grounded in evidence-based practice, informed by longitudinal epidemiological studies and guided by multidisciplinary consensus. The conflation of correlation with causation, particularly in the context of neurodevelopmental outcomes, undermines the integrity of maternal healthcare decisions. One must not overlook the profound morbidity associated with untreated depression, which, as the source material accurately notes, contributes significantly to maternal mortality and adverse perinatal outcomes. A balanced, individualized approach remains not only prudent but ethically imperative.
Cynthia Springer
November 27, 2025 AT 05:30Wait, so if the risk of PPHN only goes from 1-2 in 1,000 to 3-6 in 1,000… that’s still less than 1%? But then why do so many forums act like it’s a guaranteed disaster? And what about the fact that depression itself increases preterm birth risk? It feels like the scary stats get all the attention while the real danger-the untreated illness-is quietly ignored. I just want to know: if I’m on sertraline and my mood’s stable, am I really putting my baby at more risk than if I quit cold turkey?
Also, is there data on how many women who stop SSRIs end up needing hospitalization postpartum?
Marissa Coratti
November 27, 2025 AT 20:07As a perinatal psychiatrist with over two decades of clinical experience, I must emphasize that the prevailing narrative around SSRIs during pregnancy is not only misinformed but dangerously oversimplified. The fear-mongering propagated by non-clinical sources often stems from a fundamental misunderstanding of pharmacokinetics, statistical confounding, and the biopsychosocial nature of depression. The notion that SSRIs cause autism or developmental delays is not supported by the most rigorous, large-scale, sibling-controlled studies-including those published in The Lancet and JAMA Psychiatry. Moreover, the assertion that stopping medication is a ‘safe’ alternative ignores the fact that 92% of women who discontinue treatment experience clinically significant relapse, which correlates directly with poor fetal growth, inadequate prenatal care, and increased neonatal morbidity. The real public health crisis is not medication use-it’s the systemic failure to provide accessible, nonjudgmental mental healthcare to pregnant women. We must prioritize evidence over anecdote, compassion over fear, and science over sensationalism.
Rachel Whip
November 28, 2025 AT 08:25For anyone panicking about this-sertraline is your best friend. It’s the least likely to cross the placenta, safest for breastfeeding, and has the most data backing it. If you’re on paroxetine, switch. If you’re thinking of quitting, don’t. Talk to your OB and your therapist. Track your mood with the PHQ-9. You’re not being selfish-you’re being responsible. Your mental health isn’t a luxury. It’s the foundation of your baby’s future. And you deserve to feel okay.
Also, if you’re breastfeeding, skip fluoxetine. Sertraline or citalopram are way better. Your baby will thank you.
Ezequiel adrian
November 29, 2025 AT 00:35Bro, I’m Nigerian and we don’t even talk about this stuff here. My cousin took Prozac while preggo and her kid is now a genius at chess. Meanwhile, my auntie’s baby who was ‘naturally’ born to a depressed mom? Never learned to walk till 2. So yeah… meds > suffering. 🤷♂️
Also, why is everyone acting like SSRIs are poison? My grandma smoked through 3 pregnancies and I’m here. Maybe stop being scared of science?
Joe bailey
November 29, 2025 AT 02:24Just wanted to say thank you for writing this. I was terrified when I got pregnant and had been on sertraline for 5 years. Everyone told me to stop. My mom cried. My sister said it’d make my baby autistic. I read the studies. I talked to my doc. I stayed on it. My daughter is 18 months old, hitting every milestone, and I’m finally sleeping through the night. You’re not weak for needing help. You’re strong for choosing yourself. ❤️
Amanda Wong
November 30, 2025 AT 20:59Oh please. The ‘experts’ say it’s fine. The same experts who said thalidomide was safe. The same experts who told women smoking was fine during pregnancy. The same experts who said vaccines don’t cause autism. You’re just trusting the system because you’re too scared to think for yourself. And now you’re poisoning your child with chemicals just so you can feel ‘normal.’
My friend took SSRIs and her kid has sensory issues. Coincidence? Or just the next generation of broken kids? You want peace of mind? Stop taking pills. Try yoga. Eat clean. Walk in nature. Your baby doesn’t need a drug cocktail to survive. You just need to be brave enough to face your emotions without a chemical crutch.
Stephen Adeyanju
December 1, 2025 AT 08:08So I stopped my SSRI because I was scared and now I’m crying every day and my husband left and I don’t know if I can take care of my baby and I feel like I failed and why does no one just tell you this stuff before you get pregnant and why is it so hard to get help and why does everyone act like you’re a monster for needing help and why is the internet full of people who think you’re a bad mom if you take a pill but no one says anything when you’re crying in the shower at 3am and no one tells you that the real danger is not taking it and I just want someone to say it’s okay to be scared and it’s okay to need help and I’m not a bad person for wanting to live
thank you for writing this