Is It Safe to Take Antidepressants While Pregnant or Breastfeeding?

For most women, the answer is reassuring. Several of the commonly used antidepressants are considered compatible with both pregnancy and breastfeeding, and Australian guidelines say it is not usually necessary to stop them. The point many women never hear is that the real choice is rarely “medication versus no medication.” It is much closer to “treated illness versus untreated illness,” because untreated depression and anxiety in pregnancy carry their own risks to mother and baby. Whatever the right answer turns out to be for you, it should always be reached with your doctor, never by stopping medication suddenly on your own.

If you are pregnant, planning a pregnancy, or breastfeeding and weighing up an antidepressant, this article explains what the current evidence actually shows: how common perinatal depression is, what the risks of treatment really look like, why stopping is not automatically the safe option, and how breastfeeding fits into the picture.

You are not the exception, because perinatal depression is common

Around one in five Australian mothers experiences depression or anxiety during pregnancy or in the year after birth, according to the 2023 National Perinatal Mental Health Guideline produced by the Centre of Perinatal Excellence (COPE). Roughly one in ten women experience depression during pregnancy itself, and about one in seven in the year after birth, while anxiety is at least as common and frequently occurs alongside depression.

These are treatable conditions, and seeking help, including medication where it is appropriate, is a sign of good care for yourself and your baby rather than a failure of any kind.

The risk that often gets overlooked is untreated illness

Conversations about antidepressants tend to focus entirely on the medication, as though the alternative of untreated depression were somehow risk-free. It isn’t, and understanding that is the key to making a calm decision rather than a frightened one.

Untreated antenatal depression is associated with measurable risks to the pregnancy and the baby. A systematic review found that it raised the likelihood of preterm birth by roughly one and a half times and of low birth weight by around two times, and the associations extend further to include small-for-gestational-age babies, more complicated deliveries, and a higher chance of the depression continuing into the postnatal period. Beyond those obstetric outcomes, severe untreated illness affects a mother’s sleep, appetite and ability to attend antenatal care, and in the most serious cases it carries risks to her own safety.

This is why perinatal psychiatry frames the decision as a balance rather than a simple instinct to avoid all risk by avoiding the drug. Sometimes the lowest-risk option for both mother and baby is to continue effective treatment, because the question is rarely whether a medicine is perfectly risk-free, but which path, treated or untreated, carries the lower overall risk for this particular woman and her baby.

What the evidence says about antidepressants in pregnancy

Now that we have set the decision in its proper context, it helps to look at the specific concerns women most often raise, because each one is smaller and more manageable than the headlines suggest.

The first is birth defects. The best available evidence argues against any substantial increase in major birth defects from the SSRI class of antidepressants. An early signal linking these medicines to heart defects has largely shrunk or disappeared in the most rigorous studies, particularly those that account for the underlying depression itself and those that compare siblings. In other words, much of the apparent risk reflects the illness and other confounding factors rather than the medication. Some SSRIs have been studied far more extensively in pregnancy than others and a few are generally preferred for that reason, while one or two are usually avoided because of older concerns about a small increase in cardiac defects. Which specific antidepressant is most suitable is an individual decision made with your doctor, and never one to change by stopping abruptly on your own.

A second concern is a rare newborn breathing problem called persistent pulmonary hypertension of the newborn. The evidence here is genuinely mixed, and where a signal does appear it is small, on the order of one or two extra cases per thousand births above the normal background rate, and mainly tied to use later in pregnancy. It is best understood as a small possible increase in an already-rare condition rather than a common outcome.

The concern women hear about most often is neonatal adaptation, where a baby exposed to an SSRI near the end of pregnancy shows jitteriness, irritability, or mild feeding or breathing difficulty in the first days of life. This is reported in up to around a third of exposed newborns, but it is usually mild and self-limiting and has generally settled within about two weeks, managed with simple measures such as skin-to-skin contact, swaddling and frequent feeding. In practice it is something your maternity team will keep a gentle eye on rather than something to fear.

Stopping medication is not automatically the safe choice

It is natural to assume that stopping a medication must be the cautious thing to do, yet for women with moderate to severe depression the opposite is often true, because stopping carries a high risk of relapse at the very time depression is hardest to manage. In a frequently cited study, around 68% of women who stopped their antidepressant in pregnancy relapsed, compared with about 26% of those who continued, and Australian guidance from COPE reflects this in noting the high risk of relapse when medication is ceased and the fact that continuing is often the appropriate, individualised decision.

For milder illness a gradual, planned reduction with added psychological support may be very reasonable. The honest conclusion is that there is no single right answer, because it depends on your history, the severity of your illness and your own preferences, all of which are best worked through with your doctor.

Breastfeeding and antidepressants

The news for breastfeeding is particularly reassuring, since most SSRIs pass into breast milk only in very small amounts. For the commonly used options the relative infant dose, a standard safety measure in which anything under ten per cent is considered acceptable, sits well within the safe range, and the amount actually reaching the baby is often undetectable in their bloodstream.

A few nuances are worth understanding. The antidepressants preferred during breastfeeding are not always the same as those preferred during pregnancy, because a medicine that is generally avoided in pregnancy can be among the safer choices while breastfeeding, which is exactly why these decisions are made stage by stage rather than once and for all. Higher doses can mean slightly more transfer, so the choice and dose are tailored to you and your baby, and the medication that is right for you is decided with your doctor with your history and your baby in mind. NICE actively encourages women to continue breastfeeding while taking these medications, weighing its well-established benefits against the small remaining uncertainties.

What to actually do

If you take just a few things from this article, let them be these. Never stop an antidepressant suddenly, because abrupt cessation risks both discontinuation symptoms and relapse, and any change should be planned with your prescriber. Have the conversation early, ideally before conception or as soon as you know you are pregnant, so that the approach can be calm and planned rather than reactive. Remember that psychological therapy is first-line for milder illness and a valuable addition for more severe illness, and you can read about the types of psychotherapy used in practice.

If you ever have thoughts of harming yourself or your baby, please treat that as an emergency and call 000, or see the crisis support page for more options.

This article is general information rather than personal medical advice, and decisions about medication in pregnancy and breastfeeding should always be made with your own doctor, who knows your history.

Perinatal care with Dr Sangeetha Makielan

Dr Sangeetha Makielan is a Sydney psychiatrist specialising in perinatal mental health, which includes preconception planning, antenatal and postnatal depression and anxiety, and the medication decisions that pregnancy and breastfeeding bring. As part of her broader focus on women’s mental health across the lifespan, she works with each woman to find the approach that carries the lowest overall risk for her and her baby, whether that means continuing, adjusting or carefully reducing medication alongside psychological support.

You do not have to weigh these decisions alone, and with the right information and support the great majority of women find a path that protects both their own wellbeing and their baby’s.

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