Below is a list of print and online resources about depression and pregnancy.
We encourage you to use these resources to better inform your decision about antidepressant use in pregnancy. Most information in these resources is of high quality. However, we cannot guarantee the accuracy of external websites as they may change over time. Please seek confirmation from other sources or your health care provider as needed.
Books
Canadian Network for Mood and Anxiety Treatments (CANMAT). Seeds of Hope: Nuturing Mental Health. Patient and Family Guide to CANMAT’s 2024 Guidelines for Perinatal Mood, Anxiety, and Related Disorders.
- Downloadable at no cost from the CANMAT Website in English and in French: https://www.canmat.org/2025/02/10/seeds-of-hope-nurturing-mental-health-and-managing-perinatal-mood-anxiety-and-related-disorders/
Best Start (Health Nexus). Managing Depression – A Self-help Skills Resource for Parents Living With Depression During Pregnancy, After Delivery and Beyond (2020)
- Downloadable at no cost from the Best Start Website in English and in French: https://resources.beststart.org/product/m14e-managing-depression-workbook/
Wiegartz, PS and Gyoerkoe KL. The pregnancy and postpartum anxiety workbook:
Practical skills to help you overcome anxiety, worry, panic attacks, obsessions and compulsions.
- Hard copies and electronic copies are available online and in stores.
- Copies can be purchased online and in stores (electronic: ~ $15 – $25; new: ~ $20 – $35).
Peer Support and General Information
Postpartum Support International (PSI)
This website is dedicated to helping women suffering from mood and anxiety disorders during the perinatal period. It provides educational resources to family, friends and healthcare providers so mothers and mothers-to-be can get the support they need. (USA)
- Information about depression during pregnancy and postpartum, and the symptoms and risks of having depression: Under heading, “Depression during Pregnancy & Postpartum”.
- PSI Online Support Group and Chat Rooms and Discussion Boards (free): Under heading, “Get Help”. Note: no professional advice is provided on these online forums.
- Frequently asked questions page: Under heading, “Frequently Asked Questions”.
- Links to resources for mom, dad, and family, and a blog with stories: Under heading, “Learn More”.
- Resources with information about antidepressants in pregnancy.
Medication-Specific Information
First Exposure (Canada)
A Canadian digital information hub and research network providing evidence-based information to the public and health care providers on the safety of medications, plant and environmental substances and other exposures during pregnancy and lactation.
Additional resources
MotherToBaby (United States) and Best Use of Medicines in Pregnancy (BUMPS) (United Kingdom).
Published Guidelines
The Canadian Network for Mood and Anxiety Treatments (CANMAT) 2024 Clinical Guidelines for the Management of Perinatal Mood, Anxiety and Related Disorders: Section 6. includes a section on the antidepressant use in pregnancy.
The American College of Obstetricians and Gynecologists have produced the following guidelines: Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum (2023)
COPE: Centre of Perinatal Excellence was commissioned by the Commonwealth Government of Australia to review and update the National Perinatal Mental Health Guideline, previously developed by beyondblue (2023).
Below is a list of print and online resources about depression and pregnancy.
We encourage you to use these resources to better inform your decision about antidepressant use in pregnancy. Most information in these resources is of high quality. However, we cannot guarantee the accuracy of external websites as they may change over time. Please seek confirmation from other sources or your health care provider as needed.
Books
Canadian Network for Mood and Anxiety Treatments (CANMAT). Seeds of Hope: Nuturing Mental Health. Patient and Family Guide to CANMAT’s 2024 Guidelines for Perinatal Mood, Anxiety, and Related Disorders.
- Downloadable at no cost from the CANMAT Website in English and in French: https://www.canmat.org/2025/02/10/seeds-of-hope-nurturing-mental-health-and-managing-perinatal-mood-anxiety-and-related-disorders/
Best Start (Health Nexus). Managing Depression – A Self-help Skills Resource for Parents Living With Depression During Pregnancy, After Delivery and Beyond (2020)
- Downloadable at no cost from the Best Start Website in English and in French: https://resources.beststart.org/product/m14e-managing-depression-workbook/
Wiegartz, PS and Gyoerkoe KL. The pregnancy and postpartum anxiety workbook:
Practical skills to help you overcome anxiety, worry, panic attacks, obsessions and compulsions.
- Hard copies and electronic copies are available online and in stores.
- Copies can be purchased online and in stores (electronic: ~ $15 – $25; new: ~ $20 – $35).
Peer Support and General Information
Postpartum Support International (PSI)
This website is dedicated to helping women suffering from mood and anxiety disorders during the perinatal period. It provides educational resources to family, friends and healthcare providers so mothers and mothers-to-be can get the support they need. (USA)
- Information about depression during pregnancy and postpartum, and the symptoms and risks of having depression: Under heading, “Depression during Pregnancy & Postpartum”.
- PSI Online Support Group and Chat Rooms and Discussion Boards (free): Under heading, “Get Help”. Note: no professional advice is provided on these online forums.
- Frequently asked questions page: Under heading, “Frequently Asked Questions”.
- Links to resources for mom, dad, and family, and a blog with stories: Under heading, “Learn More”.
- Resources with information about antidepressants in pregnancy.
Medication-Specific Information
First Exposure (Canada)
A Canadian digital information hub and research network providing evidence-based information to the public and health care providers on the safety of medications, plant and environmental substances and other exposures during pregnancy and lactation.
Additional resources
MotherToBaby (United States) and Best Use of Medicines in Pregnancy (BUMPS) (United Kingdom).
Published Guidelines
The Canadian Network for Mood and Anxiety Treatments (CANMAT) 2024 Clinical Guidelines for the Management of Perinatal Mood, Anxiety and Related Disorders: Section 6. includes a section on the antidepressant use in pregnancy.
The American College of Obstetricians and Gynecologists have produced the following guidelines: Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum (2023)
COPE: Centre of Perinatal Excellence was commissioned by the Commonwealth Government of Australia to review and update the National Perinatal Mental Health Guideline, previously developed by beyondblue (2023).
This is what you have told us so far:
How much does it matter?
Your reasons to CONTINUE
antidepressant medication
Your reasons to STOP
antidepressant medication
What else affects your decision?
Positive A factor that makes your decision easier
Negative A factor that makes your decision harder
Thank you for taking the time to use this Patient Decision Aid for antidepressant medication in pregnancy. We hope that the Patient Decision Aid has helped you make a decision that feels right for you.
Women may have trouble making decisions about antidepressant use during pregnancy for a number of different reasons – not only the harms and benefits of the treatment options.
Which of the following are helpful or not helpful in your decision-making?
Browse the options below to learn more. Choose:
-
if the option is helpful,
-
if it doesn’t affect you,
-
if not helpful.
Friends and Family
Women often described friends who worked in the mental health field or had personal experience with mental health problems as particularly important. However, they also cautioned against accepting lay advice.
Partners
Many women feel the opinions of their partners are important in their decision-making – making it easier or harder to make a decision.
Media
Some women feel that the media portrays negative messages about antidepressant use in pregnancy, and that this reduces the chances that they would take medication.
Culture
Women perceive pressure from society and cultural groups.
Providers
Interactions with Physicians
Women describe challenges they have discussing antidepressant use with their care providers.
Other Influences
You may add any additional outside influences impacting your decision-making process by adding them here.
Walton, GD, Ross, LE, Stewart DE, Grigoriadis S, Dennis CL, Vigod S. Decisional conflict among women considering antidepressant medication use in pregnancy. Arch Womens Ment Health. Dec 2014;17(6): 493-501
Now that you have identified what else affects your decision-making, you can discuss these issues with your health care provider to find ways to deal with those factors that are unhelpful to your decision-making.
Please indicate how much each reason matters to you.
Reasons to CONTINUE
antidepressant medication
Reasons to STOP
antidepressant medication
Where are you in your decision-making process now?
Reasons to CONTINUE
antidepressant medication
- My symptoms of depression are less likely to return. Read about this
- Read about this
- If my symptoms of depression come back, this might directly affect the developing baby. Depression may increase the chance of preterm birth or low birthweight, behaviour abnormalities, and long-term problems with child health.
- If my symptoms of depression come back, they might lead to other factors including poor sleep, poor nutrition, poor prenatal care, more smoking, alcohol and drug use, and postpartum depression that could affect the health of my baby. Read about this.
Reasons to STOP
antidepressant medication
- Antidepressant medication might affect the health of my pregnancy. Read about this.
- Antidepressant medication may affect my developing baby including slightly increased risk for heart malformations, preterm birth or low birthweight, persistent pulmonary hypertension of the newborn, and/or neonatal adaptation syndrome .
- Information about long-term child mental health and development after antidepressant use in pregnancy is not definitive.
- I will not have side effects of medication. Read about this.
- I will not have to remember to take daily medication.
- I will not have to pay for medication.
Grigoriadis S, VonderPorten EH, Mamisashvili L, et al. The Impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis. J Clin Psychiatry. Apr 2013; 74(4):e321-341.
Ross LE, Grigoriadis S, Mamisashvili L, et al. Selected Pregnancy and delivery outcomes after exposure to antidepressant medication: a systematic review and meta-analysis. JAMA Psychiatry. Apr 2013; 70(4):436-443.
Robakis TK, Miyares S, Bergink V. Risks and benefits of predelivery taper in pregnant women taking antidepressants. Acta Psychiatr Scand. 2024;150(5):355-359.
Vigod SN, Frey BN, Clark CT, Grigoriadis S, Barker LC, Brown HK, Charlebois J, Dennis CL, Fairbrother N, Green SM, Letourneau NL, Oberlander TF, Sharma V, Singla DR, Stewart DE, Tomasi P, Ellington BD, Fleury C, Tarasoff LA, Tomfohr-Madsen LM, Da Costa D, Beaulieu S, Brietzke E, Kennedy SH, Lam RW, Milev RV, Parikh SV, Ravindran AV, Samaan Z, Schaffer A, Taylor VH, Tourjman SV, Ameringen MV, Yatham LN, Van Lieshout RJ. Canadian Network for Mood and Anxiety Treatments 2024 Clinical Practice Guideline for the Management of Perinatal Mood, Anxiety, and Related Disorders. Can J Psychiatry. 2025 Jun;70(6):429-489.
Wang J, Cosci F. Neonatal withdrawal syndrome following late in utero exposure to selective serotonin reuptake inhibitors: A systematic review and meta-analysis of observational studies. Psychotherapy and Psychosomatics. May 2021:1-9
Gao SY, Wu QJ, Sun C, et al. Selective serotonin reuptake inhibitor use during early pregnancy and congenital malformations: a systematic review and meta-analysis of cohort studies of more than 9 million births. BMC Medicine. 2018;16(1):205.
De Vries C, Gadzhanova S, Sykes MJ, Ward M, Roughead E. A systematic review and meta-analysis considering the risk for congenital heart defects of antidepressant classes and individual antidepressants. Drug Safety 2021 Mar;44(3):291-312.
Masarwa R, Bar-Oz B, Gorelik E, Reif S, Perlman A, Matok I. Prenatal exposure to selective serotonin reuptake inhibitors and serontonin norepinephrine reuptake inhibitors and risk for persistent pulmonary hypertension of the newborn: a systematic review, meta-analysis and network meta-analysis. American Journal of Obstetrics and Gynecology 2019 Jan;220(1):57.e1-57.e13.
Endendijk JJ, et al. Maternal interaction quality moderates effects of prenatal maternal emotional symptoms on girls’ internalizing problems. Infant mental health journal, vol. 38(5), 634-644 (2017).
Raposa E, et al. The long-term effects of maternal depression: early childhood physical health as a pathway to offspring depression. J Adolesc Health 2014; 54:88.
Baker R, Tata LJ, Orton E, Kendrick D. Maternal depression and risk of injuries in children aged 0-4 years: a population-based cohort study. Lancet 2015; 386:S21.
Zhou C, et al. Prenatal maternal depression related to allergic rhinoconjunctivitis in the first 5 years of life in children of the EDEN mother-child cohort study. Allergy Rhinol 2017;8:3132-e138.
Uguz F. Is there an association between use of antidepressants and preeclampsia or gestational hypertension? A systematic review of current studies. Journal of Clinical Psychopharmacology 2017 February; 37 (1): 72-77.
Palmsten K, et al. Use of antidepressants near delivery and risk of postpartum hemorrhage: cohort study of low income women in the United States. BMJ 2013; 347:f4877.
Jiang, HY et al. Antidepressant use during pregnancy and risk of postpartum hemorrhage: a systematic review and meta-analysis. Journal of Psychiatric Research 2016 Dec; 83:160-167.
Zhou, et al. Association between maternal antidepressant use during pregnancy and autism spectrum disorder: an updated meta-analysis. Molecular Autism 2018; 9:21.
Jiang HY et al. Antidepressant use during pregnancy and the risk of attention-deficit/hyperactivity disorder in the children: a meta-analysis of cohort studies. BJOG 2018 Aug; 125(9): 1077-84.
Al-Fadel N, Alrwisan A. Antidepressant use during pregnancy and the potential risk of motor outcomes and intellectual disabilities in offspring: a systematic review. Drugs Real World Outcomes. 2021 Jun;8(2):105-123.
Rommel AS, Bergink V, Liu X, Munk-Olsen T, Molenaar NM. Long-term effects of intrauterine exposure to antidepressants on physical, neurodevelopmental and psychiatric outcomes: a systematic review. J Clin Psychiatry. 2020 May 12;81(3):19r12965.
Where are you in your decision-making process now?
The chances of relapse depend on how severe and long-standing your depression has been.
Out of 1000 women with severe depression who are taking antidepressant medication:
- 680 may relapse if they stop
- 260 may relapse if they continue
For women with milder depression, STOPPING medication may NOT necessarily increase the chance of relapse.
A baby is considered ‘preterm’ if born before the 37th week of pregnancy. The average birthweight for a baby born at term is approximately 3500 grams. Low birthweight is generally considered < 2500 grams.
Babies born preterm or with low birthweight can be at risk for breathing problems, digestive problems, hearing, vision and neurological problems, as well as have longer term health problems and problems with cognitive and motor development. In general, the risk of these problems is greater in infants who are very preterm or of very low birthweight.
For every 1000 pregnancies the number of women with preterm birth are:
- No depression: around 60
- Untreated depression: around 80
- Antidepressant use: between 70 and 90
Most studies suggest that children exposed to either untreated depression OR antidepressants are born only a few days earlier, or < 100 grams lighter than children born to women with no depression.
Compared to infants born to non-depressed mothers, neonates born to depressed mothers were at increased risk in some research studies, for:
- Abnormal arousal and activity patterns
- Disturbed or disorganized sleep
- Irritability or difficult temperament, including excessive infant crying
Exact proportions of infants born to depressed mothers who experience these difficulties are not available because the way these factors are measured is not easy to translate into “proportion affected”.
While the reasons for this are not entirely clear, maternal depression in pregnancy may be linked to increased risk for child health problems, and delays in child motor and language development. Children whose mothers had depression in pregnancy may also be at increased risk for problems with social and emotional health in childhood, including anxiety, depression and attentional or behavioural problems. However, it is unclear how much of this risk for child social and emotional health problems is related to untreated depression in pregnancy itself, to postpartum maternal mental health problems or to shared maternal and child genetic risk for mental health problems.
| Problem | Out of 1000 women with untreated depression | Out of 1000 women with no depression |
|---|---|---|
| Poor Sleep | 200 | 100 |
| Smoking | 300 | 50 |
| Alcohol or Drug Problems | 120 | 50 |
| Postpartum Depression | 670 | 80 |
Poor nutrition and poor antenatal care are also more common among women with depression.
Some studies have suggested that antidepressant medications may increase risk for blood pressure problems in pregnancy, such as preeclampsia or eclampsia, but the risk of this occurring because of antidepressants is thought to be very small. Antidepressant use in pregnancy may increase risk for postpartum bleeding slightly (e.g. ~ 40 in 1000 women taking antidepressants compared to ~ 30 in 1000 not taking antidepressants). The amount of extra blood loss is thought to be very small (~300ml) and does not appear to be linked to complications for the mother or infant.
Infants born to mothers taking antidepressant medications during the first trimester of pregnancy MAY have slightly higher rates of certain heart defects, usually “septal defects” (up to 8 per 1000), compared to the general population (about 5 per 1000).
A “septal defect” is a hole between the heart chambers that results in abnormal blood flow through the heart. Smaller septal defects (more common) can close on their own, and children typically develop normally without lasting effects. Larger septal defects (less common) can be corrected surgically, allowing children to live largely normal lives.
A baby is considered ‘preterm’ if born before the 37th week of pregnancy. The average birthweight for a baby born at term is approximately 3500 grams. Low birthweight is generally considered < 2500 grams.
Babies born preterm or with low birthweight can be at risk for breathing problems, digestive problems, hearing, vision and neurological problems, as well as have longer term health problems and problems with cognitive and motor development. In general, the risk of these problems is greater in infants who are very preterm or of very low birthweight.
For every 1000 pregnancies the number of women with preterm birth are:
- No depression: around 60
- Untreated depression: around 80
- Antidepressant use: between 70 and 90
Most studies suggest that children exposed to either untreated depression OR antidepressants are born only a few days earlier, or < 100 grams lighter than children born to women with no depression.
This is a rare condition where the infant’s lungs do not adapt properly to breathing outside the womb. It requires treatment with oxygen and other supportive measures, and no fatalities have been reported when this occurs after a mother took antidepressants in pregnancy.
For every 1000 pregnancies of women with:
- No depression or untreated depression – about 1 to 2 newborns will have PPHN
- Antidepressants during the 3rd trimester – about 2 or 3 newborns may develop PPHN
This is a more common condition that can arise within 1 to 2 weeks after birth.
- It is usually mild, resolving on its own over 2 weeks
- Symptoms can include: difficulty sleeping or sleepiness, agitation, tremors, jitteriness, shivering, stiff muscle tone, restlessness, irritability, and constant crying, poor feeding, vomiting, or diarrhea and, rarely, respiratory problems or seizures
For every 1000 pregnancies of women with:
- No depression – ~ 100 newborns will have PNAS
- Untreated depression – unknown, may be slightly more than women with no depression
- Antidepressants during 3rd trimester – 200 to 300 newborns will have PNAS
Antidepressant medications do reach the fetus, so research studies have been conducted to understand whether exposure to antidepressants is linked to increased risk for child health problems longer term.
Most studies in this area have focused on risk for child anxiety and mood problems, behavioural problems such as attention deficit hyperactivity disorder, and autism spectrum disorder. Some studies have focused on issues with child physical health and development.
Some of these studies have suggested that antidepressants may lead to a small increased risk for these problems. Studies that accounted well for other possible explanations, such as untreated depression in pregnancy itself, postpartum maternal mental health problems and shared maternal and child genetic risk for mental health problems do not support the idea that antidepressant medications are causing increase in risk.
Therefore, the chance that children of depressed mothers will develop these conditions because of antidepressant exposure during pregnancy is likely to be small or even non-existent.
Common (~ 100 out of 1000):
- Nausea, diarrhea and constipation
- Dry mouth and sweating
- Tremor, headache, dizziness
- Nervousness or agitation
- Drowsiness or insomnia
Rare (< 1 out of 1000 women) but serious:
- Bleeding
- Reduced blood sodium
- Low white blood cells
- Serotonin syndrome (involves fever, sweating, muscle problems)
The next section will review possible reasons for and against continuing antidepressant medication during pregnancy.
No research study about depression or antidepressant medication in pregnancy is guaranteed to be 100% accurate. We will give you what we believe is the most “high-quality” information available. When we can, we tell you about “meta-analyses” that combine data from multiple well-done studies.
Many women want to know whether one of the antidepressants covered by this Patient Decision Aid is more effective, or safer, than another. It is not clear whether real or important differences exist between the individual drugs. Most studies pool these drugs together in their analyses, and when they do separate them out, the risks tend to overlap. This suggests that identified benefits and risks are probably attributable to all drugs in the classes covered by this Patient Decision Aid. This is why most experts say that when symptoms are well-controlled for a person taking an SSRI or SNRI antidepressant covered in this decision aid, it is not usually advisable to change it to another one for safety reasons. This is also why, in this Patient Decision Aid, we do not separate out the individual medications, and we recommend that you consider the information in the next section as applicable to all of the medications covered.
That being said, for additional detailed information about possible differences between specific medications, you can ask your health care provider and/or refer to the resources on the last page of this Patient Decision Aid, including the Canadian Network for Mood and Anxiety Treatments 2024 Clinical Practice Guideline for the Management of Perinatal Mood, Anxiety, and Related Disorders, which you can also access free of charge here at the Canadian Journal of Psychiatry Website.
…CONTINUE Antidepressant Medication
- You will follow up with your health care provider to monitor for side effects and make sure that your depression symptoms do not return.
- If symptoms return, your antidepressant dose may be adjusted and/or you may be offered talk therapy to try to help improve your symptoms without increasing your dose of medication.
- As long as you continue to feel well, there is no reason to change your medication dose during pregnancy.
- Some women ask whether lowering the dose of, or stopping medication, just before delivery will benefit their infant by reducing the chances that the infant will develop poor neonatal adaption syndrome (PNAS ). Most studies suggest that this is not the case, and experts advise that, regardless, the potential benefits of reducing the dose or stopping to reduce the risk of PNAS in the infant do not outweigh the risk of worsening mental illness in the mother. This is because PNAS resolves on its own without serious complications in most cases.
…STOP Antidepressant Medication
- In most cases, you will gradually decrease the dose that you are taking before you stop.
- If you stop your antidepressant too quickly you may experience “discontinuation syndrome” for 1 to 2 weeks with symptoms of dizziness, nausea, fatigue, muscle aches, chills, anxiety and irritability.
- You will see your physician every few weeks while decreasing the dose of the antidepressant to watch for any depressive symptoms that may return.
- If your symptoms return, you may be offered a psychological treatment such as talk therapy to try to improve your symptoms without medication. If this does not improve your symptoms in a timely manner, you may discuss restarting your antidepressant with your health care provider.
Robakis TK, Miyares S, Bergink V. Risks and benefits of predelivery taper in pregnant women taking antidepressants. Acta Psychiatr Scand. 2024;150(5):355-359.
Vigod SN, Frey BN, Clark CT, Grigoriadis S, Barker LC, Brown HK, Charlebois J, Dennis CL, Fairbrother N, Green SM, Letourneau NL, Oberlander TF, Sharma V, Singla DR, Stewart DE, Tomasi P, Ellington BD, Fleury C, Tarasoff LA, Tomfohr-Madsen LM, Da Costa D, Beaulieu S, Brietzke E, Kennedy SH, Lam RW, Milev RV, Parikh SV, Ravindran AV, Samaan Z, Schaffer A, Taylor VH, Tourjman SV, Ameringen MV, Yatham LN, Van Lieshout RJ. Canadian Network for Mood and Anxiety Treatments 2024 Clinical Practice Guideline for the Management of Perinatal Mood, Anxiety, and Related Disorders. Can J Psychiatry. 2025 Jun;70(6):429-489.
Based on your selection, the decision you are considering is shown below.
Sometimes visualizing where you are in your decision-making can help you clarify what it is that you want to do.
Drag the “button” to show which way you are leaning.
I am deciding if I should CONTINUE or STOP an antidepressant medication in pregnancy:
Reasons to START
antidepressant medication
- My symptoms of depression are more likely to improve, compared to psychotherapy alone, or if I took a placebo pill. Read about this.
- If my depression gets better I will not have to worry about the negative effects of depression on my developing baby. Depression may increase the chance of preterm birth or low birthweight, behaviour abnormalities, and long-term problems with child health.
- If my depression gets better, there will be less chance of having other problems that could affect me and the health of my baby such as poor sleep, poor nutrition, poor prenatal care, more smoking, alcohol and drug use, and postpartum depression. Read about this.
Reasons to NOT START
antidepressant medication
- I might get side effects from antidepressant medication. Read about this.
- Antidepressant medication might affect the health of my pregnancy. Read about this.
- Antidepressant medication may affect my developing baby including slightly increased risk for heart malformations, preterm birth or low birthweight, persistent pulmonary hypertension of the newborn, and/or poor neonatal adaptation syndrome.
- Information about long-term child mental health and development after antidepressant use in pregnancy is not definitive.
- I will have to remember to take daily medication.
- I will have to pay for medication.
Grigoriadis S, VonderPorten EH, Mamisashvili L, et al. The Impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis. J Clin Psychiatry. Apr 2013; 74(4):e321-341.
Vigod SN, Frey BN, Clark CT, Grigoriadis S, Barker LC, Brown HK, Charlebois J, Dennis CL, Fairbrother N, Green SM, Letourneau NL, Oberlander TF, Sharma V, Singla DR, Stewart DE, Tomasi P, Ellington BD, Fleury C, Tarasoff LA, Tomfohr-Madsen LM, Da Costa D, Beaulieu S, Brietzke E, Kennedy SH, Lam RW, Milev RV, Parikh SV, Ravindran AV, Samaan Z, Schaffer A, Taylor VH, Tourjman SV, Ameringen MV, Yatham LN, Van Lieshout RJ. Canadian Network for Mood and Anxiety Treatments 2024 Clinical Practice Guideline for the Management of Perinatal Mood, Anxiety, and Related Disorders. Can J Psychiatry. 2025 Jun;70(6):429-489.
Ross LE, Grigoriadis S, Mamisashvili L, et al. Selected Pregnancy and delivery outcomes after exposure to antidepressant medication: a systematic review and meta-analysis. JAMA Psychiatry. Apr 2013; 70(4):436-443.
Wang J, Cosci F. Neonatal withdrawal syndrome following late in utero exposure to selective serotonin reuptake inhibitors: A systematic review and meta-analysis of observational studies. Psychotherapy and Psychosomatics. May 2021:1-9
Gao SY, Wu QJ, Sun C, et al. Selective serotonin reuptake inhibitor use during early pregnancy and congenital malformations: a systematic review and meta-analysis of cohort studies of more than 9 million births. BMC Medicine. 2018;16(1):205.
De Vries C, Gadzhanova S, Sykes MJ, Ward M, Roughead E. A systematic review and meta-analysis considering the risk for congenital heart defects of antidepressant classes and individual antidepressants. Drug Safety 2021 Mar;44(3):291-312
Masarwa R, Bar-Oz B, Gorelik E, Reif S, Perlman A, Matok I. Prenatal exposure to selective serotonin reuptake inhibitors and serontonin norepinephrine reuptake inhibitors and risk for persistent pulmonary hypertension of the newborn: a systematic review, meta-analysis and network meta-analysis. American Journal of Obstetrics and Gynecology 2019 Jan;220(1):57.e1-57.e13.
Endendijk JJ, et al. Maternal interaction quality moderates effects of prenatal maternal emotional symptoms on girls’ internalizing problems. Infant mental health journal, vol. 38(5), 634-644 (2017).
Raposa E, et al. The long-term effects of maternal depression: early childhood physical health as a pathway to offspring depression. J Adolesc Health 2014; 54:88.
Baker R, Tata LJ, Orton E, Kendrick D. Maternal depression and risk of injuries in children aged 0-4 years: a population-based cohort study. Lancet 2015; 386:S21.
Zhou C, et al. Prenatal maternal depression related to allergic rhinoconjunctivitis in the first 5 years of life in children of the EDEN mother-child cohort study. Allergy Rhinol 2017;8:3132-e138.
Uguz F. Is there an association between use of antidepressants and preeclampsia or gestational hypertension? A systematic review of current studies. Journal of Clinical Psychopharmacology 2017 February; 37 (1): 72-77.
Palmsten K, et al. Use of antidepressants near delivery and risk of postpartum hemorrhage: cohort study of low income women in the United States. BMJ 2013; 347:f4877.
Jiang, HY et al. Antidepressant use during pregnancy and risk of postpartum hemorrhage: a systematic review and meta-analysis. Journal of Psychiatric Research 2016 Dec; 83:160-167.
Zhou, et al. Association between maternal antidepressant use during pregnancy and autism spectrum disorder: an updated meta-analysis. Molecular Autism 2018; 9:21.
Jiang HY et al. Antidepressant use during pregnancy and the risk of attention-deficit/hyperactivity disorder in the children: a meta-analysis of cohort studies. BJOG 2018 Aug; 125(9): 1077-84.
Al-Fadel N, Alrwisan A. Antidepressant use during pregnancy and the potential risk of motor outcomes and intellectual disabilities in offspring: a systematic review. Drugs Real World Outcomes. 2021 Jun;8(2):105-123.
Rommel AS, Bergink V, Liu X, Munk-Olsen T, Molenaar NM. Long-term effects of intrauterine exposure to antidepressants on physical, neurodevelopmental and psychiatric outcomes: a systematic review. J Clin Psychiatry. 2020 May 12;81(3):19r12965.
Where are you in your decision-making process now?
The chances of relapse depend on how severe and long-standing your depression has been.
Out of 1000 women with severe depression who are taking antidepressant medication:
- 680 may relapse if they stop
- 260 may relapse if they continue
For women with milder depression, STOPPING medication may NOT necessarily increase the chance of relapse.
A baby is considered ‘preterm’ if born before the 37th week of pregnancy. The average birthweight for a baby born at term is approximately 3500 grams. Low birthweight is generally considered < 2500 grams.
Babies born preterm or with low birthweight can be at risk for breathing problems, digestive problems, hearing, vision and neurological problems, as well as have longer term health problems and problems with cognitive and motor development. In general, the risk of these problems is greater in infants who are very preterm or of very low birthweight.
For every 1000 pregnancies the number of women with preterm birth are:
- No depression: around 60
- Untreated depression: around 80
- Antidepressant use: between 70 and 90
Most studies suggest that children exposed to either untreated depression OR antidepressants are born only a few days earlier, or < 100 grams lighter than children born to women with no depression.
Compared to infants born to non-depressed mothers, neonates born to depressed mothers were at increased risk in some research studies, for:
- Abnormal arousal and activity patterns
- Disturbed or disorganized sleep
- Irritability or difficult temperament, including excessive infant crying
Exact proportions of infants born to depressed mothers who experience these difficulties are not available because the way these factors are measured is not easy to translate into “proportion affected”.
While the reasons for this are not entirely clear, maternal depression in pregnancy may be linked to increased risk for child health problems, and delays in child motor and language development. Children whose mothers had depression in pregnancy may also be at increased risk for problems with social and emotional health in childhood, including anxiety, depression and attentional or behavioural problems. However, it is unclear how much of this risk for child social and emotional health problems is related to untreated depression in pregnancy itself, to postpartum maternal mental health problems or to shared maternal and child genetic risk for mental health problems.
| Problem | Out of 1000 women with untreated depression | Out of 1000 women with no depression |
|---|---|---|
| Poor Sleep | 200 | 100 |
| Smoking | 300 | 50 |
| Alcohol or Drug Problems | 120 | 50 |
| Postpartum Depression | 670 | 80 |
Poor nutrition and poor antenatal care are also more common among women with depression.
Common (~ 100 out of 1000):
- Nausea, diarrhea and constipation
- Dry mouth and sweating
- Tremor, headache, dizziness
- Nervousness or agitation
- Drowsiness or insomnia
Rare (< 1 out of 1000 women) but serious:
- Bleeding
- Reduced blood sodium
- Low white blood cells
- Serotonin syndrome (involves fever, sweating, muscle problems)
Some studies have suggested that antidepressant medications may increase risk for blood pressure problems in pregnancy, such as preeclampsia or eclampsia, but the risk of this occurring because of antidepressants is thought to be very small. Antidepressant use in pregnancy may increase risk for postpartum bleeding slightly (e.g. ~ 40 in 1000 women taking antidepressants compared to ~ 30 in 1000 not taking antidepressants). The amount of extra blood loss is thought to be very small (~300ml) and does not appear to be linked to complications for the mother or infant.
Infants born to mothers taking antidepressant medications during the 1st trimester of pregnancy MAY have slightly higher rates of certain heart defects, usually “septal defects” (up to 8 per 1000) compared to the general population (about 5 per 1000).
A “septal defect” is where there is a hole between the heart chambers that results in abnormal blood flow through the heart. Smaller septal defects (more common) can close on their own, and children develop normally without lasting effects. Larger septal defects (less common) can be corrected surgically, allowing children to live largely normal lives.
A baby is considered ‘preterm’ if born before the 37th week of pregnancy. The average birthweight for a baby born at term is approximately 3500 grams. Low birthweight is generally considered < 2500 grams.
Babies born preterm or with low birthweight can be at risk for breathing problems, digestive problems, hearing, vision and neurological problems, as well as have longer term health problems and problems with cognitive and motor development. In general, the risk of these problems is greater in infants who are very preterm or of very low birthweight.
For every 1000 pregnancies the number of women with preterm birth are:
- No depression: around 60
- Untreated depression: around 80
- Antidepressant use: between 70 and 90
Most studies suggest that children exposed to either untreated depression OR antidepressants are born only a few days earlier, or < 100 grams lighter than children born to women with no depression.
This is a rare condition where the infant’s lungs do not adapt properly to breathing outside the womb. It requires treatment with oxygen and other supportive measures, and no fatalities have been reported when this occurs after a mother took antidepressants in pregnancy.
For every 1000 pregnancies of women with:
- No depression or untreated depression – about 1 to 2 newborns will have PPHN
- Antidepressants during the 3rd trimester – about 2 or 3 newborns may develop PPHN
This is a more common condition that can arise within 1 to 2 weeks after birth.
- It is usually mild, resolving on its own over 2 weeks
- Symptoms can include: difficulty sleeping or sleepiness, agitation, tremors, jitteriness, shivering and/or stiff muscle tone, restlessness, irritability, and constant crying, poor feeding, vomiting, or diarrhea and, rarely, respiratory problems or seizures
For every 1000 pregnancies of women with:
- No depression – ~ 100 newborns will have PNAS
- Untreated depression – unknown, may be slightly more than women with no depression
- Antidepressants during 3rd trimester – 200 to 300 newborns will have PNAS
Antidepressant medications do reach the fetus, so research studies have been conducted to understand whether exposure to antidepressants is linked to increased risk for child health problems longer term.
Most studies in this area have focused on risk for child anxiety and mood problems, behavioural problems such as attention deficit hyperactivity disorder, and autism spectrum disorder. Some studies have focused on issues with child physical health and development. Some of these studies have suggested that antidepressants may lead to a small increased risk for these problems. Studies that accounted well for other possible explanations, such as untreated depression in pregnancy itself, postpartum maternal mental health problems and shared maternal and child genetic risk for mental health problems do not support the idea that antidepressant medications are causing increase in risk.
Therefore, the chance that children of depressed mothers will develop these conditions because of antidepressant exposure during pregnancy is likely to be small or even non-existent.
The next section will review possible reasons for and against starting antidepressant medication during pregnancy.
No research study about depression or antidepressant medication in pregnancy is guaranteed to be 100% accurate. We will give you what we believe is the most “high-quality” information available. When we can, we tell you about “meta-analyses” that combine data from multiple well-done studies.
Many women want to know whether one of the antidepressants covered by this Patient Decision Aid is more effective than, or safer, than another. It is not clear whether real or important differences exist between the individual drugs. Most studies pool these drugs together in their analyses, and when they do separate them out, the risks tend to overlap. This suggests that identified benefits and risks are probably attributable to all drugs in the classes covered by this Patient Decision Aid. So, in this Patient Decision Aid, we do not separate out the individual medications, and we recommend that you consider the information in the next section as applicable to all of the medications covered.
For additional detailed information you can ask your health care provider and/or refer to the resources on the last page of this Patient Decision Aid.
This is what you have told us so far:
How much does it matter?
Your reasons to TAKE antidepressants
Your reasons to NOT TAKE antidepressants
What else affects your decision?
Positive A factor that makes your decision easier
Negative A factor that makes your decision harder
Thank you for taking the time to use this Patient Decision Aid for antidepressant medication in pregnancy. We hope that the Patient Decision Aid has helped you make a decision that feels right for you.
Women may have trouble making decisions about antidepressant use during pregnancy for a number of different reasons – not only the harms and benefits of the treatment options.
Which of the following are helpful or not helpful in your decision-making?
Browse the options below to learn more. Choose:
-
if the option is helpful,
-
if it doesn’t affect you,
-
if not helpful.
Friends and Family
Women often described friends who worked in the mental health field or had personal experience with mental health problems as particularly important. However, they also cautioned against accepting lay advice.
Partners
Many women feel the opinions of their partners are important in their decision-making – making it easier or harder to make a decision.
Media
Some women feel that the media portrays negative messages about antidepressant use in pregnancy, and that this reduces the chances that they would take medication.
Culture
Women perceive pressure from society and cultural groups.
Providers
Interactions with Physicians
Women describe challenges they have discussing antidepressant use with their care providers.
Other Influences
You may add any additional outside influences impacting your decision-making process by adding them here.
Walton, GD, Ross, LE, Stewart DE, Grigoriadis S, Dennis CL, Vigod S. Decisional conflict among women considering antidepressant medication use in pregnancy. Arch Womens Ment Health. Dec 2014;17(6): 493-501
Now that you have identified what else affects your decision-making, you can discuss these issues with your health care provider to find ways to deal with those factors that are unhelpful to your decision-making.
Please indicate how much each reason matters to you.
Reasons to START
antidepressant medication
Reasons to NOT START
antidepressant medication
Where are you in your decision-making process now?
…START Antidepressant Medication
You will decide with your health care provider whether to start medication on its own or along with psychological treatment (Talk Therapy) or another treatment if you have not tried other treatments already.
- You may start at a low dose to allow your body to adjust and minimize side effects.
- Once you are at a dose that is known to improve depressive symptoms (therapeutic dose) you may start to feel better within 1 to 2 weeks.
- If you do not feel better within 3 to 4 weeks, your health care provider may suggest that you increase the dose, add a second medication, or switch to another medication.
- Once you are feeling better you will stay on medication for several months or longer to reduce the chances that your depressive symptoms will come back.
- As long as you continue to feel well, there is usually no reason to change your medication dose during pregnancy.
- Pregnancy can change how your body processes the medication and your symptoms may start to come back. If that happens your health care provider may advise you to increase the medication dose.
- Some women ask whether lowering the dose of, or stopping medication, just before delivery will benefit their infant by reducing the chances that the infant will develop poor neonatal adaption syndrome (PNAS ). Most studies suggest that this is not the case, and experts advise that, regardless, the potential benefits of reducing the dose or stopping to reduce the risk of PNAS in the infant do not outweigh the risk of worsening mental illness in the mother. This is because PNAS resolves on its own without serious complications in most cases.
…Do NOT START Antidepressant Medication
You may be offered other treatment options, such as:
Low-intensity activity (including walking) may reduce the severity of depression symptoms. Moderate-intensity activity may reduce symptoms more than lower-intensity activity. Talk to your healthcare provider about what would be advisable, especially if you are currently pregnant
Support by trained peers (people who have experienced depressive pregnancy) may also reduce the severity of depression symptoms.
- Psychological Treatment (Talk Therapy): Talk therapies can lead to resolution of depression in pregnancy, especially with mild or moderate-severity of symptoms. Examples are:
- Cognitive Behaviour Therapy (CBT): This therapy can be in individual or group format and usually lasts for 12-16 weekly sessions. CBT challenges thinking and behaviour patterns in a way that leads to a positive change in a way a person is feeling. This also includes therapies related to CBT such as behavioural activation (BA) and mindfulness-based therapies.
- Interpersonal Therapy (IPT): This therapy can also be in individual or group format and also usually lasts about 12-16 weekly sessions. IPT explores how the way a person feels is liked to events occurring in their life, and to their relationships with others. One main focus in pregnancy is on how a person can improve their interpersonal relationships to help them navigate stress and changes they are experiencing in the transition to parenthood.
Robakis TK, Miyares S, Bergink V. Risks and benefits of predelivery taper in pregnant women taking antidepressants. Acta Psychiatr Scand. 2024;150(5):355-359.
Vigod SN, Frey BN, Clark CT, Grigoriadis S, Barker LC, Brown HK, Charlebois J, Dennis CL, Fairbrother N, Green SM, Letourneau NL, Oberlander TF, Sharma V, Singla DR, Stewart DE, Tomasi P, Ellington BD, Fleury C, Tarasoff LA, Tomfohr-Madsen LM, Da Costa D, Beaulieu S, Brietzke E, Kennedy SH, Lam RW, Milev RV, Parikh SV, Ravindran AV, Samaan Z, Schaffer A, Taylor VH, Tourjman SV, Ameringen MV, Yatham LN, Van Lieshout RJ. Canadian Network for Mood and Anxiety Treatments 2024 Clinical Practice Guideline for the Management of Perinatal Mood, Anxiety, and Related Disorders. Can J Psychiatry. 2025 Jun;70(6):429-489.
Based on your selection, the decision you are considering is shown below.
Sometimes visualizing where you are in your decision-making can help you clarify what it is that you want to do.
Drag the “button” to show which way you are leaning.
When we discuss antidepressants in this Patient Decision Aid, we are talking about all of the following antidepressant medications:
Selective Serotonin Reuptake Inhibitors (SSRIs)
- Citalopram (Celexa)
- Escitalopram (Cipralex)
- Fluoxetine (Prozac)
- Fluvoxamine (Luvox)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
- Venlafaxine (Effexor)
- Duloxetine (Cymbalta)
- Desvenlafaxine (Pristiq)
What decision are you considering?
Please choose one option:
This Patient Decision Aid does not focus on antidepressant medications such as Mirtazapine (Remeron™) or Bupropion (Wellbutrin™), nor other, less commonly prescribed medications for depression such as tricyclic antidepressants or monoamine oxidase inhibitors. Please speak directly with your health care provider about these medications.
When used in day-to-day language “Depression” has many meanings, from periods of sadness that may resolve on their own, to “Major Depression” that requires treatment.
To be diagnosed with “Major Depression” there must be a period of at least 2 weeks when a person has low mood for most of the day, nearly every day, and/or has lost interest or pleasure in most activities.
These symptoms may be accompanied by problems with sleep, energy, appetite, concentration, guilty thoughts and feelings of worthlessness. Sometimes people with depression have thoughts of not wanting to live anymore (“suicidal thoughts”).
Depression is one of the most common problems that women face during pregnancy.
Some women develop depression prior to pregnancy, while some women develop depression in pregnancy for the first time.
Close to 1 in every 5 pregnant women experience symptoms of depression.
About half of these women experience “Major Depression.”
Women may develop depression in pregnancy if they have:
- A past history of depression or other mental illness
- Poor social support
- Major life stress such as financial, work or relationship problems
- Complications in the pregnancy
- Stopped an effective treatment for depression, such as antidepressant medication
Women CAN become depressed in pregnancy without any of these risk factors.
Treatment recommendations differ depending on the severity of depression.
This is when only the minimum number of symptoms needed to diagnose depression are present, and there is only a small amount of impact on a person’s life and relationships or where a person can still function well even though this requires significant effort. Education about symptoms, self-care strategies, and psychological approaches such as individual or group psychotherapy (talk therapy) without medication are usually tried first in this case.
This is when many symptoms of depression are present, and there is some impact on a person’s ability to function well on a daily basis. Some women in this group will respond to specific kinds of psychotherapy without medication treatment. Treatment with antidepressant medication, either alone or combined with psychotherapy, is a reasonable treatment option, especially if therapy was not previously effective or is not resolving symptoms in a timely manner.
This is when most of the symptoms needed to diagnose depression are met and there is clear, observable impact on the person (e.g. inability to work, take care of children). Treatment with antidepressant medication, either alone or combined with psychotherapy, is usually the first treatment option. If depression is very severe and a woman needs to be treated urgently, hospitalization and other types of medication or treatments might be recommended.
Continuation of antidepressant medication in pregnancy is usually recommended for women who are feeling well but are at high risk of having their depression symptoms come back.
This includes women who have had:
- Two or more episodes of depression
- Severe depression
- Suicide attempts
- Hard to treat depression, where it took a long time to get better or it took trying several different antidepressants to find one that worked
Some women who have had depression of mild or moderate severity may choose to continue antidepressant medication in pregnancy after considering the potential harms and benefits of stopping vs. continuing medication.
Vigod SN, Frey BN, Clark CT, Grigoriadis S, Barker LC, Brown HK, Charlebois J, Dennis CL, Fairbrother N, Green SM, Letourneau NL, Oberlander TF, Sharma V, Singla DR, Stewart DE, Tomasi P, Ellington BD, Fleury C, Tarasoff LA, Tomfohr-Madsen LM, Da Costa D, Beaulieu S, Brietzke E, Kennedy SH, Lam RW, Milev RV, Parikh SV, Ravindran AV, Samaan Z, Schaffer A, Taylor VH, Tourjman SV, Ameringen MV, Yatham LN, Van Lieshout RJ. Canadian Network for Mood and Anxiety Treatments 2024 Clinical Practice Guideline for the Management of Perinatal Mood, Anxiety, and Related Disorders. Can J Psychiatry. 2025 Jun;70(6):429-489.
Bayrampour H, Kapoor A, Bunka M, Ryan D. The risk of relapse of depression during pregnancy after discontinuation of antidepressants: a systematic review and meta-analysis. J Clin Psychiatry. 2020;81(4):19r13134.
- As you click through the pages of this Patient Decision Aid, we will provide you with information about depression in pregnancy and about antidepressant medication use.
- As you work through the website, you will be asked about how confident you feel about your decision. You will have the chance to identify issues that are most important to your ability to make a decision.
- At the end, you will be given a summary of your answers which may (1) help you to clarify what choice you want to make, and (2) help you to discuss your decision further with your health care provider.
Patient Decision Aids (PDAs) help people make difficult decisions about their health care.
This Patient Decision Aid is designed to help you decide whether or not
to use antidepressant medication for depression in pregnancy.
Sometimes health care providers will recommend antidepressants to treat anxiety disorders. If you do NOT have depression (or do not have a history of depression) and you are considering the use of antidepressants ONLY to treat anxiety, the information in this Patient Decision Aid may not apply to you.
Last Updated: August 2025
We want to help you to make a decision about antidepressant use in pregnancy.
There is no “right ” or “wrong” choice.
By the time you have completed this Patient Decision Aid, we hope that you will:
- Understand why antidepressant medication is being recommended for you.
- Know more about the pros and cons of using antidepressant medication in pregnancy.
- Better understand which pros and cons are important for YOU.
- Feel confident in your decision-making.