A JAMA Psychiatry review sets out the current state of evidence on depression and SSRI treatment in pregnancy. Major depression affects about one in eight pregnant women, and psychiatric illness is a leading cause of maternal morbidity and death.
The authors argue that observational studies of SSRI risk are heavily confounded by depression itself. Once that is accounted for, the accumulated evidence suggests SSRIs carry little or no risk of serious adverse outcomes, while stopping treatment in moderate to severe depression has been linked with relapse and harm.
The practical shift is in the conversation. Rather than defaulting to stopping an SSRI when pregnancy is planned or found, clinicians should weigh the risks of untreated illness against the risks of exposure in a structured discussion, and continue effective treatment where the illness warrants it.
- Do not stop an effective SSRI by default when a woman becomes pregnant
- Weigh relapse risk, past severity and the woman's preferences in a structured discussion
- Discuss the risks of untreated depression for mother and baby, not only drug exposure
- Plan close review through pregnancy and the postpartum months
- Share the plan with the obstetric team and the woman's GP
Why it matters
Stopping antidepressants out of caution can carry more risk than continuing them.
Don't overread it
This is a narrative review; individual risk still depends on the drug, dose and illness history.
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