Depression During Pregnancy: What You Can Safely Take

The math here isn’t medication risk versus zero risk: it’s medication risk versus the well-documented risk of depression left untreated, and current guidelines are explicit that the second option isn’t the safer default.

What This Article Covers

• What the 2023 ACOG guideline actually recommends for medication during pregnancy
• What’s known about SSRI safety, including the one real signal worth understanding
• What untreated depression itself does to a pregnancy
• Why stopping medication abruptly carries its own risk
• How common perinatal depression actually is
• Frequently asked questions about specific medications and timing

Depression during pregnancy isn’t rare, and it isn’t something most people are getting adequate treatment for. An estimated 10% of pregnant patients and 21.9% of postpartum patients experience depression, according to a 2026 review in the Cleveland Clinic Journal of Medicine summarizing current guidance, yet only about 20% receive adequate treatment. That treatment gap exists partly because of a reasonable-sounding but incomplete instinct: the assumption that avoiding medication is automatically the safer choice for the baby. Current clinical guidance says that assumption doesn’t hold up.

What the Current Guideline Actually Recommends

The American College of Obstetricians and Gynecologists published its Clinical Practice Guideline Number 5 on perinatal mental health treatment in 2023, developed with a maternal-fetal medicine subspecialist and reviewed by the American Psychiatric Association’s Committee on Women’s Mental Health. For patients starting pharmacotherapy for perinatal depression who haven’t previously taken medication for a mood disorder, the guideline recommends sertraline and escitalopram as first-line SSRIs, with SNRIs as a reasonable alternative. For patients who were already stable on a different antidepressant before pregnancy, the general clinical approach favors continuing what has already worked rather than switching medications, since restarting the search for an effective medication from scratch carries its own delay and risk.

The One Safety Signal Worth Understanding

There is a real, documented safety signal connected to SSRI use in pregnancy, and it’s worth naming directly rather than glossing over: an association with a rare newborn breathing condition called persistent pulmonary hypertension of the newborn, or PPHN. According to ACOG’s guideline, this body of evidence “suggests that there may be an increased risk of PPHN associated with SSRI exposure,” but the absolute risk is low, approximately 1 to 2 additional cases per 1,000 births, and that added risk should be weighed against the significant, well-documented risks of untreated depression. The FDA’s own guidance, cited in the same ACOG document, advises clinicians not to alter their prescribing practice for depression during pregnancy because of this signal. Outside of this specific, quantified risk, ACOG’s patient-facing guidance states that antidepressants appear to have a low risk of causing birth defects when taken during pregnancy.

What Untreated Depression Actually Does

This is the half of the risk-benefit conversation that gets skipped most often. Untreated depression during pregnancy is not a neutral, risk-free default. According to ACOG’s own 2025 statement on SSRI access during pregnancy, untreated depression can put patients at risk for substance use, preterm birth, preeclampsia, limited engagement in medical care and self-care, low birth weight, impaired attachment with their infant, and suicide. That’s a longer and more serious list than most people expect when they’re weighing whether to “just try to get through it” without medication.

Why Stopping Suddenly Isn’t the Safe Middle Ground

A common instinct after a positive pregnancy test is to stop a current antidepressant right away, on the theory that less exposure is automatically safer. The evidence doesn’t support that as a blanket rule. Research cited in the Cleveland Clinic Journal of Medicine’s summary of the ACOG guideline found that patients who discontinue antidepressants during pregnancy have a higher risk of depression than those who continue pharmacotherapy. If a change is warranted, it’s a decision to make deliberately with a prescriber, weighing the specific medication, dose, and history involved, not a reflexive stop.

Weighing the Decision

Because this decision involves comparing two real, non-zero sets of risk, it helps to see them side by side rather than treat one as “risk” and the other as “safety.”

Factor	Continuing or Starting an SSRI	Leaving Depression Untreated
Birth defect risk	Low, per ACOG’s patient guidance	Not applicable
Documented specific risk	Small absolute increase in PPHN (about 1 to 2/1,000)	Preterm birth, preeclampsia, low birth weight
Relapse risk	Lower than stopping abruptly	High if depression continues untreated
Maternal risk	Managed through prescriber monitoring	Substance use, impaired attachment, suicide risk

This is a general framework from current guidelines, not a substitute for an individualized conversation with your own prescriber about your specific history and medication.

About SiggyMD

SiggyMD’s current clinical scope covers SSRIs, anxiety, and depression, with every treatment plan reviewed and approved by a licensed prescriber before anything moves forward. If you’re already taking an antidepressant and learn you’re pregnant, or you’re experiencing depression symptoms during pregnancy for the first time, that’s exactly the kind of decision that shouldn’t be made alone or reversed abruptly without guidance. An anonymous intake conversation gathers your full history, a prescriber reviews it against your specific situation, and support continues between visits so a plan can be adjusted as your pregnancy progresses rather than left on autopilot.

Ready to Talk Through Your Options?

Depression during pregnancy deserves a real risk-benefit conversation, not a guess made alone at 2 a.m. An anonymous intake with SiggyMD starts with no login, no name, and no email, and every treatment plan is reviewed by a licensed prescriber before you receive it.

Ready to take control of your mental health? Get started with SiggyMD today.