SSRIs During Pregnancy: Is Stopping Antidepressants Always the Safer Choice?

Finding out you are pregnant can raise questions about medications you have been taking for years. For women who rely on antidepressants such as Zoloft, Prozac, or Lexapro, one of the biggest concerns is whether continuing treatment could affect their baby’s development. While some may assume that stopping medication is the safest option, the decision is not always that simple.

Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to treat depression and anxiety. Although their use during pregnancy has been extensively studied, questions remain about certain potential risks. The American College of Obstetricians and Gynecologists (ACOG) emphasizes that psychiatric medications should not be discontinued solely because of pregnancy. Instead, providers should consider both the potential effects of medication exposure and the consequences of leaving a mental health condition untreated.

Why Stopping Antidepressants Is Not Always Safer

One concern with discontinuing SSRIs is the possibility that depression or anxiety symptoms will return. Untreated mental health conditions can affect a mother’s well-being and have been associated with complications such as premature birth and low birth weight.

In a 2006 study published in JAMA, researchers followed 201 pregnant women with histories of major depression. Among women who discontinued antidepressants, 68% experienced a relapse during pregnancy, compared with 26% of women who continued treatment. Although the study was observational and involved women with established histories of depression, the findings highlight the potential consequences of discontinuing effective treatment.

Stopping an SSRI abruptly can also cause withdrawal symptoms, including dizziness, nausea, sleep disturbances, and increased anxiety. For these reasons, medication changes should be discussed with a healthcare provider rather than made independently.

Are All SSRIs the Same During Pregnancy?

Not all SSRIs have identical pregnancy safety data, and some medications have been studied more extensively than others.

• Sertraline (Zoloft): According to MotherToBaby, information from more than 25,000 exposed pregnancies is available. Most studies have not identified an increased overall risk of birth defects.
• Fluoxetine (Prozac): More than 10,000 first-trimester exposures have been reported, with no consistent pattern of birth defects identified. Some studies have suggested associations with certain defects, but the overall evidence has been reassuring.
• Escitalopram (Lexapro) and citalopram (Celexa): Research involving more than 15,000 pregnancies exposed to one or the other has generally not identified an increased risk of birth defects.
• Paroxetine (Paxil): Some studies suggest a small increased risk of birth defects, particularly heart defects, following first-trimester exposure, while others have not found an increased risk.

ACOG identifies sertraline and escitalopram as reasonable first-line options for patients without a prior medication-treatment history. However, a medication that has successfully controlled a patient’s symptoms may not need to be changed simply because she becomes pregnant.

Can SSRIs Cause Birth Defects?

One of the most frequently discussed concerns is whether SSRI exposure during early pregnancy increases the likelihood of congenital heart defects.

A 2014 study published in The New England Journal of Medicine examined 949,504 pregnancies. Researchers initially observed higher rates of cardiac defects among infants exposed to antidepressants. However, after adjusting for maternal depression and other factors, the association was substantially reduced. The fully adjusted relative risk for SSRI exposure was 1.06, and the result was not statistically significant.

The researchers concluded that the findings did not suggest a substantial increase in cardiac malformations attributable to first-trimester antidepressant exposure. Nevertheless, the study does not eliminate every possible medication-specific risk.

What Happens to Babies Exposed to SSRIs Before Birth?

Some babies exposed to SSRIs during pregnancy experience temporary symptoms after delivery, sometimes referred to as poor neonatal adaptation syndrome. Symptoms may include:

• Jitteriness, tremors, or increased irritability.
• Feeding difficulties.
• Changes in muscle tone.
• Low blood sugar.
• Breathing difficulties.

The Canadian Paediatric Society estimates that approximately one-third of newborns exposed to SSRIs or related antidepressants may experience adaptation symptoms. Most cases are mild and resolve with supportive care, although some infants require additional monitoring or treatment.

Another concern is persistent pulmonary hypertension of the newborn (PPHN), a potentially serious condition affecting blood circulation through the lungs. In a 2015 study, PPHN occurred in approximately 31.5 per 10,000 infants exposed to SSRIs late in pregnancy, compared with 20.8 per 10,000 unexposed infants. The association weakened after researchers accounted for maternal depression and other factors.

These findings suggest that a potential risk may exist, but the absolute risk remains small. Importantly, newborn symptoms following SSRI exposure do not automatically mean that inappropriate medical care occurred.

What About Long-Term Development?

Researchers have also examined whether prenatal antidepressant exposure contributes to autism, ADHD, or other developmental conditions.

A 2022 study published in JAMA Internal Medicine examined more than three million pregnancies, including 145,702 involving antidepressant exposure. Although initial comparisons suggested increased rates of certain neurodevelopmental disorders, those associations were no longer observed after more extensive adjustments, including comparisons between siblings.

The findings are reassuring, although continued research is necessary to understand the possible long-term effects of medication exposure during pregnancy.

Why Proper Counseling and Monitoring Matter

Deciding whether to continue an SSRI should involve more than reviewing a list of potential side effects. Providers should consider the patient’s mental health history, previous response to treatment, medication dosage, and the risks associated with stopping treatment.

ACOG recommends monitoring depression and anxiety symptoms throughout pregnancy and adjusting treatment when clinically appropriate. Communication between an OB/GYN, the prescribing provider, and the newborn’s healthcare team can also help ensure that potential complications are recognized and appropriately managed.

Patients should receive an explanation of the known risks, remaining uncertainties, and available treatment alternatives so they can participate in decisions about their care.

When Could SSRI Management During Pregnancy Involve Medical Malpractice?

Taking an SSRI during pregnancy, developing a complication, or delivering a baby with a medical condition does not automatically establish negligence. In Connecticut, a medical malpractice claim generally requires proof that a provider’s care fell below the applicable professional standard and that the departure caused injury. Expert medical testimony is generally necessary to establish those issues. (Conn. Gen. Stat. § 52-184c).

In a potential case involving antidepressant treatment during pregnancy, a review may examine whether providers appropriately evaluated the patient’s medical and psychiatric history, discussed material risks and treatment alternatives, monitored concerning symptoms, and responded appropriately to complications.

The question is not simply whether an SSRI was prescribed or whether the baby experienced an adverse outcome. It is whether the treatment decisions and medical care were appropriate under the circumstances, and whether any failure caused additional harm.

For families facing unexpected complications, answering those questions may require a careful review of the prenatal, prescribing, delivery, and newborn medical records, along with qualified medical opinions.

If you believe that you or a loved one suffered harm because antidepressant treatment during pregnancy was not properly evaluated or managed, contact Berkowitz Hanna to discuss your concerns and request a free consultation.