Getting the Facts Straight: Pregnancy, Depression, and SSRIs
By: Adam K. Lewkowitz, MD, MPHS, and Emily S. Miller, MD, MPH
On July 21, 2025, the Food and Drug Administration (FDA) convened a roundtable panelist discussion on the use of selective serotonin reuptake inhibitors (SSRIs), a class of antidepressant medication, in pregnancy. The FDA panelists questioned the safety of SSRIs during pregnancy with unsubstantiated claims, misrepresentation of scientific studies, and biased critiques.
Despite longstanding scientific consensus regarding the safety and efficacy of SSRIs as a widely accepted therapy for depression during pregnancy and postpartum, several panelists made inaccurate and misleading claims. One panelist falsely claimed that SSRI use during pregnancy causes fetal alcohol syndrome and that any medication that causes a birth defect leads to autism. Another panelist referred to the largely debunked “chemical imbalance” theory of depression and claimed that higher rates of depression in women is attributed to the “gift” of women being more emotionally sensitive. There were also false accusations such as lack of informed consent and coercion of patients to take SSRIs during pregnancy.
In contrast to these unsubstantiated and inaccurate claims, one panelist provided a balanced testimony about the risks of untreated depression during pregnancy and reaffirmed the scientific consensus regarding the use of SSRIs in pregnancy, which have been well-studied.
We greatly appreciate the courage that this panelist demonstrated by consistently using scientific evidence to counter other co-panelists’ far-fetched statements, some of which bordered on conspiracy theories. As maternal-fetal medicine subspecialists with expertise in perinatal mood and anxiety disorders, we have supported hundreds of patients during and after their pregnancies who have greatly benefited from SSRIs. We worry that this panel—and the media frenzy it generated—may increase the number of patients who either self-discontinue SSRIs or are told by their clinician to discontinue them.
From our perspective, the data on SSRIs are clear: like many medications, SSRIs are associated with some risk, but these added risks either resolve on their own and without intervention or they occur exceptionally uncommonly. Poor neonatal adaptation syndrome (PNAS) is one example of a commonly encountered risk. Appearing in the first few days postpartum, PNAS is a group of behavioral symptoms in the newborn, such as fussiness and poor feeding, which usually resolves within two weeks and may require additional supportive care for the newborn in the first days of life.1
There may be an additional risk of persistent pulmonary hypertension of the newborn (PPHN), although the data supporting this are unclear. PPHN is a condition of newborn babies who develop high blood pressure in their lungs that makes it hard for oxygen to get into their bloodstream. Although PPHN is a serious medical condition associated with severe morbidity and even mortality, the potential absolute risk of PPHN associated with SSRIs is estimated to be less than 1-2 per 1,000 pregnancies.2 While all pregnant patients deserve individualized counseling, the risks of SSRIs are, in general, greatly overshadowed by the profound risk that untreated depression has for both pregnant people and their children.
The Global Burden of Perinatal Depression
The perinatal period is a critical time of growth, transition, and recovery, and can be a vulnerable time in the pregnant or postpartum patient’s life. Some people experience symptoms of depression and anxiety during pregnancy or after childbirth and these symptoms can progress to clinical depression.
Globally, perinatal depression is estimated to have a prevalence rate of 26.3% and is even higher among certain populations, such as mothers who gave birth to preterm or very low birth weight infants or experienced substance use disorder during pregnancy.3 In the U.S., the prevalence of perinatal depression ranges from 6.5 -12.9% during the different trimesters of pregnancy and in the postpartum period.4
Depression during pregnancy and the postpartum period is both common and treatable. The good news is that under the care of a health care provider and with access to treatment, most pregnant and postpartum patients get better, even in the most severe and complex forms of depression.
Unfortunately, up to 95% of those with perinatal depression have inadequate clinical support because they lack access to appropriate mental health screening and encounter treatment barriers.5 These barriers may include time constraints; limited referral access to trained mental health professionals; lack of prenatal providers’ comfort in managing psychiatric medications; and perceived stigma of receiving psychiatric care.6,7
The Risk of Untreated Depression
Untreated or undertreated depression during pregnancy and postpartum impairs quality of life. In addition, untreated or undertreated depression poses risks to the mother and child. Some of these complications include1:
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Preterm birth;
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Low birth weight;
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Increased suicide risk;
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Impaired infant attachment (which may lead to long-term neurodevelopmental effects); and
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Negative effects on personal relationships (eg, partner and/or family members).
The Maternal Mortality Review Committees, state and local multidisciplinary groups that work with the Centers for Disease Control and Prevention to review deaths that occur during or within one year of the end of pregnancy in the U.S., found mental health conditions to be the leading cause of pregnancy-related deaths in 2020.8 These pregnancy-related deaths are largely preventable with appropriate screening and treatment which is why it is critical for all pregnant and postpartum patients to have access to timely treatment.
Sometimes, patients may decide to change how they take their medication or completely stop when they become pregnant. When this decision is made with an understanding of the risks and benefits, we support their autonomy to do so. But far too often, stopping medication happens without evidence-based counseling, fueled by fear rather than informed by scientific data. Abruptly discontinuing SSRIs during pregnancy or in the postpartum period is associated with markedly increased risk of relapse, especially in those with severe depression.9,10 These risks need to be balanced against the potential risks of the medication exposure itself.
Messaging that minimizes the seriousness of perinatal depression and falsely represents the evidence behind SSRIs creates confusion for pregnant and postpartum patients, their families, health care providers, and the public. This misinformation and disinformation also lead to unnecessary barriers to maternal care and puts lives at risk.
Treatment Options and the Role of Shared-Decision Making
Pregnant and postpartum patients are recommended different treatment options depending on the severity and complexity of their depression. SSRIs are just one of many available treatment options for perinatal depression. As clinicians, it is our role to counsel patients on the benefits and risks of treatments and help them make informed decisions.
The recent misrepresentation and stigmatization of SSRIs casts doubt on one of the most well-studied classes of medications in pregnancy. Additionally, the larger trend of criticizing the practice of evidence-based medicine and false accusations of inadequate counseling on SSRIs damages trust and confidence in the patient-physician shared-decision making process.
What some of the panelists failed to acknowledge is patients who choose to start or continue treatment with an SSRI during pregnancy or in the postpartum period do so under close care with a clinician. Through counseling on the benefits and risks of treatment and alignment with the patients’ unique needs, preferences, and values, patients and their provider can choose if a medication, such an SSRI, is the best option for them. Armed with the best available evidence-based health information, our patients should be trusted to decide on the best treatment choice for themselves.
Adam Lewkowitz, MD, MPHS, is an SMFM State Liaison Network Member and Publication Committee member, and Emily Miller, MD, MPH, is a member of the SMFM Document Review Committee and a liaison to the SMFM Committee on Infectious Diseases and Emerging Threats. Dr. Lewkowitz is an Assistant Professor in the Division of MFM at the Warren Alpert Medical School of Brown University and Director of MFM Research at Women & Infants Hospital in Rhode Island. Dr. Miller is an Associate Professor in Obstetrics & Gynecology at the Warren Alpert Medical School of Brown University and Division Director of MFM at Women & Infants Hospital of Rhode Island.
References

1. Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum: ACOG Clinical Practice Guideline No. 5. Obstet Gynecol. Jun 1 2023;141(6):1262–1288. doi:10.1097/aog.0000000000005202
2. Ng QX, Venkatanarayanan N, Ho CYX, Sim WS, Lim DY, Yeo WS. Selective Serotonin Reuptake Inhibitors and Persistent Pulmonary Hypertension of the Newborn: An Update Meta-Analysis. J Womens Health (Larchmt). Mar 2019;28(3):331–338. doi:10.1089/jwh.2018.7319
3. Al-Abri K, Edge D, Armitage CJ. Prevalence and correlates of perinatal depression. Soc Psychiatry Psychiatr Epidemiol. Nov 2023;58(11):1581–1590. doi:10.1007/s00127-022-02386-9
4. Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol. Nov 2005;106(5 Pt 1):1071–83. doi:10.1097/01.AOG.0000183597.31630.db
5. Cox EQ, Sowa NA, Meltzer-Brody SE, Gaynes BN. The Perinatal Depression Treatment Cascade: Baby Steps Toward Improving Outcomes. J Clin Psychiatry. Sep 2016;77(9):1189–1200. doi:10.4088/JCP.15r10174
6. LaRocco-Cockburn A, Melville J, Bell M, Katon W. Depression screening attitudes and practices among obstetrician-gynecologists. Obstet Gynecol. May 2003;101(5 Pt 1):892–8. doi:10.1016/s0029-7844(03)00171-6
7. Button S, Thornton A, Lee S, Shakespeare J, Ayers S. Seeking help for perinatal psychological distress: a meta-synthesis of women's experiences. Br J Gen Pract. Oct 2017;67(663):e692–e699. doi:10.3399/bjgp17X692549
8. Centers for Disease Control and Prevention. Pregnancy-Related Deaths: Data From Maternal Mortality Review Committees in 38 U.S. States, 2020. May 28, 2024. Maternal Mortality Prevention Accessed August 11, 2025. https://www.cdc.gov/maternal-mortality/php/data-research/index.html#cdc_research_or_data_summary_themes_conclu-acknowledgements
9. 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. Jun 9 2020;81(4)doi:10.4088/JCP.19r13134
10. Cesta CE, Reutfors J, Cohen JM, et al. Postpartum Psychiatric Outcomes and Sick Leave After Discontinuing SSRI or SNRI in Pregnancy. JAMA Network Open. 2024;7(10):e2438269–e2438269. doi:10.1001/jamanetworkopen.2024.38269