Antidepressant use in pregnancy: a critical review focused on risks and controversies
Open accessAbstract
Objective: Conflicting data have led to controversy regarding antidepressant use during pregnancy. The objectives of this study are to i) review the risks of untreated depression and anxiety, ii) review the literature on risks of exposure to antidepressants during pregnancy, iii) discuss the strengths and weaknesses of the different study designs used to evaluate those risks, and iv) provide clinical recommendations. Method: MEDLINE/PubMed was searched for reports and studies on the risk of first‐trimester teratogenicity, postnatal adaptation syndrome (PNAS), and persistent pulmonary hypertension (PPHN) with in utero antidepressant exposure. Results: While some individual studies suggest associations between some specific major malformations, the findings are inconsistent. Therefore, the absolute risks appear small. PNAS occurs in up to 30% of neonates exposed to antidepressants. In some studies, PPHN has been weakly associated with in utero antidepressant exposure, while in other studies, there has been no association. Conclusion: Exposures of concern include that of untreated maternal illness as well as medication exposure. It is vital to have a careful discussion, tailored to each patient, which incorporates the evidence to date and considers methodological and statistical limitations. Past medication trials, previous success with symptom remission, and women's preference should guide treatment decisions.
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The use of antidepressants during pregnancy is controversial because of potential teratogenicity.
“The use of antidepressants is controversial, because of potential teratogenicity.20 21”
From Effects of bright light therapy for depression during pregnancy: a randomised, double-blind controlled trial (2020) · cites this paper as [20]
The safety of maternal use of antidepressants during pregnancy remains to be established.
“However, psychotherapy might not be readily available and the safety of maternal use of antidepressants, which cross the placenta, still remains to be established.”
From Effects of bright light therapy for depression during pregnancy: a randomised, double-blind controlled trial (2020) · cites this paper as [20]
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- Authors
- Byatt, N., Deligiannidis, K. M., & Freeman, M. P.
- Affiliations
- University of Massachusetts Chan Medical School (US)
- Harvard University (US)
- Corresponding author
- Byatt, N.
- Venue
- Acta Psychiatrica Scandinavica
- Publisher
- Wiley
- Published
- 2012-12-14
- Volume
- 127
- Issue
- 2
- Pages
- 94-114
- ISSN
- 0001-690X (ISSN-L)
- 1600-0447
- PMC
- PMC4006272
- OpenAlex
- W2023682546
- Cited by
- 158
- References
- 158
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 12 · 2023: 11 · 2022: 5 · 2021: 8 · 2020: 9 · 2019: 12 · 2018: 7 · 2017: 13 · 2016: 17 · 2015: 20 · 2014: 18 · 2013: 18
- FWCI
- 2.76
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Acta Psychiatrica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- The Journal of the American Medical Association (JAMA) Network (American Medical Association) (submittedVersion)
- Funders
- National Institutes of Health (UL1TR000161, KL2TR000160)
- National Institute of Mental Health (K23MH097794, L30 MH104713)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Keywords
- antidepressant use in pregnancy, maternal depression, maternal anxiety, teratogenicity, persistent pulmonary hypertension of the newborn, prenatal drug exposure, study design limitations, clinical guidelines
- MeSH terms
- Abnormalities, Drug-Induced, Antidepressive Agents, Depressive Disorder, Female, Humans, Infant, Newborn, Persistent Fetal Circulation Syndrome, Pregnancy, Pregnancy Complications, Pregnancy Trimester, First, Prenatal Exposure Delayed Effects, Risk Factors, Selective Serotonin Reuptake Inhibitors, Paroxetine
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