Klin Farmakol Farm. 2025;39(2):103-110 | DOI: 10.36290/far.2025.038

Antidepressants in the treatment of depressive disorder during pregnancy: to treat or not to treat?

Lenka Sušilová
BENU Lékárna, Brno

Antidepressants, as well as untreated depressive disorder during pregnancy, represent risk factors for the course of pregnancy, fetal development, and neonatal adaptation after birth. This review summarizes currently published data on the impact of untreated depressive disorder and the risks associated with antidepressant treatment on the course of pregnancy, fetal development, and early neonatal adaptation. Available studies do not indicate that most antidepressants have teratogenic potential or clinically significantly increase the risk of pregnancy complications or impaired fetal development. However, exposure to antidepressants may increase the risk of neonatal adaptation disorders, which complicate the early adaptation of the child. Severe untreated depressive disorder, however, poses a greater risk to the fetus than antidepressant treatment during pregnancy.

Keywords: antidepressants treatment, depression in pregnancy, selective serotonin reuptake inhibitor, in utero exposure to antidepressants, congenital malformations.

Accepted: July 3, 2025; Published: July 4, 2025  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Sušilová L. Antidepressants in the treatment of depressive disorder during pregnancy: to treat or not to treat? Klin Farmakol Farm. 2025;39(2):103-110. doi: 10.36290/far.2025.038.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. . American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM‑5). Arlington, VA: American Psychiatric Publishing. 2013. Go to original source...
    2. . World Health Organization. International Classification of Diseases, 11th Revision (ICD‑11). Geneva: WHO. 2019.
    3. . Kozinszky Z, Dudas RB. Validation studies of the Edinburgh Postnatal Depression Scale for the antenatal period. J Affect Disord. 2015;176:95‑105. Go to original source... Go to PubMed...
    4. . American College of Nurse‑Midwives. A Brief Depression Screening Tool for Perinatal Clinical Practice. 2022.
    5. . Yin X, Sun N, Jiang N, et al. Prevalence and associated factors of antenatal depression: systematic reviews and meta‑analyses. Clin Psychol Rev. 2021;83:101932. Go to original source... Go to PubMed...
    6. . Boekhorst MGBM, Beerthuizen A, Endendijk JJ, et al. Different trajectories of depressive symptoms during pregnancy: a longitudinal population‑based study in China. J Affect Disord. 2019;248:139‑146. Go to original source... Go to PubMed...
    7. . Bao C, Jin D, Sun S, Xu L, et al. Trajectories and depressive symptoms during the perinatal period: a longitudinal population‑based study in China. 2022;13:762719. Go to original source... Go to PubMed...
    8. . Lee H, Kim KE, Kim MY, et al. Trajectories of depressive symptoms and anxiety during pregnancy and associations with pregnancy stress. Int J Environ Res Public Health. 2021;18(5):2733. Go to original source... Go to PubMed...
    9. . Gelaye B, Sanchez SE, Andrade A, et al. Association of antepartum depression, generalized anxiety, and posttraumatic stress disorder with infant birth weight and gestational age at delivery. J Affect Disord. 2020;262:310‑316. Go to original source... Go to PubMed...
    10. . Rahi M, Heikkinen T, Hartter S, et al. Placental transfer of quetiapine in relation to P‑glycoprotein activity. J Psychopharmacol. 2007;21(7):751‑756. Go to original source... Go to PubMed...
    11. . Ewing G, Tatarchuk Y, Appleby D, et al. Placental transfer of antidepressant medications: implications for postnatal adaptation syndrome. Clin Pharmacokinet. 2015;54(4):359‑370. Go to original source... Go to PubMed...
    12. . Watanabe O. Current evaluation of teratogenic and fetotoxic effects of psychotropic drugs. Seishin Shinkeigaku Zasshi. 2014;116(12):996‑1004.
    13. . Betcher HK, Wisner KL. Psychotropic treatment during pregnancy: research synthesis and clinical care principles. J Womens Health (Larchmt). 2020;29(3):310‑318. Go to original source... Go to PubMed...
    14. . Seifertová D, Mohr P, Strunzová V. Léčba psychofarmaky v těhotenství a laktaci. Psychiatrie Pro Praxi. 2007;3:118‑124.
    15. . Šebela A, Nosková E, Goetz M, et al. Psychofarmaka během těhotenství - mírní, nebo zvyšují riziko pro plod? Část druhá: stabilizátory nálady, anxiolytika. Pediatrie Pro Praxi. 2017;18(5):282‑286. Go to original source...
    16. . Cepeda MS, Kern DM, Nicholson S. Treatment resistant depression in women with peripartum depression. BMC Pregnancy Childbirth. 2019;19(1):323. Go to original source... Go to PubMed...
    17. . Ornoy A, Weinstein‑Fudim L, Ergaz Z. Antidepressants, antipsychotics, and mood stabilizers in pregnancy: what do we know and how should we treat pregnant women with depression. Birth Defects Res. 2017;109(12):933‑956. Go to original source... Go to PubMed...
    18. . Gentile S. Use of benzodiazepines in pregnancy and lactation: a review. Expert Opin Drug Saf. 2011;10(4):537‑551.
    19. . Shyken JM, Babbar S, et al. Benzodiazepines in pregnancy. Clin Obstet Gynecol. 2019;62(1):156‑167. Go to original source... Go to PubMed...
    20. . Tomson T, Battino D, Bonizzoni E, et al. Comparative risk of major congenital malformations with eight different antiepileptic drugs: a prospective cohort study of the EURAP registry. Lancet Neurol. 2018;17(6):530‑538. Go to original source... Go to PubMed...
    21. . Česká psychiatrická společnost. Doporučené postupy pro léčbu depresivních poruch v těhotenství a při kojení. Praha: Česká psychiatrická společnost. 2022.
    22. . Málová V. Esketamin. Psychiatr. praxi. 2023;24(3):194‑198. Go to original source...
    23. . Meltzer‑Brody S, Kanes S. Brexanolone injection in postpartum depression: two multicentre, double‑blind, randomised, placebo‑controlled, phase 3 trials. Lancet. 2018;392(10152):1058‑1070. Go to original source... Go to PubMed...
    24. . Grigoriadis S, VonderPorten EH, Mamisashvili L, et al. The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta‑analysis. J Clin Psychiatry. 2013;74(4):e321‑e341. Go to original source... Go to PubMed...
    25. . Grote NK, Bridge JA, Gavin AR, et al. A meta‑analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010;67(10):1012‑1024. Go to original source... Go to PubMed...
    26. . Jarde A, Morais M, Kingston D, et al. Neonatal outcomes in women with untreated antenatal depression compared with women without depression: a systematic review and meta‑analysis. JAMA Psychiatry. 2016;73(8):826‑837. Go to original source... Go to PubMed...
    27. . Yang J, Qu Y, Zhan Y, et al. Trajectories of depressive symptoms during pregnancy and risk of premature birth: a multicenter and prospective cohort study. Psychiatry Res. 2023;326:115251. Go to original source... Go to PubMed...
    28. . Staneva A, Bogossian F, Pritchard M, et al. The effects of maternal depression, anxiety, and perceived stress during pregnancy on preterm birth: a systematic review. Midwifery. 2015;28(3):179‑193. Go to original source... Go to PubMed...
    29. . Ghimire U, Papabathini SS, Kawuki J, et al. Depression during pregnancy and the risk of low birth weight, preterm birth and intrauterine growth restriction: an updated meta‑analysis. Early Hum Dev. 2021;152:105243. Go to original source... Go to PubMed...
    30. . Shenassa ED, Widemann LG, Hunt CD. Antepartum depression and preterm birth: pathophysiology, epidemiology, and disparities due to structural racism. Curr Psychiatry Rep. 2021;23(3):14. Go to original source... Go to PubMed...
    31. . Jahan N, Went TR, Sultan W, et al. Untreated depression during pregnancy and its effect on pregnancy outcomes: a systematic review. Cureus. 2021;13(8):e17251. Go to original source... Go to PubMed...
    32. . Shapiro GD, Fraser WD, Frasch MG, et al. Psychosocial stress in pregnancy and preterm birth: associations and mechanisms. J Perinat Med. 2013;41(6):631‑645. Go to original source... Go to PubMed...
    33. . Bindt C, Guo N, Bonle MT, et al. Association of antepartum and postpartum depression in Ghanaian and Ivorian women with febrile illness in their offspring: a prospective birth cohort study. Am J Epidemiol. 2013;178(9):1394‑1402. Go to original source... Go to PubMed...
    34. . Bonari L, Pinto N, Ahn E, et al. Perinatal risks of untreated depression during pregnancy. Can J Psychiatry. 2004;49(11):726‑735. Go to original source... Go to PubMed...
    35. . Mesches GA, Wisner KL, Betcher HK. A common clinical conundrum: antidepressant treatment of depression in pregnant women. Semin Perinatol. 2020;44(3):151‑229. Go to original source... Go to PubMed...
    36. . Grigoriadis S, Graves L, Peer M, et al. Maternal anxiety during pregnancy and the association with adverse perinatal outcomes: systematic review and meta‑analysis. J Clin Psychiatry. 2018;79(5):17r1201. Go to original source... Go to PubMed...
    37. . Gentile S. Untreated depression during pregnancy: short‑ and long‑term effects in offspring. A systematic review. Neuroscience. 2017;342:154‑166. Go to original source... Go to PubMed...
    38. . Weikum WM, Mayes LC, Grunau RE, et al. The impact of prenatal serotonin reuptake inhibitor (SSRI) antidepressant exposure and maternal mood on mother‑infant interactions at 3 months of age. Infant Behav Dev. 2013;36(4):485‑493. Go to original source... Go to PubMed...
    39. . Rogers A, Obst S, Teague SJ, et al. Association between maternal perinatal depression and anxiety and child and adolescent development: a meta‑analysis. JAMA Pediatr. 2020;174(11):1082‑1092. Go to original source... Go to PubMed...
    40. . Grigoriadis S, VonderPorten EH, Mamisashvili L, et al. Anti­depressant exposure during pregnancy and congenital malformations: is there an association? A systematic review and meta‑analysis of the best evidence. J Clin Psychiatry. 2013;74(4):e293‑e308. Go to original source... Go to PubMed...
    41. . Bérard A, Zhao JP, Sheehy O. Antidepressant use during pregnancy and the risk of major congenital malformations in a cohort of depressed pregnant women: an updated analysis of the Quebec Pregnancy Cohort. BMJ Open. 2017;7(1):e013372. Go to original source... Go to PubMed...
    42. . Bar‑Oz B, Einarson T, Einarson A, et al. Paroxetine and congenital malformations: meta‑analysis and consideration of potential confounding factors. Clin Ther. 2007;29(5):918‑926. Go to original source... Go to PubMed...
    43. . Yang J, Qu Y, Zhan Y, et al. Trajectories of depressive symptoms during pregnancy and risk of premature birth: a multicenter and prospective cohort study. J Affect Disord. 2020;275:149‑156.
    44. . Venkatesh KK, Castro VM, Perlis RH, et al. Impact of antidepressant treatment during pregnancy on obstetric outcomes among women previously treated for depression: an observational cohort study. J Perinatol. 2017;37(9):1003‑1009. Go to original source... Go to PubMed...
    45. . Malm H, Sourander A, Gissler M, et al. Pregnancy complications following prenatal exposure to SSRIs or maternal psychiatric disorders: results from population‑based national register data. Am J Psychiatry. 2015;172(12):1224‑1231. Go to original source... Go to PubMed...
    46. . Huang H, Coleman S, Bridge JA, et al. A meta‑analysis of the relationship between antidepressant use in pregnancy and the risk of preterm birth and low birth weight. Hosp Psychiatry. 2014;36(1):13‑18. Go to original source... Go to PubMed...
    47. . Prady SL, Hanlon I, Fraser LK, et al. A systematic review of maternal antidepressant use in pregnancy and short‑ and long‑term offspring outcomes. Arch Womens Ment Health. 2018;21(2):127‑140. Go to original source... Go to PubMed...
    48. . Gurnot C, Martin‑Subero I, Mah SM, et al. Prenatal anti­depressant exposure associated with CYP2E1 DNA methylation change in neonates. Epigenetics. 2015;10(5):361‑368. Go to original source... Go to PubMed...
    49. . El Marroun H, White T, Verhulst FC, et al. Maternal use of antidepressant or anxiolytic medication during pregnancy and childhood neurodevelopmental outcomes: a systematic review. Eur Child Adolesc Psychiatry. 2014;23(10):973‑992. Go to original source... Go to PubMed...
    50. . Korayem GB, Alanazi Y, Alanazi H, et al. Exploring women's perception and attitude towards antidepressant use: a cross‑sectional study. BMC Womens Health. 2024;24(1):453. Go to original source... Go to PubMed...
    51. . Ban L, Tata LJ, Fiaschi L, et al. Live and non‑live pregnancy outcomes among women with depression and anxiety: a population‑based study. PLoS One. 2012;7(8):e43462. Go to original source... Go to PubMed...
    52. . Adhikari K, Patten SB, Lee S, et al. Risk of adverse perinatal outcomes among women with pharmacologically treated and untreated depression during pregnancy: a retrospective cohort study. Paediatr Perinat Epidemiol. 2019;33(5):323‑331. Go to original source... Go to PubMed...
    53. . Marks C, Silvola R, Teal E, et al. Comparing newborn outcomes after prenatal exposure to individual antidepressants: a retrospective cohort study. Pharmacotherapy. 2021;41(11):907‑914. Go to original source... Go to PubMed...
    54. . Tharp MA, Silvola RM, Marks C, et al. Does lack of exposure to individual antidepressants at different points during pregnancy associate with reduced risk of adverse newborn outcomes? BMC Pregnancy Childbirth. 2022;22(1):926. Go to original source... Go to PubMed...
    55. . Fitton CA, Steiner MFC, Aucott L, et al. In utero exposure to antidepressant medication and neonatal and child outcomes: a systematic review. Acta Psychiatr Scand. 2020;141(1):21‑33. Go to original source... Go to PubMed...
    56. . Ng QX, Venkatanarayanan N, Ho CYX, et al. Selective serotonin reuptake inhibitors and persistent pulmonary hypertension of the newborn: an updated meta‑analysis. J Womens Health (Larchmt). 2019;28(3):331‑338. Go to original source... Go to PubMed...
    57. . Huybrechts KF, Bateman BT, Palmsten K, et al. Antidepressant use late in pregnancy and risk of persistent pulmonary hypertension of the newborn. JAMA. 2015;313(21):2142‑2149. Go to original source... Go to PubMed...
    58. . Bérard A, Sheehy O, Zhao JP, et al. SSRI and SNRI use during pregnancy and the risk of persistent pulmonary hypertension of the newborn. Br J Clin Pharmacol. 2017;83(5):1126‑1133. Go to original source... Go to PubMed...
    59. . Wurst KE, Poole C, Ephross SA, et al. First trimester paroxetine use and the prevalence of congenital, specifically cardiac, defects: a meta‑analysis of epidemiological studies. Birth Defects Res A Clin Mol Teratol. 2010;88(3):159‑170. Go to original source... Go to PubMed...
    60. . Grigoriadis S, Graves L, Peer M, et al. Benzodiazepine use during pregnancy alone or in combination with an antidepressant and congenital malformations: systematic review and meta‑analysis. J Clin Psychiatry. 2019;80(4):18r12412. Go to original source... Go to PubMed...
    61. . Chan JKN, Lee KCK, Wong CSM, et al. Prenatal antidepressant use and risk of congenital malformations: a population‑based cohort study. Psychiatry Res. 2024;339:116038. Go to original source... Go to PubMed...
    62. . Campbell KSJ, Collier AC, Irvine MA, et al. Maternal serotonin reuptake inhibitor antidepressants have acute effects on fetal heart rate variability in late gestation. Front Psychiatry. 2021;12:680177. Go to original source... Go to PubMed...
    63. . Anderson KN, Lind JN, Simeone RM, et al. Maternal use of specific antidepressant medications during early pregnancy and the risk of selected birth defects. JAMA Psychiatry. 2020;77(12):1246‑1255. Go to original source... Go to PubMed...
    64. . Bérard A, Zhao JP, Sheehy O. Sertraline use during pregnancy and the risk of major malformations. Am J Obstet Gynecol. 2015;212(6):799.e1‑799.e13. Go to original source... Go to PubMed...
    65. . Uguz F. Selective serotonin reuptake inhibitors and the risk of congenital anomalies: a systematic review of current meta‑analyses. Expert Opin Drug Saf. 2020;19(12):1595‑1604. Go to original source... Go to PubMed...
    66. Einarson A, Pistelli A, De Santis M, et al. Evaluation of the risk of congenital cardiovascular defects associated with use of paroxetine. J Obstet Gynaecol Can. 2008;30(8):696‑701.
    67. . O'Brien L, Einarson TR, Sarkar M, et al. Does paroxetine cause cardiac malformations? J Obstet Gynaecol Can. 2008;30(8):696‑701. Go to original source... Go to PubMed...
    68. . Petersen I, Evans SJ, Gilbert R, et al. Selective serotonin reuptake inhibitors and congenital heart anomalies: comparative cohort studies of women treated before and during pregnancy and their children. J Clin Psychiatry. 2016;77(1):e36‑e42. Go to original source... Go to PubMed...
    69. . Ban L, Gibson JE, West J, et al. Maternal depression, antidepressant prescriptions, and congenital anomaly risk in offspring: a population‑based cohort study. BJOG. 2014;121(12):1471‑1481. Go to original source... Go to PubMed...
    70. . Hutchison SM, Brain U, Grunau RE, et al. Associations between maternal depressive symptoms and selective serotonin reuptake inhibitor antidepressant treatment on internalising and anxiety behaviours in children: 12‑year longitudinal study. BJPsych Open. 2023;9(2):e26. Go to original source... Go to PubMed...
    71. . Rommel AS, Bergink V, Liu X, et al. Long‑term effects of intrauterine exposure to antidepressants on physical, neurodevelopmental, and psychiatric outcomes: a systematic review. J Clin Psychiatry. 2020;81(3):20r13461. Go to original source... Go to PubMed...
    72. . Campbell KSJ, Brain U, Hanley GE, et al. Maternal depressed mood and serotonergic antidepressant treatment during pregnancy differentially shape the continuity between fetal‑newborn neurobehaviour. Early Hum Dev. 2024;198:106-129. Go to original source... Go to PubMed...
    73. . Mezzacappa A, Lasica PA, Gianfagna F, et al. Risk for autism spectrum disorders according to period of prenatal anti­depressant exposure: a systematic review and meta‑analysis. JAMA Pediatr. 2017;171(6):555‑563. Go to original source... Go to PubMed...
    74. . Sujan AC, Rickert ME, Öberg AS, et al. Associations of maternal antidepressant use during the first trimester of pregnancy with preterm birth, small for gestational age, autism spectrum disorder, and attention‑deficit/hyperactivity disorder in offspring. JAMA. 2017;317(15):1553‑1562. Go to original source... Go to PubMed...
    75. . Clements CC, Castro VM, Blumenthal SR, et al. Prenatal anti­depressant exposure is associated with risk for attention‑deficit hyperactivity disorder but not autism spectrum disorder in a large health system. Mol Psychiatry. 2015;20(6):727‑734. Go to original source... Go to PubMed...
    76. . Yonkers KA, Wisner KL, Stewart DE, et al. The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. Gen Hosp Psychiatry. 2009;31(5):403‑413. Go to original source... Go to PubMed...
    77. . Česká psychiatrická společnost ČLS JEP. Doporučené postupy psychiatrické péče 2024 - Specifika léčby depresivní epizody v těhotenství. Praha; 2024.
    78. . Haskey C, Galbally M. Mood stabilizers in pregnancy and child developmental outcomes: a systematic review. Aust N Z J Psychiatry. 2017;51(11):1087‑1097. Go to original source... Go to PubMed...

    Return to the content


    Clinical Pharmacology and Pharmacy

    Madam, Sir,
    please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
    Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

    I declare:

    1. that I have met the above instruction
    2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited

    No
    Yes

    If your statement is not true, please be aware
    that brings the risk of danger to their health or the health of others.