Antidepressants and pregnancy: What parents-to-be should know about ADHD, autism risks

Antidepressants are considered generally safe and effective for depression, anxiety and other disorders. gpointstudio/Getty Images via CNN Newsource

Concerns about whether antidepressants cause harms to developing fetuses, including neurodevelopmental disorders, have grown in recent years.

Now, a group of researchers has published the best evidence to date on links between both parents’ antidepressant use before and during pregnancy, and autism and attention deficit hyperactivity disorder in their children. The large study found that for most antidepressants, exposure during either period ultimately had little to no association with the conditions once the authors considered other influential factors.

The evidence results from a review and meta-analysis of 37 previous studies including more than 600,000 pregnant women taking antidepressants, and nearly 25 million pregnancies with no antidepressant use. The report was published Thursday in the journal The Lancet Psychiatry.

Initially, the authors found maternal antidepressant use during pregnancy was linked with a 35 per cent higher risk of ADHD and a 69 per cent higher risk of autism without intellectual disabilities. Use of the medications by the father was associated with a 46 per cent higher risk of ADHD and a 28 per cent increase in the risk of autism. However, when the researchers adjusted the findings for other factors that can affect risk for the conditions, known as confounders — such as genetic and familial influences and the reasons for taking antidepressants — most links significantly weakened or disappeared. The risk for autism decreased to about 15 per cent.

“This pattern strongly suggests that the higher rates of ADHD and autism seen in previously exposed groups are largely driven by the underlying vulnerability of these mothers and families,” said Dr. Wing Chung Chang , co-senior author of the study and clinical professor of psychiatry at the University of Hong Kong, via email.

Antidepressants “are the mainstay medication treatment for depressive disorder,” which affects more than 10 per cent of pregnant women worldwide, Chang added. Much of the conversation around potential risks has centred on selective-serotonin reuptake inhibitors, which are known as SSRIs and are the most prescribed class of antidepressants.

“This concern has been amplified by the July 2025 FDA expert panel discussions about possibly strengthening warnings on SSRIs in pregnancy, highlighting potential risks such as autism, miscarriage, and birth defects,” Chang said. Medical organizations widely criticized statements made during the event held by the US Food and Drug Administration for being “alarmingly unbalanced” and neglecting to “adequately acknowledge the harms of untreated perinatal mood disorders.”

• READ MORE: No clear autism link to antidepressant use during pregnancy, large study finds

Past studies have amounted to an inconsistent body of evidence and have been limited by small sample sizes and insufficient measurement of confounders, Chang said. Additionally, until now, no reviews have comprehensively evaluated the potential effects of the antidepressant class, specific antidepressant, medication dose, and both maternal and paternal antidepressant use shortly before or during pregnancy, he added. These gaps — as well as the significant positives of antidepressants and the risks of untreated depression — steered the authors’ research.

They also wanted “to help clinicians and patients make informed choices,” Chang added.

Making treatment decisions

Experts understand that the potential impact of psychiatric medications on children “is naturally a source of concern for parents and prescribing clinicians alike,” said Dr. Jonathan Alpert, the Dorothy and Marty Silverman Chair of the department of psychiatry and behavioral sciences at Montefiore Medical Center in New York City, via email.

“Pregnancy is inevitably a time of heightened worry about one’s health and the health of one’s unborn child,” added Alpert, who wasn’t involved in the study.

People planning to have kids or those who are already pregnant should know that the study’s findings affirm current clinical guidelines, which generally support continuing antidepressant treatment during pregnancy when needed, Chang said. “Our findings do not provide strong evidence that prenatal antidepressant exposure causes neurodevelopmental disorders.”

When there is concern, patients and clinicians should have in-depth discussions that include weighing “the potential small risks of continued medication against the substantial risks of untreated maternal depression and make a carefully considered, individualized decision,” Chang said.

In addition to impacts of untreated depression on the mother, developing children are also at greater risk for prematurity and low birth weight, and higher rates of impulsivity, socialization issues, and cognitive, behavioral and emotional difficulties. Perinatal mental health issues can lead to altered metabolism of serotonin, placental dysfunction and inflammation, and altered fetal brain structure, said Dr. Nancy Byatt, a perinatal psychiatrist, via email.

Mental health conditions also caused nearly 28 per cent of maternal pregnancy-related deaths in 2022, up from 23 per cent in 2017 to 2019, Byatt added. Byatt wasn’t involved in the study and is also executive director of the Lifeline for Families Center and Lifeline for Moms Program and a professor at UMass Chan Medical School.

If the decision is to stop taking antidepressants, that should only be done gradually with close clinical monitoring and while practicing other ways to get or stay well, Alpert said. Antidepressant discontinuation syndrome can be particularly distressing in combination with common pregnancy symptoms such as nausea and fatigue, Chang said.

“Please appreciate that you are supporting good health for both of you by getting the treatment you need,” Alpert said.

Depending on how severe your depression is, nonpharmaceutical treatments such as different therapies may help, the authors said.

Given the findings, the mental health of the fathers “might also represent a key, yet understudied, contributor to offspring neurodevelopmental risk,” the researchers wrote in the study. “Perinatal psychiatry has evolved into a field of three, involving mother, infant, and father. Optimising both maternal and paternal mental health is essential, not only for the parents’ own wellbeing, but also for the child’s long-term development.”

‘Meaningful reassurance’ about antidepressant safety

In the new research, involving parents around age 28 on average, antidepressant use was largely not associated with increased risks of motor disorders, speech and language disorders, and intellectual disabilities.

Minimally increased risks for ADHD and autism also didn’t seem to depend on antidepressant dosage, but most studies included in the review didn’t have detailed information on dosing, Chang said. “This is a particularly relevant question in pregnancy, where doses are sometimes increased to account for changes in plasma volume and drug metabolism.”

Similarly, only a few studies examined potential influences of the length of treatment or other more detailed exposure patterns, so the authors of the latest research couldn’t reliably tell possible differences between continuous antidepressant use or use that was limited to one trimester, for example, Chang said. Since the fetal brain and nervous system develop throughout pregnancy, clarifying these factors is an important next step, he added.

Overall, the findings, “together with a growing body of rigorous science on the topic of antidepressant use during pregnancy, offer meaningful reassurance about safety of contemporary antidepressants,” Alpert said.

What’s more concerning are the results for tricyclic antidepressants, which are older as they were first discovered in the 1950s and ’60s, Alpert said — the first SSRI, fluoxetine, was developed in the 1970s and approved for the US by the FDA in 1987. While SSRIs affect only the neurotransmitter serotonin, tricyclic antidepressants such as amitriptyline and nortriptyline impact both serotonin and norepinephrine and other chemical messengers. These drugs therefore have more negative side effects and are considered second- or third-line treatments.

In the new research, when other influential factors were considered, only amitriptyline and nortriptyline remained linked with a higher risk of ADHD.

“Whether that link is causal … or whether it is due to other factors, such as the greater severity of depression for which this class of older antidepressants is often reserved, remains unknown,” Alpert said. “Pending further research on this topic, it is worthwhile for pregnant individuals on these older medications or considering starting them to discuss the potential risks and benefits with their clinicians.”

For any health and medication concerns during pregnancy, seeking guidance from trusted sources is important, Alpert said. Besides perinatal health clinicians, he added, those sources can include the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the American Psychiatric Association.

Kristen Rogers, CNN