The Confusion Over Antidepressants During Pregnancy Is Harming People

Hand-wringing over antidepressants during pregnancy harms women

TO Katherine Birndorf

The Food and Drug Administration and the Department of Health and Human Services are playing with women's health. In the summer, the Food and Drug Administration convened a commission about whether certain antidepressants are safe to use during pregnancy. Department of Health and Human Services officials recently said they believe Tylenol (acetaminophen) taken during pregnancy may cause autism.

This claim about antidepressants and the claim about Tylenol cause fear and confusion among pregnant women who may need these medications. It is well known that maternal mental health Major complication associated with childbirth and one of the leading causes of maternal mortality in the United States. The federal government's whirlwind of anxiety has given rise to the idea that suffering is the only choice: Either a pregnant woman will be sick or in pain for longer than necessary, or she will bear the guilt of putting her fetus at risk.

I don't agree.

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I have been a reproductive psychiatrist for 25 years and now primarily focus on pregnancy and the postpartum period as co-founder, CEO and medical director of a company. Motherhood Center in New York. My job has been to help thousands of women understand their mental health during their reproductive years, consider treatment options, and ease their path to becoming the mother they want to be.

In the mid-1990s, no one talked about depression or anxiety during or after pregnancy. I was a medical resident seeking to understand what I was sure was a hidden epidemic, so I knocked on the doors of obstetricians and asked if their patients had ever suffered from these diseases. They looked puzzled and told me that their patients loved having children, period. I knew this wasn't always the case.

With the support of mentors, I explored the underbelly of new motherhood; I was definite that the medical community has not institutionalized, let alone understood, the mental health of mothers and expectant mothers during and after pregnancy. I prepared a lecture series on postpartum illness and asked the hospital nursing department to allow me to present it to expectant parents. They refused.

While all this was happening, I was pregnant with my first child. Working 100 hour weeks meant I didn't have much time to deal with my feelings other than sheer exhaustion. I remember asking our first pediatrician if any of the new mothers were taking antidepressants for postpartum depression or anxiety. He said no. Then I asked if he would ever asked them if they feel depressed or anxious. He paused. And again he said no. I knew why: no one was going to voluntarily reveal this information because it risked being seen as a failure for not being a happy parent.

And here we are in 2025, with FDA-approved drugs for treat postpartum depression And checklist that pediatricians go through with new parents to make sure they are adjusting to these massive changes in their lives. However, the FDA panel attempted to discredit recent years of SSRI research. most category under study medications during pregnancy, which causes fear of these drugs. One panelist suggested that women's higher rates of depression and anxiety were simply due to emotional sensitivity. The panelist went so far as to call these measurable changes in emotional state “gifts.”

After decades of successfully treating pregnant women with depression, we cannot continue to allow them to suffer. We don't whisper about “postpartum” anymore—it's a real category of depression. We now have a National Curriculum in Reproductive Psychiatry to train health professionals. We know that pregnancy does not protect people from mental illness or mental health problems. We know that having a baby can be both wonderful and incredibly difficult. And we know that becoming a mother is what the late anthropologist Dana Rafael called matrescence– This is a real, seismic stage of life. How could you not create a completely new creature?

I think about my own patients, like Mrs. A, pregnant with twins at 13 weeks after years of in vitro fertilization (IVF). The joy she imagined disappeared and was replaced by panic: I can't do this. I don't want these children anymore. It was a mistake. She came to my clinic because her partner was frightened by how often she mentioned ending the pregnancy she had fought so hard for.

I think of Ms. M with the textbook signs and symptoms of depression: poor sleep, lack of appetite, brain fog, low energy, withdrawal. She sat hunched over and expressionless, feeding her seven-month-old baby on the couch in my office. She put off the visit and was afraid that I would offer her medications: she was breastfeeding and did not know if the medications were safe. “I'm not suicidal,” she said. “I just want to get away from my life and this child’s relentless demands.”

I treated both women with SSRIs and both showed significant improvement over time. If they were left untreated, Ms A might terminate her pregnancy out of fear, and Ms M might struggle to connect with her baby, which would also negatively impact her baby's attachment style. Why take such a risk?

SSRIs taken during pregnancy may have some short-term effects on the newborn, such as fussiness or mild breathing problems, which usually go away within a few days and do not have long-term effects. Contrast this with the risks of untreated illnesses for mother and baby after birth: premature birth, low birth weight, poor self-care, substance use and increased risk of suicide, traumatic pregnancy and birth, difficulty bonding, and the unthinkable: infanticide.

This much is certain: Untreated depression and anxiety during pregnancy are far more dangerous—for both parent and baby—than carefully monitored antidepressant treatment. When a pregnant or postpartum woman experiences difficulties—whether it's anxiety, depression, obsessive-compulsive disorder, PTSD, mania, or even psychosis—the question they most often ask me is, “What's wrong with me?”

Untreated maternal mental health problems can impact a child's development, impact parenting abilities and, according to growing research, leave biological “footprints” in the epigenome that can last for generations. How we treat mothers affects their children, but not in the same way that the FDA panel found.

To fight back, follow information from trusted sources such as the American College of Obstetricians and Gynecologists and the American Psychiatric Association. You can fight for access to these medications by leaving comments via Federal Register when the FDA reviews drug warnings. You can be an advocate for postpartum support and maternal mental health. You can share your story to help break the stigma of depression during and after pregnancy.

A lot has changed in 25 years, and women may now be losing some of the gains we have made in maternal mental health. We cannot go back to the days when we experienced silence, stigma and suffering in the shadows – not for ourselves; not for our children.

This is an opinion piece and analysis and the views expressed by the author or authors are not necessarily the views of Scientific American.