My husband and I knew we wanted to try to have a baby. But before we even started trying, I circled a date on the calendar. That was the day when I would start weaning myself off my SSRI, an antidepressant medication that I’d been on for the previous five years.
I was worried, actually terrified, that the beautiful life I’d been building with my new husband would crumble without the medication that squashed the symptoms of my Major Depressive Disorder. But I’d also heard the warnings that SSRIs might harm a baby during pregnancy. I didn’t want to risk it.
About one in four women take an antidepressant, most of which are SSRIs like Lexapro, Prozac, and Zoloft, according to the Centers for Disease Control and Prevention (CDC). That means millions of women face the choice between mental health treatment and possible pregnancy risks.
In July, the Federal Drug Administration (FDA) shined a light on the debate over whether some antidepressants are safe during pregnancy, advocating for a black box warning on these prescriptions. Research is contradictory — some studies highlight possible risks for child development, while others suggest untreated depression itself is the greater concern. The American College of Obstetricians and Gynecologists and other organizations criticized the panel for overstating the risks and spreading misinformation.
Left out of the debate are women like me, who need SSRIs because untreated symptoms pose greater risks to the baby than the SSRIs do. Like Dorothy landing in Oz, Lexpro adjusted the serotonin levels in my brain so that I could finally see the world in color. Alongside decades of therapy, it lifted the feelings of hopelessness and overwhelming dread that followed me through my teens and 20s.
I tried to talk to my doctors about staying on my medication during pregnancy, but neither my gynecologist nor PCP knew much about the potential risks SSRIs pose to a fetus. They agreed that I shouldn’t take the medication if I didn’t need it. What none of us could answer is: Would I need it?
Here’s how I made one of the hardest medical decisions of my life — whether to keep taking an SSRI while pregnant — and what I learned trying to protect both my mental health and my baby.
What we know — and why we don’t know more
Searching for answers to questions about mental health has shaped my life. After my brother’s suicide, I began working at the National Suicide Prevention Lifeline, now 988, and went to grad school for public health. I wanted to find a way to make it easier for people to take care of their mental health.
While hoping to become pregnant, I focused my research at school on untreated depression during pregnancy. I quickly learned that there isn’t much scientific data on SSRI use during pregnancy. To clearly understand SSRI risks, scientists would need what’s called a randomized controlled trial: a study of pregnant women with depression or anxiety where half are given medication and half are given a sugar pill. Researchers would then compare outcomes for the mothers and babies. But that kind of study is considered unethical, since it could put babies at risk without their consent. Instead, pregnancy exposure registries — which track the experiences of women who take SSRIs in real life, some of whom happen to become pregnant while doing so — provide the best insight we have.
From these registries, I learned that there is a clear link between infants who were exposed to SSRIs and lower birth weight. These babies also sometimes have a lower score on the Apgar scale, a test that measures a newborn’s breathing, heart rate, muscle tone, reflexes, and color. When I was considering my options, there was also a theory that SSRIs could be related to autism, but that study has since been debunked.[1]
When depression is untreated during pregnancy, both mom and baby feel the ripple effects. A mom who can barely get out of bed may skip prenatal checkups or struggle to eat well, and that can show up in her baby’s health at birth — similar impacts like lower weight or a lower Apgar score could occur.[2] Depression also makes bonding harder once the baby arrives, which can cause attachment issues and impact development well into childhood.[3]
For many women — myself included — the ever-present image of a happy and strong pregnant woman bringing new life into the world is at odds with how hard and dark motherhood can feel. After all, suicide and overdose are the leading causes of death during pregnancy.
I understood how I could lose control of my emotions if depression crept back into my life. I had struggled with suicidal thoughts before, when I’d felt so much pain and shame that I truly wanted to disappear forever. As much as I wanted to believe that my newlywed bliss would shield depression from returning, I knew that love wasn’t responsible for my mental stability. It was Lexapro.
There really is no risk-free option
As a New Yorker with great insurance, I was able to meet with a reproductive psychiatrist to discuss my own risk levels and the possibility of weaning off medication. She explained that although my Major Depressive Disorder was in remission, having a preexisting mental health condition put me at a much higher risk for developing a perinatal mood disorder.
Her words hit me like a punch in the gut. I couldn’t choose an option in which I didn’t have depression — only potential risks from SSRIs or potential risks from untreated symptoms. I had to decide which was worse.
For me it came down to this: I wanted to be healthy enough to take care of my pregnancy. And to be able to do that, I needed to take an SSRI while trying to conceive and during pregnancy.
As it turned out, Lexpro wasn’t quite enough to smooth the turbulence of anxiety I felt while trying to get pregnant. Even with the SSRI, therapy, and acupuncture, I felt frantic about my fertility.
Once I became pregnant, I found out that I had three risk factors for pregnancy complications: asthma, taking an SSRI, and being 36, which is considered advanced maternal age during pregnancy. I was referred to a Maternal Fetal Medicine specialist. Interestingly, I never felt any shame about my age or having asthma, but the stigma of taking medication for my depression made me feel like I had opted in to that risk factor.
My daughter was born one week late, small, and very healthy, with an Apgar score of 9 out of 10. I made it through an anxiety-riddled fertility struggle, a physically difficult pregnancy (hello, migraines), and all the way to my daughter’s first birthday without a depression flare-up. I’m confident that was only possible because of my SSRI.
What I want other moms to know
This experience taught me how important it is to consider my own risk factors over general recommendations. Every woman’s decision is unique — based on medical history, symptoms, and support system. A psychiatrist, especially one trained in reproductive psychiatry or perinatal mental health, can help you understand what your individual risk will be.
My research showed me just how much more support moms need. In 2022, I helped launch the National Maternal Mental Health Hotline, a designated place for any person who needs a supportive voice or text from a trained counselor.
For some women, counseling and therapy are enough, but not for me. I want all moms to know what I learned firsthand: Taking care of your own mental health is the healthiest thing you can do for your baby.
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