Antidepressants During Pregnancy Not Linked to Autism, ADHD. Here’s Why

• A comprehensive review found no causal link between antidepressant use before or during pregnancy and ADHD or autism.
• Any association of neurodevelopmental disorders appears to be linked to genetic or environmental factors.
• While antidepressants do have potential risks, it’s important to weigh them against the benefits.
• Untreated depression is associated with serious risks to both the pregnant person and their baby.

Antidepressants have recently come under scrutiny by top U.S. health officials despite their well-established safety and efficacy profiles.

A large international study investigated whether antidepressant use before or during pregnancy is linked to neurodevelopmental disorders in children. 

Researchers from the University of Hong Kong and several global institutions aimed to clarify concerns about whether prenatal exposure to antidepressants raises the risk of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in offspring.

The comprehensive review, published online in The Lancet Psychiatry on May 14, found no such association.

According to the American College of Obstetricians and Gynecologists (ACOG), around 10% of pregnant people experience depression. Untreated mental illness can lead to risks for both the pregnant person and their baby.

Antidepressants, therefore, are commonly prescribed during and after pregnancy.

Despite this, Secretary of Health and Human Services Robert F. Kennedy Jr. discourages the use of selective serotonin reuptake inhibitors (SSRIs), a commonly prescribed class of antidepressants.

These new findings could help dispel misinformation around antidepressant use during pregnancy.

Massive study examines SSRI use during pregnancy

The researchers reviewed dozens of previous studies to better understand whether antidepressant use before or during pregnancy was linked to neurodevelopmental conditions in children.

They examined outcomes including ADHD, autism spectrum disorder, intellectual disabilities, motor disorders, and speech or language delays.

To do this, they searched several major medical research databases and screened nearly 2,000 studies before selecting 37 high quality studies to include in their final analysis.

Altogether, the research covered more than 648,000 pregnancies involving antidepressant exposure and nearly 25 million pregnancies without exposure.

The researchers combined the findings from these studies and adjusted for factors that could affect the results, such as maternal mental illness, family genetics, and differences in how antidepressant exposure was measured.

They also looked at different types of antidepressants, when they were used during pregnancy, dosage levels, and even paternal antidepressant use to help determine whether other underlying factors could explain the findings.

To improve transparency and research quality, the study plan was registered in advance through PROSPERO, an international database for systematic reviews.

No link between SSRIs and autism, ADHD

The analysis found that when mothers used antidepressants during pregnancy, there was a small increase in the chance of their children developing certain neurodevelopmental disorders, such as ADHD and autism.

This increased risk was seen whether the antidepressants were used before or during pregnancy.

However, the researchers also found that when they carefully considered other factors — like the pregnant person’s mental health history or comparisons between siblings — the link between antidepressant use and these disorders became much weaker or disappeared entirely. 

The researchers suggest that the underlying mental health of the parents and other family factors might explain most of the risk, rather than the antidepressant use itself.

Further bolstering the idea of the role of genetic or environmental factors, the team also found that the fathers’ antidepressant use during their partner’s pregnancy was linked to a greater chance of ADHD or ASD in children.

The study, however, did not find increased risks for other developmental issues, such as intellectual disabilities or speech and language problems. Also, taking higher doses of antidepressants did not appear to increase the risk.

Among the different types of antidepressants, only two older medications, amitriptyline and nortriptyline, were consistently linked with higher risks. However, these drugs are less commonly prescribed and often reserved for severe depression. 

More commonly prescribed antidepressants, like the SSRIs fluoxetine and sertraline, did not show a clear increased risk once the pregnant person’s mental health was taken into account.

Overall, the evidence was not strong and was limited by differences in study methods and remaining uncertainties. 

The authors also emphasize that untreated depression during pregnancy carries its own risks for both the pregnant person and the baby, highlighting the need for careful, personalized decisions about antidepressant use during pregnancy.

Benefits of antidepressants outweigh potential risk

Sandra Dunkin, MD, a board certified psychiatrist and founder of BrainWell Psychiatry, said the review’s findings reinforce what she has seen in her own practice. Dunkin wasn’t involved in the research.

“This research is genuinely reassuring, and I want women to hear it clearly: the evidence does not support a causal link between antidepressant use in pregnancy and neurodevelopmental conditions like autism or ADHD,” she told Healthline.

Dunkin said this is important because the fear of causing harm to their baby has led many women to discontinue necessary medications, which can have serious consequences.

Abrupt cessation of an antidepressant without going through a period of tapering off under your doctor’s supervision can lead to antidepressant discontinuation syndrome, which may lead to a range of unpleasant symptoms, including:

• nausea
• headaches
• electric-shock sensations

Additionally, females may experience a return of their depression symptoms, including suicidal ideation.

There are also effects on the developing fetus to consider, said MaryEllen Eller, MD, a board certified psychiatrist with Radial Health who wasn’t involved in the review.

Managing mental health conditions such as depression and anxiety during pregnancy “is not a choice between treatment risk and no risk,” she told Healthline. Instead, it’s a matter of choosing between competing risks, Eller said.

“A growing body of research shows that untreated mental illness during pregnancy carries real consequences for both mother and baby, including premature birth, low birth weight, high blood pressure complications, and long-term effects on a child’s brain development such as increased risk of anxiety, ADHD, learning difficulties, and mood disorders later in life,” Eller said.

Additionally, while antidepressants are not completely without side effects, the likelihood of serious complications is low, she noted.

Also, not all antidepressants have the same risk profile, so switching to another medication is also an option.

Eller said that the availability of other effective treatments, including talk therapy, lifestyle changes, transcranial magnetic stimulation (TMS), and electroconvulsive therapy (ECT), may be appropriate for some people.

“When medications are prescribed, providers aim for the lowest dose that fully controls symptoms — because under-treating mental illness carries its own risks,” Eller said.

“Ultimately, the greatest risk to a developing baby is a mother whose mental illness is untreated.”