One of the most common things I hear from pregnant patients is, “Do I need to stop my medication now that I’m pregnant?” It is an understandable concern. Pregnancy is a time when many moms want to reduce exposures and protect their developing baby.
In psychiatric care, though, the answer is rarely that simple. In many cases, continuing treatment is actually the safest option for both parent and baby.
Mental Health Is Part of Pregnancy Health
As a psychiatric nurse practitioner specializing in perinatal mental health, my role is to help patients weigh risks and benefits using the best available research. What often gets missed is that untreated psychiatric illness also carries risk.
Depression and anxiety are among the most common complications of pregnancy, with research estimating that 10–20% of pregnant individuals experience clinically significant depression, and anxiety disorders occur at similar rates (American College of Obstetricians and Gynecologists [ACOG], 2023).
Untreated symptoms can affect sleep, appetite, daily functioning, relationships, prenatal care, and overall well-being, and have also been associated with risks such as preterm birth and low birth weight. Mental health is not separate from pregnancy health. It is part of it.
Finding the Right Treatment for You
So, what treatment is right for you? A psychiatric provider will usually look at the full picture, including the severity of symptoms, prior history of relapse, response to medication, trimester of pregnancy, available safety data for specific medications, and what non-medication supports are in place. For some patients with milder symptoms, therapy, lifestyle changes, and added support may be enough. For others with more moderate to severe illness, medication can be a critical part of maintaining stability.
In perinatal psychiatry, the goal is always to balance two sets of risks: the potential risks of medication exposure and the very real risks of untreated illness. When we look carefully at the data, many patients find reassurance in knowing that continuing medication can be both reasonable and medically appropriate.
What the Research Says About SSRIs
SSRIs are among the most commonly used and most studied psychiatric medications in pregnancy. Over the last two decades, extensive research has been done on their use in pregnancy, and the overall data is reassuring. A major study published in the New England Journal of Medicine examining over 900,000 pregnancies found no substantial increase in cardiac malformations associated with antidepressant exposure once maternal illness was accounted for (Huybrechts et al., 2014).
Similarly, the American College of Obstetricians and Gynecologists (ACOG) states, “For many women with moderate to severe depression, the benefits of pharmacotherapy during pregnancy outweigh the potential risks of medication exposure” (ACOG Clinical Practice Guideline, 2023).
Understanding Relapse Risk
Relapse risk is also an important part of the conversation. Pregnancy is not protective against mental illness, and many women who discontinue antidepressants during pregnancy will relapse.
One landmark study found that 68% of women who discontinued antidepressants relapsed, compared with 26% of women who continued treatment. That reflects what many of us see clinically: stopping medication abruptly or out of fear can sometimes create more risk than continuing a medication that has already been helping (Nonacs, 2020).
The Bottom Line
The bottom line is that these decisions should be individualized, thoughtful, and grounded in evidence rather than fear. For many patients, staying on medication during pregnancy is not only reasonable but may be one of the best ways to protect both maternal and infant health.
