Are Antidepressants Safe During Pregnancy? New Research on Autism and ADHD Risk
Quick Answer
For most antidepressants, use during pregnancy is not linked to a meaningful increase in autism or ADHD in children, according to a 2026 meta-analysis published in The Lancet Psychiatry. The only exception was two older tricyclic antidepressants, amitriptyline and nortriptyline, which remained linked to a higher risk of ADHD after the data was adjusted for confounding factors. Untreated maternal depression carries its own well-documented risks, and continuing treatment is often the safer choice for both parent and baby.
Should you stay on antidepressants during pregnancy?
It is one of the most common questions patients bring into perinatal therapy. The answer has never been simple. It comes down to weighing risks and benefits. A new study published this month in The Lancet Psychiatry gives patients and providers more to work with. For most antidepressants, use before or during pregnancy showed little to no link to autism or ADHD in children once researchers accounted for other risk factors.
Public concern has been growing. In July 2025, an FDA expert panel proposed stronger warnings on SSRIs during pregnancy, and major medical organizations pushed back, saying the panel ignored how dangerous untreated depression can actually be during pregnancy.
What Did the New 2026 Lancet Psychiatry Study Examine?
A research team led by Dr. Wing Chung Chang at the University of Hong Kong conducted a review and meta-analysis of 37 prior studies. The combined sample included more than 600,000 pregnant women who took antidepressants and nearly 25 million pregnancies with no antidepressant exposure. The researchers looked at both maternal and paternal use, the class of medication, dose where reported, and a range of neurodevelopmental outcomes in children including autism, ADHD, motor disorders, speech and language disorders, and intellectual disabilities.
It is the largest review of antidepressants and child neurodevelopmental outcomes to date.
What Did the Initial Numbers Show?
Before adjusting for other variables, the unadjusted findings sounded alarming:
Maternal antidepressant use during pregnancy: 35% higher risk of ADHD
Maternal use: 69% higher risk of autism without intellectual disabilities
Paternal use: 46% higher risk of ADHD and 28% higher risk of autism
These are the kinds of numbers that get pulled into headlines and frighten pregnant patients already weighing a hard decision. The picture changed after the researchers controlled for confounders.
What Happened After Adjusting for Confounders?
Once the researchers adjusted for genetic and familial influences and the reasons parents were taking antidepressants, most associations weakened significantly or disappeared:
Increased autism risk dropped to about 15%
Antidepressant use was not associated with motor disorders, speech and language disorders, or intellectual disabilities
Dose did not appear to drive the small remaining risk
The authors concluded that the apparent associations were largely driven by the underlying vulnerability of the parents and families themselves, not the medication. The conditions antidepressants treat, not the drugs, account for most of the elevated risk seen in earlier research.
Which Antidepressants Still Showed a Risk?
Two older tricyclic antidepressants remained associated with a higher risk of ADHD after adjustment:
Amitriptyline
Nortriptyline
Whether that link is causal, or whether it reflects the more severe depression these older drugs are typically reserved for, is still unknown. SSRIs, the most commonly prescribed class, did not show a meaningful association after adjustment.
If you are pregnant or planning to be and currently taking either of these medications, raise it with your prescriber.
Should You Stop Antidepressants During Pregnancy?
The data does not support stopping medication as a default "safer" choice for the baby. Untreated depression during pregnancy is itself associated with:
Prematurity and low birth weight
Placental dysfunction and inflammation
Changes in fetal brain development
Higher rates of postpartum depression
Approximately 23% of maternal pregnancy-related deaths involve mental health conditions
Depression affects more than one in ten pregnant women worldwide. For many people, continuing treatment is the protective choice, both for the parent and the developing child. The decision belongs to you and your prescriber, and it should be made with full information rather than fear. Any taper or discontinuation should be gradual and clinically supervised.
If you are pregnant or planning to be and want support thinking through medication, mood, and the emotional weight of this decision, pregnancy and postpartum therapy can help you work through it alongside your medical care.
What This Study Cannot Tell Us
The review has clear limits:
Most included studies did not report detailed dosing data
Researchers could not reliably separate continuous antidepressant use from single-trimester use
The review focused on a specific set of neurodevelopmental outcomes and is not a verdict on every aspect of fetal development
It is the strongest evidence to date, not the final word.
Frequently Asked Questions
Why did earlier studies link antidepressants to autism if this one does not? Earlier studies did not fully account for genetic and familial factors, or for the underlying conditions that led parents to take antidepressants in the first place. Once researchers adjusted for those confounders, most of the association disappeared.
Which antidepressants are considered safest during pregnancy? SSRIs, the most prescribed class, did not show a meaningful association with autism or ADHD after adjustment. They remain a first-line option for perinatal depression. Older tricyclics are second or third-line treatments due to side effects and weaker pregnancy data.
What if I am on amitriptyline or nortriptyline? These two older tricyclics remained linked to a higher risk of ADHD even after adjustment. Whether the link is causal or reflects more severe underlying depression is still unknown. If you are pregnant or planning to be and currently on either, raise it with your prescriber.
Should you stop antidepressants before trying to conceive? Not by default. Stopping before conception raises the risk of relapse during pregnancy, which carries its own risks for both parent and baby. Any change should be planned and clinically supervised.
Does the father's antidepressant use affect the baby? Initial associations between paternal antidepressant use and ADHD or autism largely disappeared once researchers controlled for shared genetic and familial factors.
The Bottom Line
For most contemporary antidepressants, the largest analysis to date does not show a meaningful link to autism or ADHD in children once other factors are considered. If you have been frightened into believing that staying on your medication will harm your baby, the most rigorous evidence we have does not support that fear.
Talk to your perinatal psychiatrist or prescriber. Make the decision that protects both of you.
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About the Author
Rachel Goldberg, LMFT is a Licensed Marriage and Family Therapist and the founder of Rachel Goldberg Therapy, a multi-state telehealth practice serving clients across 45 states plus DC. She specializes in perinatal mental health, infertility and IVF, third-party reproduction psychological evaluations, and couples therapy. See full credentials and licensure.
