Medication During Pregnancy and Postpartum: Weighing Risks, Benefits, and Myths

Written By Jess Coleman, Ph.D.

Table of Contents

Few decisions feel more loaded during pregnancy or the postpartum period than the question of medication. For people already navigating a significant life transition, the question of whether to start, continue, or stop a psychiatric medication can feel complex — carrying weight not just clinically, but emotionally, morally, and socially. Many people bring this question into therapy not because they are looking to be told what to do, but because they feel alone in thinking through it and are not sure who to trust.

This post is not a prescribing guide. I am a psychologist, not a prescriber, and medication decisions should always be made in partnership with a qualified medical provider — a psychiatrist, OB, midwife, or primary care physician with experience with prescribing psychiatric medications for perinatal mental health. What I can offer is a clinical perspective on how these decisions get made and what the evidence actually suggests about the risks of untreated mental health conditions, not just the risks of treatment. The goal is to make space for a more complete, more honest conversation.

Why this conversation can be so charged

Psychiatric medication during pregnancy and postpartum sits at the intersection of several deeply loaded cultural narratives: the idea that a good parent sacrifices everything for their child, the stigma surrounding mental health treatment in general, the lingering myth that pregnancy is a naturally joyful and emotionally protected state, and the well-documented tendency of medicine and culture alike to deprioritize the wellbeing of pregnant people as independent from the wellbeing of the fetus.

In this context, the decision about medication rarely feels like a straightforward clinical question. People worry about being judged for considering medication, about being perceived as prioritizing their own comfort over their baby's safety, or about what it means about them as a parent that they need this kind of support.

These fears are understandable. They are also, in many cases, based on incomplete or inaccurate information and they can lead people to make decisions that are not actually in their own best interest or in the best interest of their baby.

The bias we bring to risk assessment

When people consider medication during pregnancy or while breastfeeding, the conversation almost always centers on one question: what are the risks to the baby? This is a reasonable question. It deserves a thoughtful, evidence-based answer. What it does not deserve is to be the only question asked.

There has historically been a deep and largely unexamined asymmetry in how we frame perinatal medication decisions. The risks of medication exposure are often treated as concrete and serious — something to be carefully weighed and often avoided. The risks of untreated mental illness are often treated as background noise, as something that will probably work itself out, or as the pregnant or postpartum person's problem to manage rather than a clinical concern with real consequences for both parent and baby.

This asymmetry is not evidence-based. It reflects a cultural bias that positions the pregnant person as a vessel whose own suffering matters less than the calculus of fetal exposure. And it leads, not infrequently, to people discontinuing effective treatment, white-knuckling through significant mental health conditions without support, and suffering consequences that were neither necessary nor inevitable.

A genuinely balanced risk assessment asks two questions simultaneously: what are the risks of treatment, and what are the risks of non-treatment? Both sides of that equation deserve rigorous, honest attention.

The real risks of untreated perinatal mental health conditions

Untreated depression and anxiety during pregnancy and postpartum are not benign. Research consistently documents real, measurable risks for the pregnant person and for the baby when significant mental health conditions go unsupported.

For the pregnant person, untreated depression and anxiety are associated with increased risk of self-harm, difficulty adhering to prenatal care, poor nutrition and sleep, greater use of substances including alcohol and tobacco, and elevated rates of postpartum depression. The experience of significant, unaddressed mental illness during pregnancy is not simply uncomfortable — it is a clinically significant stressor on a system already under considerable demand.

For the fetus and developing infant, the picture is equally important and often underemphasized. Research links untreated antenatal depression and anxiety to elevated rates of preterm birth, low birth weight, and adverse neonatal outcomes. Studies have also found associations between maternal mental health conditions during pregnancy and infant neurodevelopmental outcomes including differences in cognitive, language, and motor development in the first two years of life. Notably, emerging evidence suggests that some of the developmental differences previously attributed to antidepressant exposure may actually be more closely associated with the untreated depression itself.

There is also the postpartum period to consider. Untreated perinatal mental illness affects the parent-infant relationship in ways that matter for attachment and long-term child development. A parent who is significantly depressed, anxious, or overwhelmed may have reduced capacity for the kind of responsive, attuned caregiving that supports secure attachment — not because they don't love their baby, but because their nervous system is not resourced to show up the way they want to. This is not a moral failure. It is a predictable consequence of undertreated illness.

None of this is to say that medication is always the answer, or that untreated mental illness inevitably leads to harm. It is to say that the risks of non-treatment are real, documented, and deserve to be part of the conversation every time medication decisions are made.

Common types of medications used in the perinatal period

While this post is not a guide to specific medications, it can be helpful to understand the general categories of medications that are most commonly considered during pregnancy and the postpartum period.

Antidepressants — particularly selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) — are the most frequently used psychiatric medications in the perinatal period. They are used to treat depression, anxiety, and OCD, among other conditions. SSRIs have the largest body of evidence for reproductive safety of any psychiatric medication class, and they are often the first-line pharmacological recommendation when medication is indicated.

Anti-anxiety medications represent a broader category that includes several different drug classes with different safety profiles and mechanisms. Some are appropriate for short-term use in specific circumstances; others require more careful risk-benefit consideration during pregnancy or breastfeeding. A perinatal psychiatrist is best positioned to advise on this.

Mood stabilizers are used to treat bipolar disorder and related conditions. Their use during pregnancy involves a more complex risk-benefit conversation, and people with bipolar disorder who are pregnant or planning pregnancy are strongly encouraged to work with a psychiatrist who has perinatal expertise.

Antipsychotic medications are used for a range of conditions including postpartum psychosis, bipolar disorder, and severe anxiety or OCD. As with mood stabilizers, the decision to use these medications during pregnancy or while breastfeeding requires individualized consultation with a knowledgeable prescriber.

Sleep medications are sometimes considered in the context of severe sleep disruption, which can significantly worsen perinatal mental health. The options vary considerably in their safety profiles during pregnancy and postpartum, and this conversation is best had with a prescriber familiar with the perinatal period.

The takeaway across all of these categories is the same: the evidence base is more nuanced than "medications are dangerous during pregnancy," and the decisions are more individualized than any general rule can capture. What matters is access to a provider who knows the literature, takes your mental health seriously, and is willing to engage in a real risk-benefit conversation rather than defaulting to avoidance out of discomfort or unfamiliarity.

Breastfeeding and medication

The question of medication during breastfeeding is distinct from the question of medication during pregnancy, and the two deserve to be separated rather than collapsed into a single category of "things that might affect the baby."

The amount of most psychiatric medications that transfer into breast milk is generally very small. For many medications, including some of the most commonly prescribed antidepressants, the evidence base for breastfeeding safety is reassuring — though it varies by medication and by individual factors such as infant age and health. The research in this area continues to evolve, and the guidance from perinatal psychiatrists has generally become more nuanced and more supportive of continuing effective treatment when it is needed.

It is also worth naming that breastfeeding and medication are not automatically an either/or choice. Many people who take psychiatric medication breastfeed their babies. Many others choose formula feeding, and that choice for whatever reason is valid and does not require justification. The decision about whether and how to feed a baby is already complicated enough without medication stigma being layered on top of it.

What often gets lost in the breastfeeding and medication conversation is the mental health cost of stopping a medication that is working in order to breastfeed. For some people, this is a genuinely worthwhile trade-off. For others, particularly those with a history of significant illness, prior episodes, or conditions that respond poorly to discontinuation, stopping an effective medication carries real risks that deserve to be acknowledged and weighed alongside everything else.

Common myths and what the evidence actually says

Myth: Stopping medication as soon as you find out you're pregnant is always the safest choice.

Many people assume that the safest thing to do upon discovering a pregnancy is to stop psychiatric medication immediately. For some, abrupt discontinuation carries significant risks: rapid return of symptoms, discontinuation effects, and destabilization that may be harder to treat once it has set in. Clinical guidelines from major perinatal psychiatry organizations consistently recommend against routine discontinuation and in favor of individualized risk-benefit assessment. The decision to stop medication during pregnancy should be made thoughtfully and collaboratively, not reflexively.

Myth: If you need medication, therapy won't be enough to help you.

Medication and therapy are not competing options — they are tools that often work best together and serve different functions. Some people do very well with therapy alone. Some do very well with medication alone. Many find that medication provides enough stabilization to make meaningful engagement in therapy possible — which then builds skills and creates change that extends beyond what the medication alone could accomplish.

Myth: Taking medication means you are not strong enough to handle this on your own.

This framing causes real harm. Psychiatric conditions during pregnancy and postpartum have biological, hormonal, psychosocial, and relational contributors. They are not failures of willpower or character. Treating them with medication when medication is indicated is not weakness — it is the same reasoning that applies to treating any other medical condition. No one tells a pregnant person with hypothyroidism to handle their thyroid levels through willpower alone.

How therapy and medication work together

I think of medication, when it is part of someone's care, as one tool among several — not a replacement for the relational, skills-based, meaning-making work of therapy, and not something that competes with it. In my clinical experience, the two often work in a complementary and synergistic way.

For some people, starting medication creates enough stabilization that therapy becomes genuinely accessible for the first time. When someone is in the depths of significant depression or anxiety, their capacity to engage with new material, tolerate emotional activation, and practice new skills between sessions is often limited. Medication can lift the floor enough that therapy can begin to yield significant change. Many people find that as the skills build and the circumstances shift, they are able to taper medication with their prescriber's guidance, having developed the internal resources to sustain the gains. For others, therapy builds enough stability and skill that medication, if it was ever needed, can be used more briefly and at lower doses. And for others, the combination of medication and therapy together create a sustainable pathway for stability and wellbeing.

In my work with clients who are also working with a prescriber, I often serve as a connector — helping clients understand their own responses to medication, communicating clearly with their prescriber about what is and isn't working, and making sense of the emotional dimensions of the medication decision itself. Many people carry grief, ambivalence, or shame about needing medication that is worth exploring in therapy, regardless of whether they ultimately take it.

When I work with clients navigating this decision, we often explore:

  • What fears or assumptions are shaping the decision
  • What the actual costs have been of the current level of distress — to them, to their relationships, to their capacity to function
  • What they would want for a close friend in the same situation
  • What their values say about how they want to move through this season of their life
  • What questions they want to bring to their prescriber

The goal is always a decision that is truly theirs — informed, considered, and not made from a place of shame or fear.

What a good decision-making process looks like

A good perinatal medication decision-making process is not one that arrives at a particular answer. It is one that is informed, collaborative, and genuinely attentive to both sides of the risk-benefit equation.

Research on how people make antidepressant decisions during pregnancy consistently finds that what people want most is a nonjudgmental environment, honest information about both the risks of medication and the risks of untreated illness, and a provider who takes their mental health seriously rather than treating medication avoidance as the automatic goal. Unfortunately, that experience is not universal. Provider confidence in prescribing psychiatric medications during pregnancy varies considerably, and some people receive guidance that is more shaped by clinician discomfort than by evidence.

Some markers of a good process:

  • Your provider discusses both the risks of treatment and the risks of non-treatment, and treats both as clinically significant
  • The conversation is individualized to your history, your severity of illness, your specific circumstances, and the perinatal context
  • You are given information about absolute risk rather than only relative risk, which is more meaningful and less alarming
  • You are supported in asking questions and in revisiting the decision as circumstances change
  • Your mental health is treated as a priority, not an afterthought

If you are not getting this kind of conversation from your current provider, seeking a second opinion from a psychiatrist who specializes in perinatal mental health — a perinatal or reproductive psychiatrist — is both reasonable and often transformative. This is a specialized area of expertise, and the quality of guidance varies substantially.

When to seek support

Mental health support — whether therapy, medication, or both — may be helpful when depression, anxiety, OCD, or other concerns are significantly affecting daily functioning, relationships, sleep, or the capacity to care for yourself or your baby. It is also valuable when you are navigating a medication decision that feels confusing, frightening, or laden with shame.

You do not need to be in crisis to seek support. Many people find that starting therapy or having an honest conversation with a prescriber before symptoms are at their worst makes both the clinical and the decision-making process significantly more manageable.

If someone is experiencing thoughts of self-harm or suicide, immediate support is needed. In the U.S., calling or texting 988 connects to the Suicide and Crisis Lifeline. If there is imminent danger, call 911 or go to the nearest emergency room.

If any of this resonates, and you're wondering if working with a specialist might help, I'd be glad to connect. You can reach me through my contact form or at contact@drjesscoleman.com.

Telehealth perinatal mental health therapy

I provide telehealth therapy to adults in North Carolina, California, and 40+ PSYPACT states. If you are pregnant or postpartum and navigating questions about medication, mental health treatment, or both, I offer a space to think through these decisions carefully, without judgment, and with clinical grounding in the perinatal mental health evidence base. I do not prescribe medication, but I work collaboratively alongside prescribers and can help you prepare for those conversations and make sense of your options. You can reach me through the contact form on this site or by emailing contact@drjesscoleman.com.

Frequently Asked Questions

Is it safe to take antidepressants during pregnancy?

This is a question that deserves a more complete answer than a simple yes or no. Antidepressants, particularly SSRIs, have the largest evidence base for safety of any psychiatric medication class used in pregnancy. The absolute risk of adverse outcomes associated with SSRI use is generally small, and must be weighed against the documented risks of untreated depression and anxiety during pregnancy, which include preterm birth, low birth weight, and adverse effects on infant neurodevelopment. The decision is individualized and should be made in conversation with a knowledgeable prescriber who takes both sides of the equation seriously.

Should I stop my psychiatric medication when I find out I'm pregnant?

Not necessarily, and not without consulting your provider first. Abrupt discontinuation of psychiatric medication can carry significant risks, including rapid return of symptoms and discontinuation effects that may be difficult to manage during pregnancy. Clinical guidelines from major perinatal psychiatry organizations advise against routine discontinuation and in favor of individualized risk-benefit assessment. If you are on medication and become pregnant, contact your prescriber before making any changes.

Can I take medication and breastfeed?

For many psychiatric medications, including some of the most commonly prescribed antidepressants, the evidence base for breastfeeding safety is generally reassuring. The amount of medication that transfers into breast milk is typically small, and for many medications, longitudinal studies have not identified neurodevelopmental concerns in infants. The decision is individualized and depends on the specific medication, the infant's age and health, and the parent's mental health needs. A perinatal psychiatrist or your prescriber can help you evaluate your specific situation.

What if I want to try therapy before considering medication?

Therapy is often an appropriate and effective first-line treatment for mild to moderate perinatal depression and anxiety, and it is always worth discussing with your provider. For some people, therapy alone produces meaningful and lasting change. For others — particularly those with moderate to severe symptoms, a history of significant illness, or limited response to therapy alone — medication may be needed alongside therapy to achieve sufficient stabilization. These options are not mutually exclusive, and the decision about what to pursue first is one that can be made collaboratively with your treatment team.

Does needing medication mean I am not a good parent?

No. Psychiatric conditions during pregnancy and postpartum have biological, hormonal, and psychosocial contributors that are not reflections of character, effort, or parenting capacity. Treating a mental health condition with medication when it is indicated is the same clinical logic that applies to treating any other medical condition during pregnancy. Seeking support — in whatever form is most appropriate — is an act of care for yourself and for your family.

How do I find a prescriber who specializes in perinatal mental health?

Postpartum Support International (postpartum.net) maintains a provider directory of perinatal mental health specialists, including prescribers, across the United States. Your OB or midwife may also be able to refer you to a perinatal psychiatrist or a collaborative care program with perinatal mental health expertise. If your current provider seems uncomfortable with or uninformed about perinatal medication decisions, seeking a second opinion is reasonable and often worthwhile.

Further Reading

Jess Coleman, Ph.D.
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