Medications in Pregnancy and Breastfeeding: What the Research Says
- Kathy Morelli
- Apr 10, 2017
- 6 min read
Updated: Feb 20
The Question Many Mothers Ask
If you need medication for your mental health, is it safe to take it during pregnancy or breastfeeding?
There is no zero-risk option.
Not treating depression, anxiety, or bipolar disorder carries risks. Taking medication carries risks.
The goal is not eliminating risk — it is weighing relative risk with good information.
A Personal Reflection
When I experienced postpartum depression over two decades ago, I chose not to take medication because I was breastfeeding. At the time, research felt limited and unclear.
Today, the evidence base is far stronger. In many cases of moderate to severe depression, anxiety, or bipolar disorder, research over the past 25 years suggests that maternal emotional stability supports better outcomes for both mother and baby.
Depression is quite painful.
People who are depressed are "allowed" to take medication to help their condition just as are diabetics. And, for both depression and diabetes, sometimes self-help techniques can augment treatment and reduce or eliminate the need for medication and sometimes self-help techniques just can’t.
You can read more about the signs and treatment of postpartum depression in my detailed perinatal mental health article.
Depression Is a Medical Condition
Depression is not a character flaw.
Just as diabetes sometimes requires insulin, some psychiatric conditions require medication. Self-help tools can be powerful adjuncts — but sometimes they are not sufficient alone.
Perinatal psychiatry is now a recognized specialty, though access can vary by region.
For referrals, organizations such as Postpartum Support International maintain state-by-state resource lists and a help line.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Selective Serotonin Reuptake Inhibitors (SSRIs) are among the most commonly prescribed medications for depression and anxiety during pregnancy and the postpartum period. Examples include sertraline, fluoxetine, citalopram, and escitalopram.
Over the past two decades, SSRIs have been extensively studied in pregnancy and lactation. While no medication is completely risk-free, most research suggests that certain SSRIs — particularly sertraline — have relatively low transfer into breast milk and are often considered compatible with breastfeeding when clinically indicated.
During pregnancy, some studies have noted small increases in specific risks (such as transient neonatal adaptation symptoms after birth), but untreated moderate to severe depression also carries risks, including:
Preterm birth
Poor maternal nutrition
Increased stress hormone exposure
Impaired bonding
Elevated risk of postpartum depression
The decision to use an SSRI during pregnancy or breastfeeding involves weighing:
Severity and history of depression or anxiety
Prior response to medication
Risk of relapse
Trimester timing
Breastfeeding goals
For women with recurrent or severe depression, research increasingly shows that maintaining emotional stability often leads to better outcomes for both mother and baby than untreated illness.
These decisions are best made collaboratively with an obstetric provider, psychiatrist, or perinatal mental health specialist.
For individualized guidance on medication safety, see the resources listed below such as MotherToBaby and the InfantRisk Center provide evidence-based information for both families and healthcare providers.
Mood Stabilizers and Bipolar Disorder
Bipolar disorder requires particularly careful management during pregnancy and the postpartum period.
The postpartum period carries one of the highest lifetime risks for mood episodes in women with bipolar disorder, including severe depression, mania, or postpartum psychosis.
For women with a known history of bipolar disorder, discontinuing mood stabilizers can significantly increase the risk of relapse.
Common mood stabilizers include:
Lithium
Lamotrigine
Valproate
Carbamazepine
Some of these medications carry known risks during pregnancy, particularly in the first trimester. For example, valproate is associated with increased risk of neural tube defects and is generally avoided in pregnancy when possible.
Lithium, historically considered high risk, has been more closely studied in recent decades. While there is a small increased risk of certain cardiac anomalies, newer research suggests that the absolute risk is lower than previously believed. In some cases, continuing lithium may be safer than untreated bipolar illness.
The postpartum period requires particular vigilance. Rapid hormonal shifts and sleep deprivation can destabilize mood quickly. For women with bipolar disorder, coordinated care between psychiatry and obstetrics is essential.
Medication decisions in bipolar disorder are highly individualized and should always be made with a specialist familiar with perinatal mental health.
Because bipolar disorder carries specific postpartum risks, I discuss this further in my article on perinatal mood disorders.
The Risks of Untreated Mental Illness During Pregnancy and Postpartum
When considering medication, it is equally important to consider the risks of untreated illness.
Moderate to severe depression, anxiety, and bipolar disorder are not benign conditions during pregnancy or the postpartum period. Research has associated untreated perinatal mood disorders with:
Increased risk of preterm birth
Low birth weight
Poor prenatal nutrition
Substance misuse
Sleep disruption
Impaired bonding
Higher rates of postpartum depression
Increased risk of maternal suicide (a leading cause of maternal mortality in the first year
Chronic stress and severe mood symptoms can also affect cortisol regulation and maternal functioning during a time when stability is especially important.
The goal of treatment is not simply symptom reduction — it is protecting maternal functioning, attachment, and family well-being.
For some women, psychotherapy and lifestyle adjustments are sufficient. For others, medication is an essential part of maintaining stability.
Every situation is unique. The safest path forward is one that carefully weighs both the risks of medication and the risks of untreated illness.
If you are unsure whether what you’re experiencing meets criteria for a mood disorder, the Edinburgh Postnatal Depression Scale (EPDS) can provide a helpful starting point.
Trusted Medication Safety Resources
Is it safe for you to take medications for your mental health while pregnant or breastfeeding?
If you would like to research options alongside your healthcare provider, the following evidence-based resources are widely respected:
Operated by teratogen specialists, MotherToBaby provides:
Free fact sheets
Live phone and chat consultations
Research-backed summaries of prescription, OTC, alcohol, herbal, and environmental exposures
It is one of the most consumer-friendly and scientifically grounded resources available.
Founded by Thomas Hale, this center focuses on evidence-based medication safety during pregnancy and lactation.
It serves both healthcare professionals and consumers.
Dr. Hale is also author of the widely known reference text:
MommyMeds
A consumer-friendly companion app associated with InfantRisk Center, offering:
Color-coded safety ratings
Information on prescription and OTC medications
Supplement guidance
Kathleen Kendall-Tackett, PhD, is a psychologist, researcher, and certified lactation consultant whose work focuses on maternal mental health, trauma, and breastfeeding. Her book Depression in New Mothers is widely referenced in the postpartum depression field.
Frank Nice, RPh, DPA, is a pharmacist and former National Institutes of Health researcher specializing in medication safety during breastfeeding. His educational materials focus on evidence-based guidance for prescription, over-the-counter, and herbal substances in lactation.
The Bigger Picture
Many women discontinue breastfeeding unnecessarily due to medication fears. Research suggests that, in many cases, continuation is possible with appropriate medical guidance.
You and your doctor can weigh:
Severity of symptoms
Medication profile
Trimester considerations
Breastfeeding goals
Family circumstances
There is rarely a perfect answer — but there is often a reasonable, informed one.
Frequently Asked Questions About Medications in Pregnancy and Breastfeeding
Is it ever safer to stay on medication during pregnancy?
For some women with moderate to severe depression, anxiety, or bipolar disorder, continuing medication reduces the risk of relapse, hospitalization, or postpartum crisis. Stability can protect both mother and baby.
Can antidepressants harm my baby during breastfeeding?
Most SSRIs transfer into breast milk at low levels. Some, such as sertraline, are commonly considered compatible with breastfeeding when clinically indicated. Individual factors matter.
What happens if I stop medication suddenly?
Abrupt discontinuation can increase risk of relapse and may cause withdrawal symptoms. Any medication change should be supervised by a healthcare provider.
Is “natural” always safer than prescription medication?
Not necessarily. Herbal supplements and “natural” remedies can have pharmacological effects and are often less studied than prescription medications. Always discuss supplements with your provider.
Who should I consult about medication decisions?
Ideally:
Your OB/GYN or midwife
A psychiatrist (preferably with perinatal expertise)
A primary care physician familiar with your history
Organizations like Postpartum Support International can help connect you to trained providers.
Final Word
You don't have to choose between your mental health and your baby’s well-being.
Supporting maternal emotional stability is one of the most protective steps you can take for your family.
Always discuss your options about pregnancy, breastfeeding and medicaiton with your doctor. You can together weigh the known risk factors. There is a wealth of free, valid information available to you.
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