Antidepressant Use in Pregnancy & Autism/ADHD in Children: Most Comprehensive Study to Date Finds No Clear Link

According to a new systematic review and meta-analysis, published today in The Lancet Psychiatry journal,¹ there is not a causal link between the use of nearly all antidepressants during pregnancy and an increased risk of neurodevelopmental disorders in children, such as autism and attention-deficit/hyperactivity disorder (ADHD).²

“We know many parents-to-be worry about the potential impact of taking medication during pregnancy; our study provides reassuring evidence that commonly used antidepressants do not increase the risk of neurodevelopmental disorders such as autism and ADHD in children,” said study author Wing-Chung Chang, MD, FRCPsych, of the University of Hong Kong. “While all medications carry risks, so too does stopping antidepressants during pregnancy due to an increased risk of relapse. Therefore, for women with moderate-severe depression, doctors and patients must carefully weigh the potential risks and benefits of continuing antidepressant treatment during pregnancy against the potential harms of untreated depression.”

“This large meta-analysis provides further evidence that selective serotonin reuptake inhibitors [SSRIs] exposure during pregnancy is not associated with autism or ADHD in exposed children. Given its size and rigor, the study offers important reassurance to patients and clinicians making treatment decisions during pregnancy,” Jennifer L. Payne, MD, shared exclusively with Psychiatric Times.

Details of the Meta-Analysis

The meta-analysis of 37 studies, covering more than 600,000 pregnancies with antidepressant use and nearly 25 million pregnancies with no antidepressant use, found no significant link between common antidepressant use during pregnancy and autism/ADHD in children after adjusting for the mother’s mental health and other factors. Before investigators accounted for confounding factors such as mental health conditions, the analysis found that antidepressant use by the mother during pregnancy was associated with a 35% increased risk of ADHD and a 69% increased risk of autism; however, this became greatly reduced in analyses that better controlled for confounding factors. Use of antidepressants during pregnancy by the father was associated with a 46% increase in the risk of ADHD and a 28% increase in the risk of autism. This suggests the association is between parental mental health and genetics, not the medication itself.

“Although our study found a small increase in the risk of autism and ADHD in the children of women who had used antidepressants during pregnancy, it also found that this risk disappeared when we accounted for other factors. The increased risk was also seen in the children of fathers who took antidepressants and of mothers with antidepressant use before, but not during, pregnancy,” said Chang. “Together, this suggests that it is not the antidepressants themselves causing an increased risk in autism and ADHD but it is more likely to be due to other factors, including genetic predisposition to conditions such as ADHD, autism, and mental health conditions.”

The last meta-analyses evaluating antidepressant use during pregnancy and neurodevelopmental disorders risk in children were conducted nearly a decade ago. They were also limited by small study numbers and lack of control of additional factors. This new meta-analysis provides the best evidence to date that the small increase in risk of autism or ADHD in the children of women who used antidepressants when pregnant identified in many studies is not caused by the medication.

A Potential Link Between Mental Health Conditions and Neurodevelopmental Disorders

Among studies amongst only mothers with mental health disorders, all SSRIs were found to not be associated. Only amitriptyline/nortriptyline remained associated with increased ADHD and autism risk, and these drugs are currently considered second or third options as treatments for depression, though they are often prescribed for treatment-resistant depression. Women taking these particular medications may have more severe, chronic, or complex underlying mental health conditions than those receiving more common, first-line antidepressants, which could be influencing the association between amitriptyline/nortriptyline and the increased ADHD and autism risk. Notably, the study found no difference in risk between high and low doses of antidepressants.

“The evidence suggests a link between either parent having a mental health condition and a slightly higher risk of ADHD or autism. In addition to genetic factors, this link could be explained by the home and social environment as ongoing family stress, changes in how the family functions, and differences in how parents behave and care for their children may influence neurodevelopment. There is a need to ensure both parents have access to support and treatment for mental health conditions; for their own sake and to support neurodevelopment of their child," said Joe Kwun-Nam Chan, PhD, of the University of Hong Kong.

Study Limitations

Investigators noted some study limitations: Data on important factors such as socioeconomic status, lifestyle risk factors, and low birth weight was lacking in the studies. Additionally, there were limited studies looking at antidepressant use in specific trimesters or exact doses and dose changes. Finally, women taking antidepressants tend to have more severe depression than those who are not, so some bias may remain even after controlling for mental health status.

Insights on Pregnancy and Neurodevelopmental Disorders

In a recent episode of Psychiatric Times’ podcast, “Brain Trust: Conversations in Psychopharmacology” by Joseph F. Goldberg, MD, leading expert in women's mental health Marlene P. Freeman, MD, conveyed the complexities of treating psychiatric disorders during pregnancy: “Our job in perinatal psychiatry is to be able to integrate all those years of studies and to explain to patients what seems to be true risk and what is not. When I am talking to patients and families about this, I really want to target what I think their concerns are,” said Marlene P. Freeman, MD. “If a patient finds the information on autism from a very old study out of context, I understand that it would be very alarming, and scary information really sticks with people. That is where our job is to really try and synthesize information for our viewers and listeners.”³

Watch the whole video here: Getting to the Truth About SSRIs and Pregnancy With Marlene Freeman, MD.

Or listen to the audio podcast here: Podcast: Depression, SSRIs, and Pregnancy. Getting to the Truth With Marlene P. Freeman, MD.

References

1. Chan JKN, Zhong AHF, Lam JYH, et al. Maternal and paternal antidepressant use before and during pregnancy and offspring risk of neurodevelopmental disorders: a systematic review and meta-analysis. Lancet Psychiatry. 2026;13(6):472-484.

2. The Lancet Psychiatry: No clear link between common antidepressant use in pregnancy and autism or ADHD in children, finds most comprehensive study to date. News release. May 14, 2026. Accessed May 14, 2026. https://firstwordpharma.com/story/7429942

3. Goldberg JF, Freeman MP. Getting to the truth about SSRIs and pregnancy with Marlene Freeman, MD. Psychiatric Times. August 15, 2025. https://www.psychiatrictimes.com/view/getting-to-the-truth-about-ssris-and-pregnancy-with-marlene-freeman-md