Lancet Psychiatry
Most antidepressants in pregnancy show no autism, ADHD link
Clinical Takeaway: For pregnant patients with moderate-to-severe depression, continuing most antidepressants is supported by evidence. Amitriptyline and nortriptyline are exceptions worth flagging, and shared decision-making should weigh relapse risk against any residual uncertainty.
Worry about antidepressants harming fetal neurodevelopment has driven some patients to stop treatment in pregnancy, despite the well-documented risks of untreated maternal depression. Earlier meta-analyses suggested a small increase in autism and ADHD risk but were limited by small samples and weak confounder control. This analysis applied more rigorous methods, including paternal antidepressant use as a negative control, to test whether the medications themselves are responsible.
Before adjustment, prenatal antidepressant exposure was associated with a 35% higher relative risk of ADHD and a 69% higher relative risk of autism spectrum disorder. After accounting for maternal mental health, shared familial factors, and sibling-matched comparisons, the ADHD association became non-significant and the autism association was substantially attenuated. Tellingly, similar elevations appeared in children of mothers who used antidepressants before but not during pregnancy, and in children of fathers who used them during pregnancy, pointing to parental psychopathology and genetics rather than the drugs themselves.
Among SSRIs and most other agents, no individual medication retained a significant association once analyses were restricted to mothers with mental health disorders. The exceptions were amitriptyline and nortriptyline, tricyclic antidepressants that remained linked to higher ADHD and autism risk. The authors note these agents are typically reserved for treatment-resistant or more severe depression, so residual confounding by illness severity cannot be ruled out. No dose-response relationship was identified between higher antidepressant doses and offspring neurodevelopmental risk.
Researchers pooled data from 37 cohort and case-control studies through May 2025, covering 648,626 antidepressant-exposed and nearly 25 million unexposed pregnancies.
The findings reinforce existing guideline recommendations: continue antidepressant treatment when clinically indicated, particularly for moderate-to-severe depression, given the established harms of untreated illness for both mother and infant. For mild depression, non-pharmacological options such as psychotherapy may be reasonable alternatives. The paternal data also point to a broader clinical frame, namely that supporting mental health in both parents may matter for a child's long-term neurodevelopment.
"Our study provides reassuring evidence that commonly used antidepressants do not increase the risk of neurodevelopmental disorders such as autism and ADHD in children. While all medications carry risks, so too does stopping antidepressants during pregnancy due to an increased risk of relapse," said senior author Wing-Chung Chang, MD, of the University of Hong Kong.
An accompanying commentary concluded, "Chang and colleagues' study adds knowledge and confirms some of the pre-existing knowledge on the use of antidepressants during pregnancy: that they should continue to be taken as they protect maternal mental health and do not harm fetal development. This result is of considerable impact after many contradictory and controversial studies."
Source: Chan JKN. Lancet Psychiatry. 2026 May 14. Maternal and paternal antidepressant use before and during pregnancy and offspring risk of neurodevelopmental disorders: a systematic review and meta-analysis