A large-scale evidence review has found no clear link between antidepressant use during pregnancy and the development of autism or attention-deficit/hyperactivity disorder (ADHD) in children, according to findings published May 14 in The Lancet Psychiatry.

The review analyzed 37 studies covering nearly 650,000 pregnancies exposed to antidepressants and compared them with almost 25 million pregnancies without antidepressant exposure.

Initial Findings Changed After Adjustments

At first, researchers observed that antidepressant use during pregnancy appeared associated with a 35% higher risk of ADHD and a 69% increased likelihood of autism in children. However, those links disappeared after researchers adjusted for factors such as parental mental health conditions and genetic predispositions.

“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 Wing Chung Chang, chair of psychiatry at the University of Hong Kong.

Untreated Depression Also Carries Risks

Chang stressed that stopping antidepressants during pregnancy may increase the risk of relapse in women with moderate to severe depression.

“While all medications carry risks, so too does stopping antidepressants during pregnancy due to an increased risk of relapse,” he said. “Doctors and patients must carefully weigh the potential risks and benefits of continuing antidepressant treatment during pregnancy against the potential harms of untreated depression.”

Genetics and Environment May Play Bigger Role

Researchers noted that a similar increase in autism and ADHD risk was also found among children whose fathers took antidepressants and among mothers who used antidepressants before—but not during—pregnancy.

According to the researchers, this suggests that genetic and environmental factors, rather than the medications themselves, are more likely responsible for the observed risks.

“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,” Chang explained.

SSRIs Showed No Link

The analysis found no association between autism or ADHD and commonly prescribed selective serotonin reuptake inhibitors (SSRIs), which are often considered first-line antidepressants.

Some increased risk was observed with older antidepressants such as amitriptyline and nortriptyline. However, researchers said these medications are frequently prescribed in more severe or treatment-resistant depression cases, which may itself contribute to developmental risks.

Family Environment Could Influence Development

Lead researcher Joe Kwun-Nam Chan said family stress and home environment may also affect children’s neurodevelopment.

“In addition to genetic factors, this link could be explained by the home and social environment,” Chan said, pointing to family stress, parenting behaviors and changes in family functioning as possible influences.

The researchers concluded that treatment decisions during pregnancy should remain individualized, balancing the benefits of antidepressants against the risks of untreated maternal depression.