Pregnant, Anxious, and Taking Medication: A Two-Patient Decision

A clear guide to depression and anxiety treatment during pregnancy, breastfeeding, and the weeks after birth.

The pregnancy test is positive. Beside it sits the pill bottle you take each morning. It can feel as if the test changed the medicine overnight.

It did not. The right next step is not panic. It is a careful review of two patients: you and the developing baby. Your symptoms, past relapses, sleep, daily function, pregnancy stage, other medicines, and feeding plans all belong in that review.

Depression and anxiety are common around pregnancy. CDC research shows about 1 in 8 women with a recent live birth reported symptoms of postpartum depression. Across international studies, anxiety disorders affected about 15% during pregnancy and 10% after birth, although estimates varied widely.[3,4]

Start with the real baseline

Every pregnancy begins with some background chance of a health problem, even when no medicine is used. CDC reports that about 1 in 33 babies is born with a birth defect. The current sertraline label gives a U.S. background range of 2% to 4% for major birth defects and 15% to 20% for miscarriage in clinically recognized pregnancies. Those categories overlap, but they are not identical, and they are not interchangeable.[10,51]

That distinction matters. A study of “major malformations” may use a different definition and a different population from national birth-defect surveillance. A fair medication comparison uses the same outcome and the same denominator in both groups.

Untreated illness is also not a no-risk baseline. In observational studies, untreated depression during pregnancy was associated with preterm birth and low birth weight.[5] A 2026 synthesis of 40 studies found similar associations with prenatal anxiety.[6] These studies cannot prove that depression or anxiety caused the outcomes, and they cannot prove that one treatment would prevent them.

Depression and anxiety are also associated with more difficulty bonding after birth, although much of that evidence cannot tell which problem came first.[7] Symptoms can disrupt sleep, eating, daily tasks, relationships, and self-care.[3] The point is not to frighten you about illness. It is to compare both sides of a decision honestly.

Why stopping suddenly can backfire

Some people remain well after a planned medication change. Others relapse. Personal history is one of the strongest clues.

In a specialist study of women with prior major depression who were well when pregnancy began, 44 of 65 who discontinued an antidepressant relapsed during pregnancy, compared with 21 of 82 who continued. That is 68% versus 26%. This was not a randomized study, and the group included many women with recurrent illness, so those percentages do not predict every person.[8]

A later meta-analysis pooled four studies and found the clearest excess relapse among people with severe or recurrent depression. Its overall estimate was imprecise and did not reach statistical significance.[9] This is why a past episode, hospital stay, suicide attempt, long period of disability, or repeated relapse after stopping deserves careful weight.

Do not stop an antidepressant or benzodiazepine suddenly on your own. Withdrawal symptoms and returning illness can both create harm. A planned change may still be reasonable, but it should be designed with the prescriber who knows your history.[2,34]

What studies say about birth defects

The largest studies are more reassuring than many online warnings, but they do not promise zero risk.

In a Nordic study of 2.3 million live births, major defects were observed in 3.7% of births exposed to an SSRI or venlafaxine in the first trimester and 3.2% of unexposed births. A published correction confirms the 3.2% value. After comparing siblings, which helps control for shared family factors, the odds ratio was 1.06, with a 95% confidence interval from 0.91 to 1.24, an estimate compatible with no increase.[11,54]

A U.S. Medicaid study looked at cardiac defects after first-trimester antidepressant exposure. They were observed in about 9.0 per 1,000 exposed births and 7.2 per 1,000 unexposed births. After the researchers restricted the comparison to women with depression and adjusted for measured differences, the SSRI estimate was 1.06, with a 95% confidence interval from 0.93 to 1.22.[12] The first pair is an observed comparison, not an adjusted estimate. The adjusted result does not prove there is no risk, but it shows how illness and other differences can change the picture.

Paroxetine has a special history. A meta-analysis of 23 studies found pooled odds ratios of 1.23 for any major malformation and 1.28 for major cardiac malformations, and the current U.S. label describes a less than two-fold increased risk for overall cardiovascular malformations while naming confounding by indication, depression severity, and exposure misclassification as important limits. The large adjusted Medicaid study did not confirm the specific cardiac links it examined.[12,13,53] That conflict is a reason for an individual review, especially before a first-trimester exposure. It is not a reason to make an abrupt change.

Evidence volume differs by medicine:

These summaries do not rank medicines for you. A medicine that worked before may deserve different weight from one you have never tried. Dose, timing, co-medicines, smoking or substance exposure, medical conditions, and illness severity can change both the evidence and the decision.[2]

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What can happen near delivery

Two late-pregnancy questions often sound scarier without absolute numbers.

Persistent pulmonary hypertension of the newborn, or PPHN, is a rare breathing and circulation problem. In one large Medicaid cohort, PPHN was observed in about 3.2 per 1,000 births after SSRI exposure in the 90 days before delivery and 2.1 per 1,000 unexposed births. That unadjusted comparison amounts to about 1 more observed case per 1,000 births. Adjustment reduced the association, and the comparison does not prove that the medicine caused those cases.[14]

A 2024 study of 280,090 term infants examined “delayed neonatal adaptation.” The composite occurred in 847 of 7,573 infants exposed to an SSRI beyond 20 weeks, or 11.2%, and in 12,078 of 272,517 infants without late SSRI exposure, or 4.4%. The adjusted odds ratio was 2.14, with a 95% confidence interval from 1.96 to 2.32. The composite included a very low five-minute Apgar score, resuscitation, or admission for respiratory support. It was not a direct measure of withdrawal, and the groups may still have differed in ways researchers could not measure.[15]

After late antidepressant exposure, some newborns have jitteriness, feeding trouble, temperature changes, or breathing problems. Many reported signs are temporary, but a newborn with symptoms needs clinical assessment.[19-22] Your obstetric and pediatric teams can plan where you will deliver and what observation makes sense. Do not lower or skip medication near delivery without that conversation.

What about autism or ADHD?

This question needs study design, not just a headline. Conventional studies sometimes find more autism or ADHD diagnoses after prenatal antidepressant exposure. Yet depression, anxiety, genetics, family environment, health care use, and other exposures can influence both medicine use and child outcomes.

A 2026 systematic review of 37 studies found that the apparent associations became much smaller or disappeared in studies that better addressed maternal illness and family factors, and it rated the certainty of evidence as low to very low. Large U.S. and Taiwanese studies also found estimates near no difference when comparing siblings.[16-18] No clear causal effect has been established. Certainty is still limited, so this is not the same as proving that every long-term risk is absent.

Treatment is more than a pill

For mild to moderate depression or anxiety, ACOG recommends psychotherapy as a first-line treatment. A 2026 review of 78 randomized trials in 11,345 participants found the strongest and most consistent evidence for cognitive behavioral therapy. Interpersonal therapy also has support for depression, though confidence was lower.[2,39]

Exercise can be a useful postpartum add-on when your obstetric clinician says it fits your recovery. Evidence for postpartum depressive symptoms is stronger than evidence for anxiety, where only two small trials contributed.[40] Bright-light therapy and omega-3 supplements have mixed or imprecise evidence.[41,42] These options should not replace urgent or intensive care when symptoms are severe.

Other medicines used for anxiety

Benzodiazepines include alprazolam (Xanax), lorazepam (Ativan), and diazepam (Valium). ACOG advises avoiding them or using them sparingly for perinatal anxiety. UK NICE guidance says not to offer benzodiazepines in pregnancy or the postnatal period except for short-term treatment of severe anxiety and agitation.[2,34]

A meta-analysis of hypnotic benzodiazepine-receptor agonists did not show a clear first-trimester malformation increase, with a pooled odds ratio of 0.87 and a wide confidence interval from 0.56 to 1.36. It did find an association with preterm birth, odds ratio 1.49, interval 1.19 to 1.86. That review pooled seven studies and mixed drugs, doses, and indications, so it cannot settle agent-specific risk for alprazolam, lorazepam, or diazepam, and it cannot prove cause.[35] Repeated use near delivery can also lead to newborn sleepiness, low muscle tone, breathing trouble, or withdrawal.[2,34] If a benzodiazepine is part of your plan, ask what problem it treats, how often it is truly needed, and what the newborn team should know.

Hydroxyzine has more than 200 reported pregnancy exposures without an identified birth-defect increase, but that number is too small to rule out uncommon risks. Late-pregnancy case reports describe newborn withdrawal symptoms, and repeated use while breastfeeding may make an infant drowsy or reduce milk supply.[37]

Buspirone data are thinner. One registry described 72 infants without birth defects, far too few to rule out an uncommon outcome. Other pregnancy outcomes and breastfeeding follow-up remain poorly studied.[38] “No events in a small sample” is not the same as “no risk.”

Breastfeeding is a separate decision

A reassuring pregnancy study does not answer what happens through milk. Clinicians look at milk transfer, active metabolites, the baby’s age and maturity, exclusive versus partial breastfeeding, symptoms, and what might happen if a parent who is well switches treatment.[2,34]

Relative infant dose, or RID, estimates the infant’s weight-adjusted dose through milk as a percentage of the parent’s dose. It is useful, but it is not a stand-alone verdict. Sampling is often small, and long-term child outcomes are limited for many medicines.[27,29]

If a baby was premature, is medically fragile, or develops poor feeding, hard-to-wake sleepiness, jitteriness, breathing trouble, or poor weight gain, contact the pediatric clinician.[2,34] The response may involve examining the baby, checking feeding, reviewing every exposure, and then making a shared plan. It is not automatically a reason to stop either breastfeeding or treatment.

The FDA letters are gone

You may still see medicines called pregnancy category A, B, C, D, or X. FDA removed those letter categories because they were often viewed as confusing and overly simplistic and did not effectively communicate risk. The change took effect on June 30, 2015. Current prescription labels use narrative sections about pregnancy, lactation, available human and animal data, and clinical considerations.[43]

The new format is better, but a label still cannot know your relapse history or your goals. Read it as one part of the conversation, not as a grade.

Symptoms and medication needs can change

Pregnancy can change how the body handles a medicine, and the early postpartum weeks can change it again. In one study of 47 people taking sertraline, the concentration-to-dose ratio in the last four weeks of pregnancy was about 22% lower than at eight or more weeks after delivery. People varied widely.[44] That finding is a reason for symptom and side-effect review, not an automatic dose change.

ACOG recommends standardized mental health screening at the initial prenatal visit, later in pregnancy, and at postpartum visits.[1,2] EPDS and GAD-7 scores can help screen and track symptoms. They do not make a diagnosis by themselves.[50]

Thoughts of suicide, inability to meet basic needs, severe confusion, hallucinations, or fixed false beliefs need immediate assessment. ACOG advises clinicians to assess suicide risk immediately on an affirmative screening response and arrange risk-tailored management.[1] Do not wait for a routine visit. Call or text 988, or call 911 if anyone is in immediate danger.[49]

A newer postpartum option, and one that left the market

Zuranolone (Zurzuvae) is FDA approved for adults with postpartum depression as a 14-day oral course. In two placebo-controlled trials, depression scores at day 15 improved by about four points more than with placebo. The label says not to drive until at least 12 hours after each dose, for the whole 14-day course, because alertness can be impaired.[45]

In the lactation data described in the label, the maximum calculated relative infant dose was below 1%, with a mean of 0.357%. The label also states that there are no data on the effects of zuranolone on a breastfed infant.[45] Low measured transfer does not fill that evidence gap.

ACOG issued a 2026 clinical practice update on these medicines and then published a correction to it. The correction removed the word “boxed” from one warning statement, removed “history of suicide attempt” from one bullet, and added a requirement that patients be monitored for at least 12 hours after dosing.[46,47]

Brexanolone (Zulresso) was formerly FDA approved for postpartum depression. Its U.S. commercial availability ended December 31, 2024. Sage asked FDA to withdraw approval because the drug was no longer marketed, and FDA withdrew approval effective April 14, 2025. The withdrawal notice did not describe a new safety or effectiveness finding.[48,52]

Build one plan with all three clinical teams

Bring one current medicine list to your prescriber and obstetric clinician. Include prescription drugs, over-the-counter products, supplements, nicotine, cannabis, and alcohol. Ask them to document why each medicine is used and what would count as improvement, relapse, or a side effect.[2]

Questions for the prescriber

• What happened during my past episodes and past medication changes?
• Which evidence applies to this medicine, this pregnancy stage, and my illness severity?
• If we consider a change, how will symptoms and withdrawal be monitored?
• What is the postpartum follow-up plan, and who covers urgent changes?

Questions for the obstetric clinician

• Do my medical or pregnancy conditions change the balance?
• What should the delivery team know about late-pregnancy exposure?
• How will sleep, blood pressure, nutrition, and prenatal follow-up be supported?

Questions for the baby’s clinician

• Does prematurity or another infant condition change the feeding plan?
• What infant signs should prompt a call or examination?
• How will feeding and weight be checked after discharge?

Before birth, write down who will monitor mood, anxiety, sleep, feeding, side effects, and the baby during the first postpartum weeks.[1,2] Include where you will seek same-day help if symptoms rise. A good plan is not a promise that nothing difficult will happen. It is a way to notice trouble early and respond together.

Frequently asked questions

Is sertraline, or Zoloft, okay in pregnancy?

Sertraline has one of the larger pregnancy evidence bases, and most studies do not show a consistent increase in overall birth defects.[11,12,19] Late-pregnancy newborn effects and your relapse history still matter. Ask for a comparison that uses your dose, timing, past response, and alternatives. Do not stop it suddenly on your own.

Is Lexapro safer than Zoloft?

There is no universal winner. Both escitalopram and sertraline have substantial pregnancy data, but their lactation transfer, half-lives, your prior response, side effects, and the baby’s health differ.[19,20,27,28] A switch can also destabilize someone who is doing well.

Should I taper my antidepressant before delivery?

Not on your own. Late exposure may affect newborn adaptation, but lowering treatment can also bring back illness or cause withdrawal.[2,8,9,15] Ask the prescriber and obstetric clinician to compare those risks and plan newborn observation.

Does taking an antidepressant cause autism?

Current evidence has not established a causal link. Associations in conventional studies became much smaller or disappeared in sibling and other confounding-focused analyses, and the certainty of that evidence is rated low.[16-18] That is reassuring, but it does not prove that every possible long-term effect has been excluded.

Can I take Xanax while pregnant or breastfeeding?

Alprazolam is a benzodiazepine. Current guidance advises avoiding or using benzodiazepines sparingly during pregnancy, with short-term use reserved for severe anxiety or agitation.[2,34] Pregnancy risks, dependence, withdrawal, timing near delivery, and infant sedation all matter. Lactation evidence differs by agent, so do not assume evidence about lorazepam applies to alprazolam.[35,36]

Can I breastfeed while taking an antidepressant?

Often, treatment and breastfeeding can be planned together, but the answer is medicine-specific and baby-specific. Milk transfer is generally low for sertraline and paroxetine, while fluoxetine and venlafaxine produce more infant exposure in many studies.[27-31] Prematurity, infant symptoms, prior response, and the risk of switching all belong in the decision.

Is a “natural” option always better?

No. Therapy has meaningful evidence, and exercise may help postpartum depressive symptoms.[39,40] Bright light and omega-3 evidence is less certain.[41,42] Tell your clinician about every supplement you take so it can be reviewed alongside your medicines and health conditions.[2] “Natural” does not mean no risk.

Where to get help

• National Maternal Mental Health Hotline: call or text 1-833-852-6262 (1-833-TLC-MAMA), free and confidential, 24/7, in English and Spanish, with interpreters for 60 more languages. For TTY, use your preferred relay service or dial 711, then the number. This is not a crisis line.
• 988 Suicide and Crisis Lifeline: call, text, or chat 988, 24/7, free and confidential. For Spanish, press 2 or text AYUDA to 988.
• 911: if anyone is in immediate danger of harm.
• Postpartum Support International HelpLine: 1-800-944-4773, press 1 for Spanish or 2 for English; text “Help” to 800-944-4773, or 971-203-7773 in Spanish. Calls and texts are returned during business hours, 8am to 11pm Eastern. This is not a crisis hotline and does not handle emergencies.
• MotherToBaby, for medication exposure questions: 1-866-626-6847 or text 1-855-999-3525, Monday to Friday, 8am to 7pm Eastern. Available to residents of the United States and its territories.
• InfantRisk Center, for breastfeeding medication questions: 1-806-352-2519, Monday to Friday, 8am to 3pm Central.

Related reading on NP FADY

• Postpartum Depression Doesn’t Always Look Like Sadness
• Staying Well Through Pregnancy and the Postpartum Weeks
• ADHD Does Not Take Maternity Leave
• Starting an SSRI: The First Weeks, the Real Side Effects, and When to Call
• Coming Off an Antidepressant Without the Crash: Withdrawal, Relapse, and How Tapers Really Work
• Benzodiazepines: When the Medicine Becomes Hard to Stop

References

1. American College of Obstetricians and Gynecologists. Screening and diagnosis of mental health conditions during pregnancy and postpartum: ACOG Clinical Practice Guideline No. 4. Obstetrics & Gynecology. 2023;141(6):1232-1261. PMID 37486660. doi:10.1097/AOG.0000000000005200.

2. American College of Obstetricians and Gynecologists. Treatment and management of mental health conditions during pregnancy and postpartum: ACOG Clinical Practice Guideline No. 5. Obstetrics & Gynecology. 2023;141(6):1262-1288. PMID 37486661. doi:10.1097/AOG.0000000000005202.

3. Centers for Disease Control and Prevention. Symptoms of Depression Among Women. Last updated May 15, 2024. CDC page.

4. Dennis CL, Falah-Hassani K, Shiri R. Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. British Journal of Psychiatry. 2017;210(5):315-323. PMID 28302701. doi:10.1192/bjp.bp.116.187179.

5. Jarde A, et al. Neonatal outcomes in women with untreated antenatal depression compared with women without depression: a systematic review and meta-analysis. JAMA Psychiatry. 2016;73(8):826-837. PMID 27276520. doi:10.1001/jamapsychiatry.2016.0934.

6. Duko B, Desta F, Sahiledengle B, et al. Maternal prenatal anxiety and risk of preterm birth and low birthweight. Comprehensive Psychiatry. 2026;148:152701. PMID 42061121. doi:10.1016/j.comppsych.2026.152701.

7. O’Dea GA, et al. Maternal psychological distress and mother-infant bonding. Archives of Women’s Mental Health. 2023;26(4):441-452. PMID 37316760. doi:10.1007/s00737-023-01332-1.

8. Cohen LS, et al. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA. 2006;295(5):499-507. PMID 16449615. doi:10.1001/jama.295.5.499.

9. Bayrampour H, et al. Risk of relapse of major depression after antidepressant discontinuation in pregnancy. Journal of Clinical Psychiatry. 2020;81(4):19r13134. PMID 32558401. doi:10.4088/JCP.19r13134.

10. Centers for Disease Control and Prevention. Data and Statistics on Birth Defects. Updated April 21, 2026. CDC page.

11. Furu K, et al. Selective serotonin reuptake inhibitors and venlafaxine in early pregnancy and risk of birth defects: population based cohort study and sibling design. BMJ. 2015;350:h1798. PMID 25888213. doi:10.1136/bmj.h1798.

12. Huybrechts KF, et al. Antidepressant use in pregnancy and the risk of cardiac defects. New England Journal of Medicine. 2014;370(25):2397-2407. PMID 24941178. doi:10.1056/NEJMoa1312828.

13. Bérard A, et al. The risk of major cardiac malformations associated with paroxetine use during the first trimester of pregnancy: a systematic review and meta-analysis. British Journal of Clinical Pharmacology. 2016;81(4):589-604. PMID 26613360. PMCID PMC4799922. doi:10.1111/bcp.12849.

14. Huybrechts KF, et al. Antidepressant use late in pregnancy and risk of persistent pulmonary hypertension of the newborn. JAMA. 2015;313(21):2142-2151. PMID 26034955. PMCID PMC4761452. doi:10.1001/jama.2015.5605.

15. Cornet MC, et al. Maternal treatment with selective serotonin reuptake inhibitors during pregnancy and delayed neonatal adaptation: a population-based cohort study. Archives of Disease in Childhood Fetal and Neonatal Edition. 2024;109(3):294-300. PMID 38071585. PMCID PMC11041605. doi:10.1136/archdischild-2023-326049.

16. Chan JKN, et al. Maternal and paternal antidepressant use before and during pregnancy and offspring risk of neurodevelopmental disorders. Lancet Psychiatry. 2026;13(6):472-484. PMID 42134364. doi:10.1016/S2215-0366(26)00089-1.

17. Suarez EA, et al. Association of antidepressant use during pregnancy with risk of neurodevelopmental disorders in children. JAMA Internal Medicine. 2022;182(11):1149-1160. PMID 36190722. PMCID PMC9531086. doi:10.1001/jamainternmed.2022.4268.

18. Lee MJ, et al. Maternal antidepressant use during pregnancy and autism or ADHD in offspring. European Child & Adolescent Psychiatry. 2024;33(12):4273-4283. PMID 38762849. doi:10.1007/s00787-024-02460-4.

19. MotherToBaby. Sertraline (Zoloft®). NBK582954. Updated August 1, 2025. Fact sheet.

20. MotherToBaby. Citalopram | Escitalopram (Celexa® | Lexapro®). NBK582639. Updated December 1, 2024. Fact sheet.

21. MotherToBaby. Fluoxetine (Prozac®). Updated June 1, 2026. Fact sheet.

22. MotherToBaby. Venlafaxine (Effexor®). NBK583017. Updated March 1, 2026. Fact sheet.

23. MotherToBaby. Duloxetine (Cymbalta®). NBK582683. Updated December 2023. Fact sheet.

24. MotherToBaby. Bupropion (Wellbutrin®). Updated January 1, 2026. Fact sheet.

25. MotherToBaby. Mirtazapine (Remeron®). NBK582852. Updated May 2025. Fact sheet.

26. MotherToBaby. Nortriptyline (Aventyl®). NBK582878. Updated March 1, 2024. Fact sheet.

27. National Library of Medicine. Sertraline. Drugs and Lactation Database (LactMed), NBK501191. Last revised August 15, 2026. LactMed record.

28. National Library of Medicine. Escitalopram. LactMed, NBK501275. Last revised June 15, 2026. LactMed record.

29. National Library of Medicine. Fluoxetine. LactMed, NBK501186. Last revised June 15, 2026. LactMed record.

30. National Library of Medicine. Paroxetine. LactMed, NBK501190. Last revised August 15, 2026. LactMed record.

31. National Library of Medicine. Venlafaxine. LactMed, NBK501192. Last revised June 15, 2025. LactMed record.

32. National Library of Medicine. Bupropion. LactMed, NBK501184. Last revised January 15, 2026. LactMed record.

33. National Library of Medicine. Nortriptyline. LactMed, NBK501176. Last revised September 15, 2025. LactMed record.

34. National Institute for Health and Care Excellence. Antenatal and postnatal mental health: clinical management and service guidance (CG192), recommendations 1.4.6 to 1.4.18. Published 17 December 2014; amendments to April 2022; last reviewed 30 May 2025. Guideline.

35. Grigoriadis S, et al. Hypnotic benzodiazepine receptor agonist exposure during pregnancy and the risk of congenital malformations and other adverse pregnancy outcomes. Acta Psychiatrica Scandinavica. 2022;146(4):312-324. PMID 35488412. doi:10.1111/acps.13441.

36. National Library of Medicine. Lorazepam. LactMed, NBK501231. Last revised January 15, 2024. LactMed record.

37. MotherToBaby. Hydroxyzine (Vistaril®, Atarax®). NBK616832. PMID 40789141. Updated May 2025. Fact sheet.

38. MotherToBaby. Buspirone (Buspar®). NBK605069. PMID 39038301. Updated January 2026. Fact sheet.

39. Leng L, et al. Efficacy of psychological treatments for perinatal depression and anxiety. British Journal of Psychiatry. 2026:1-10. PMID 42343881. doi:10.1192/bjp.2026.10694.

40. Deprato A, et al. Impact of postpartum physical activity on maternal depression and anxiety. British Journal of Sports Medicine. 2025;59(8):550-561. PMID 39500542. doi:10.1136/bjsports-2024-108478.

41. Chen Y, et al. Effect of bright light therapy on perinatal depression. Canadian Journal of Psychiatry. 2024;69(10):737-748. PMID 38863243. PMCID PMC11485670. doi:10.1177/07067437241248051.

42. Mocking RJT, et al. Omega-3 fatty acid supplementation for perinatal depression. Journal of Clinical Psychiatry. 2020;81(5):19r13106. PMID 32898343. doi:10.4088/JCP.19r13106.

43. U.S. Food and Drug Administration. Pregnancy and Lactation Labeling (Drugs) Final Rule and Pregnancy and Lactation Labeling Resources. Final rule published December 3, 2014; effective June 30, 2015. FDA page.

44. Stika CS, et al. Changes in sertraline plasma concentrations across pregnancy and postpartum. Clinical Pharmacology & Therapeutics. 2022;112(6):1280-1290. PMID 36094046. doi:10.1002/cpt.2746.

45. U.S. Food and Drug Administration. Zurzuvae (zuranolone) prescribing information, sections 5.1, 8.2, and 14. Revised April 2026. Current label.

46. American College of Obstetricians and Gynecologists. Zuranolone and brexanolone for the treatment of postpartum depression. ACOG Clinical Practice Update. Obstetrics & Gynecology. 2026;147(1):e24-e28. PMID 41066774. doi:10.1097/AOG.0000000000006093.

47. American College of Obstetricians and Gynecologists. Zuranolone and brexanolone for the treatment of postpartum depression: correction. Obstetrics & Gynecology. 2026;147(4):e96. PMID 41855550. doi:10.1097/AOG.0000000000006200.

48. U.S. Food and Drug Administration. Sage Therapeutics, Inc.; withdrawal of approval of a new drug application for Zulresso (brexanolone) solution, 100 milligrams/20 milliliters. 90 FR 12162. Published March 14, 2025; effective April 14, 2025. Federal Register notice.

49. U.S. Health Resources and Services Administration, National Maternal Mental Health Hotline and program FAQ; 988 Suicide & Crisis Lifeline, About and Contact pages; Postpartum Support International HelpLine; MotherToBaby contact page; InfantRisk Center. All accessed September 12, 2026. Hotline page.

50. Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine. 2006;166(10):1092-1097. PMID 16717171. doi:10.1001/archinte.166.10.1092.

51. DailyMed. Sertraline hydrochloride capsules, U.S. prescribing information, section 8.1. Label revised January 2026; DailyMed record updated January 20, 2026. Current label.

52. Sage Therapeutics, Inc. Form 10-Q for the quarter ended June 30, 2025, business overview and risk factors. SEC filing. SEC filing.

53. U.S. Food and Drug Administration. Paxil (paroxetine) prescribing information, sections 5.4 and 8.1. Revised November 2024. Current label.

54. Correction to Furu et al. BMJ. 2015;350:h2235. PMID 25911589. doi:10.1136/bmj.h2235.

If you or someone you know is in crisis

• Call 911 or go to your nearest emergency room for any life-threatening emergency.
• 988 Suicide & Crisis Lifeline — call or text 988, or chat at 988lifeline.org, available 24/7, free and confidential. En español: marque 988 y oprima 2, o envíe AYUDA al 988. Deaf or hard of hearing: 988 videophone (ASL) or TTY 711 then 988. Veterans: 988 and press 1, or text 838255.
• Crisis Text Line — text HOME to 741741.
• The Trevor Project (crisis support for LGBTQ+ young people) — call 1-866-488-7386, or text START to 678-678.
• National Sexual Assault Hotline (RAINN) — call 1-800-656-HOPE (4673) or text HOPE to 64673; free, confidential, 24/7. Online chat at RAINN.org/hotline.
• National Domestic Violence Hotline — call 1-800-799-SAFE (7233) or text START to 88788; 24/7, help in 200+ languages. Online chat at TheHotline.org. If your phone or computer may be monitored, calling from a safer device is an option.
• Riverside County — Inland SoCal Crisis Helpline 951-686-HELP (4357), 24/7 (Inland SoCal United Way / 211+, in partnership with RUHS-BH); Community Access, Referral, Evaluation and Support (CARES) Line 800-499-3008, 24/7.
• San Bernardino County — Access Unit (Behavioral Health Helpline) 888-743-1478, 24/7; Mobile Crisis/CCRT 800-398-0018 (24/7, all ages) or text 909-420-0560. Arrowhead Regional Medical Center (ARMC) has a dedicated walk-in adolescent psychiatric ER (ages 13–17).
• Children under 13 — call 911 for immediate danger, contact your county's mobile crisis team (they respond to all ages), or go to the nearest pediatric emergency room.
• California Peer-Run Warm Line (non-crisis — someone to talk to) — call or text 1-855-600-WARM (9276); daytime and evening hours, not a 24/7 line.
• NP Fady (non-emergency) — for routine scheduling or questions, call (909) 707-6261. This line is not monitored for emergencies.