Children whose mothers took antidepressants during pregnancy are not more likely to develop long-term anxiety or depression due to the medication itself, suggests a new study published in the Journal of Child Psychology and Psychiatry. The research examined over 140,000 children in British Columbia and tracked them from birth through adolescence. Although early data appeared to show higher levels of anxiety among children exposed to these medications in the womb, further analysis pointed to family-related factors such as genetics and maternal mental health as the more likely cause.
Depression and anxiety are common during pregnancy. Up to 30 percent of pregnant individuals screen positive for symptoms, and about 10 to 15 percent meet diagnostic criteria for an anxiety disorder. To treat these conditions, doctors often prescribe medications known as serotonin or norepinephrine reuptake inhibitors. These antidepressants cross the placenta and may influence brain development, particularly since serotonin plays an important role in how the fetal brain grows.
Concerns have lingered for years about whether these medications might affect a child’s emotional health later in life. Some earlier studies reported links between prenatal antidepressant exposure and conditions such as attention-deficit disorder or autism. But more recent work has raised the possibility that these associations might not reflect a direct effect of the drugs. Instead, they could be the result of maternal depression itself or other shared factors like genetics or a stressful family environment.
The new study aimed to clarify whether prenatal exposure to these medications was actually driving later anxiety or depression in children, or whether other explanations might better account for the patterns seen in earlier research.
“There’s been a long-standing debate about whether taking antidepressants during pregnancy affects children’s long-term emotional or behavioural health. Previous studies often found small associations but couldn’t fully separate the effects of the medication from the effects of maternal depression itself. We wanted to untangle those influences by comparing siblings born to the same mother (one exposed to medication during pregnancy and one not),” said study author Amanda Nitschke, a doctoral student at the University of British Columbia and BC Children’s Hospital Research Institute.
This study used data from British Columbia, where researchers had access to detailed health and educational records. The study followed more than 144,000 children born between 2001 and 2012, tracking their development through the end of 2022. Of these children, nearly 6,000 had been exposed to serotonin or norepinephrine reuptake inhibitors during pregnancy.
At around age five, all children in the study were assessed by their kindergarten teachers using a tool known as the Early Development Instrument. This measure captures a range of emotional, social, and academic skills. Among its components is a scale that reflects anxious and fearful behaviors. Later, the researchers used medical records to identify whether these children went on to receive clinical diagnoses of anxiety or depression during childhood or adolescence.
Initial results suggested that children exposed to antidepressants before birth were more likely to show signs of anxiety in kindergarten and more likely to be diagnosed with anxiety or depression as they grew older. But this association weakened after researchers accounted for factors such as maternal age, income, health history, and use of other medications. Even with these adjustments, a modest association remained: exposed children were still more likely to be diagnosed with anxiety or depression later in life.
However, the picture changed when the researchers looked at siblings. In families where one child had been exposed to antidepressants during pregnancy and another had not, both children had similar rates of anxious behavior and later diagnoses. In these sibling comparisons, there was no longer any significant link between prenatal antidepressant exposure and mental health outcomes.
“We were struck by how much the results changed once we compared siblings within the same family,” Nitschke told PsyPost. “It really highlights how powerful genetics and the family environment are in shaping a child’s emotional development. It also reinforced that population-level associations shouldn’t be interpreted as direct medication effects without considering those shared factors.”
Children who showed anxious behaviors at kindergarten age, regardless of whether they had been exposed to antidepressants, were more likely to receive a diagnosis of anxiety or depression later on. This pattern held true for both boys and girls, although girls were more likely overall to be diagnosed with these conditions.
“Overall, we found no evidence that antidepressant use in pregnancy directly harms children’s later emotional or behavioral development,” Nitschke said. “The differences we saw in the general population disappeared once we accounted for family background and genetics. This means the medication itself likely isn’t the driver, and that it’s more related to the underlying factors, such as genetics or ongoing parental mental health. That’s reassuring news for families making difficult treatment decisions during pregnancy.”
The results from this Canadian study align closely with findings from recent studies in other countries. A large study based in the United States, published in the Journal of the American Academy of Child & Adolescent Psychiatry, also found no long-term risk associated with antidepressant use during pregnancy after accounting for maternal depression. Similar conclusions have emerged from research in Denmark, which showed that maternal antidepressant use after pregnancy and paternal use during pregnancy were also linked with child mental health outcomes. These patterns suggest that shared genetics and family dynamics may play a larger role than medication exposure in shaping children’s emotional development.
One particularly telling observation comes from the fact that in both the current study and others, children whose mothers discontinued antidepressant use before pregnancy still showed similar mental health outcomes compared to those whose mothers continued treatment during pregnancy. This again points to maternal mental health and possibly inherited vulnerability as more plausible explanations for any observed differences.
The new study adds to this growing body of evidence by extending the follow-up period into adolescence and using multiple strategies to control for confounding factors. The sibling analysis, in particular, strengthens the argument that observed risks are likely due to shared family influences rather than the medications themselves.
Although the findings provide reassurance for many families, they also raise important questions about how to best support children at risk for anxiety and depression. The study found that children who showed anxious behaviors in kindergarten were more likely to develop anxiety or depression later, whether or not they had been exposed to antidepressants. This suggests that early signs of emotional distress may be useful for identifying children who might benefit from extra support.
The research also points to the complexity of decisions around antidepressant use during pregnancy. Since untreated depression and anxiety in mothers can carry their own risks for both the parent and the child, treatment decisions must consider both the benefits and the potential concerns. The findings suggest that when medication is needed, the long-term risk to the child’s mental health may be lower than previously feared.
At the same time, the study had some limitations. It relied on prescription records to determine medication use, which means there is no certainty that all medications were taken as prescribed. Diagnoses of anxiety or depression were based on health system records, so children who did not receive formal medical evaluations may not have been captured. And while sibling comparisons help address some forms of confounding, they do not control for every possible difference between pregnancies, such as changes in family dynamics or life stress.
Still, the study’s large size, long follow-up period, and detailed methods provide strong evidence that prenatal exposure to serotonin or norepinephrine reuptake inhibitors does not independently raise the risk of long-term anxiety or depression in children. Instead, it supports the view that the underlying mental health conditions in parents, along with family-wide factors, are more likely to shape children’s emotional trajectories.
“Our next step is to look beyond clinical diagnoses and focus on children’s own perspectives,” Nitschke said. “We’re now studying how perinatal depression relates to children’s self-reported well-being, social-emotional health, and sense of connectedness from ages 9 to 13. This will help us understand how early parental mental health shapes children’s experiences as they progress through school.”
“Treating depression during pregnancy is important and deciding whether to take antidepressants is a deeply personal and often difficult choice. Our hope is that studies like this can help reduce stigma and empower people to make informed decisions with their healthcare providers.”
The study, “Association of prenatal antidepressant use with internalizing behaviors from kindergarten to adolescence,” was authored by Amanda S. Nitschke, Paramdeep Kaur, Naomi Phagau, Helena Abreu do Valle, Jeffrey N. Bone, Brenda Poon, Martin Guhn, Simone N. Vigod, Tim F. Oberlander, and Gillian E. Hanley.
