Depression occurs across the child bearing years and is compounded in those who are having difficulty achieving a successful pregnancy. For women suffering depression, pregnancy does not confer protection against depression or other psychiatric disorders. Many women taking antidepressants who stop them while attempting pregnancy or during pregnancy are at high risk for relapse. Safety concerns of serotonin reuptake inhibitor (SSRI) antidepressant drug use during pregnancy have been addressed with more data has accumulated supporting the absence of birth defects attributable to first trimester exposure to these medications. The long term effects of these medications in children exposed to them during their mothers’ pregnancy have also been studied and no differences in outcomes have been found including IQ, reactivity, temperament, mood, or distractibility to matched non-exposed children (N. Engl. J. Med. 1997;336:258-62). SSRI use during pregnancy appears safe, although as with all medications, the risk-benefit decision regarding use in those trying to conceive and during pregnancy should be considered. One should also keep in mind that no factor more strongly predicts postpartum depression than depression during pregnancy and the adverse effects of postpartum depression on the long-term development of children and the well-being of the mother and family are substantial.