According to the National Institutes of Health, after a first depressive episode, the risk of recurrence is 50%. That jumps to 70% after a second episode, and 90% after a third.

Before getting pregnant, I met with a reproductive psychiatrist to discuss whether I should stay on my SSRI (a class of antidepressant medication). Like many people, I had heard that the side effects of SSRIs could harm my baby.

But experts agree that “the benefits of treating depression almost always outweigh the risks,” says Veronica Gillispie-Bell, MD, MAS, FACOG, an OB-GYN and system medical director of health outcomes at Ochsner Health. While certain antidepressants carry risks—like a small chance of persistent pulmonary hypertension in newborns, or increased risk of preeclampsia or miscarriage—these outcomes are rare, and doctors weigh them carefully against the serious risks of leaving maternal depression untreated.

“Untreated depression, on the other hand, can lead to poor nutrition, substance use, reduced responsiveness to the baby, and in severe cases, suicide. For these reasons, ACOG recommends the use of medications for depression or anxiety disorders during the perinatal period (from pregnancy up to a year after childbirth) when appropriate.

I wasn’t confident enough that my depression was behind me. The risks of relapse seemed much more likely, so I stayed on my SSRI and made it through pregnancy and the first year without a depressive episode.

Sometimes the meds may stop working.

I thought maybe I was in the clear. Then, COVID hit. I was a new mom in Brooklyn and ran communications for a crisis hotline. My husband and I juggled remote work and childcare in a one-bedroom apartment, where sirens wailed past our window. The intensity of that time led us to move—temporarily at first, then permanently—to Pennsylvania.

I held it together through the crisis. But in 2021, when the world started to stabilize, my depression returned. I couldn’t sleep, so I started working around 2 a.m. until my family woke up. My fuse was short and there was not a person I couldn’t find a reason to be mad at. The color drained out of everything. My antidepressant had was no longer effective—a phenomenon that psychiatrists sometimes refer to as “antidepressant tachyphylaxis”—when a medication that once worked well gradually loses its impact.