Antenatal Depression

Tovani does not treat this with ketamine

This page is here for honesty and completeness. Ketamine is not an appropriate treatment for Antenatal Depression, and in some cases it is contraindicated. Below is what the condition is and the treatments that genuinely help — and where, if at all, ketamine has any narrow role (usually only for a separate co-occurring depression). If you’re in crisis, call or text 988.

The short version

●Antenatal (prenatal) depression is major depression occurring during pregnancy — common, frequently missed, and important to treat for both parent and baby.
●Untreated antenatal depression carries real risks (poorer self-care, preterm birth, postpartum depression), so "doing nothing" is not a safe default.
●First-line treatment is psychotherapy (CBT, interpersonal therapy); when medication is needed, certain SSRIs are used after a careful risk-benefit discussion.
●Ketamine is not an established treatment in pregnancy: its safety for the developing fetus has not been established, so at-home ketamine is not appropriate during pregnancy.
●Decisions about any medication in pregnancy weigh the risks of treatment against the very real risks of untreated illness — a conversation for an obstetric and psychiatric team.
●Tovani does not provide ketamine during pregnancy; this page points toward the care that is appropriate, and to treatment once it is clinically suitable.

Clinical definition

Antenatal depression (also called prenatal or peripartum-onset depression beginning during pregnancy) is a major depressive episode occurring during gestation, with the usual features of low mood, anhedonia, sleep and appetite changes, guilt, poor concentration, and sometimes suicidal thoughts — though some symptoms overlap with normal pregnancy (fatigue, sleep and appetite change), which contributes to underrecognition. It is common, affecting a substantial minority of pregnancies, and is a strong predictor of postpartum depression. Importantly, untreated antenatal depression is itself associated with adverse outcomes, including inadequate prenatal care, substance use, preterm birth and low birth weight, so management is framed as weighing the risks of treatment against the documented risks of leaving the illness untreated.

How it differs from related conditions

vs. Postpartum depression

Postpartum depression begins after delivery; antenatal depression occurs during pregnancy and is one of its strongest predictors. Both are treatable with therapy and, when needed, carefully chosen medication.

vs. Major depressive disorder

Antenatal depression is MDD during pregnancy — the same illness, but with treatment choices shaped by fetal safety.

vs. Postpartum psychosis

A separate, rare psychiatric emergency after birth involving psychosis — distinct from the (non-psychotic) mood disorder of antenatal depression.

First-line treatments

Psychotherapy

CBT and interpersonal therapy are first-line and carry no fetal medication exposure — often the preferred starting point in pregnancy.

SSRIs after risk-benefit discussion

When symptoms are moderate-to-severe, certain SSRIs are used, choosing the agent and dose with an obstetric and psychiatric team.

Collaborative obstetric–psychiatric care

Coordinated care that monitors mother and pregnancy and individualizes decisions across trimesters.

Support, sleep, and social resources

Addressing sleep, stress, and social support is part of effective treatment and reduces symptom burden.

When standard treatments fail

When antenatal depression is severe or unresponsive, care escalates within a specialist perinatal psychiatry setting — optimizing psychotherapy, carefully selecting or adjusting medication, and, for severe or treatment-resistant cases, considering ECT, which has an established safety record in pregnancy. Rapid-acting agents whose fetal safety is unestablished, including ketamine and esketamine, are not part of the standard pregnancy pathway.

Where ketamine fits

Ketamine is not an established treatment for depression during pregnancy. Its safety for the developing fetus has not been established, and pregnancy is generally treated as exclusionary for therapeutic ketamine and esketamine because the risk-benefit balance cannot be supported by adequate safety data. The appropriate path during pregnancy is psychotherapy first, certain SSRIs when medication is warranted after a careful risk-benefit discussion with an obstetric and psychiatric team, and ECT for severe or treatment-resistant cases — all weighed against the real harms of leaving the depression untreated. If ketamine is being considered, it would be after pregnancy (with breastfeeding decisions discussed separately), not during it.

Where this fits with Tovani

Tovani does not provide ketamine during pregnancy. Pregnancy is screened at eligibility, and antenatal depression is best cared for by a clinician coordinating with your obstetric team — using therapy and, when needed, carefully chosen medication with established safety data. This is not a reason to go untreated: antenatal depression is real and treatable, and untreated illness carries its own risks. When ketamine becomes clinically appropriate after pregnancy, that's a conversation we're glad to have then.

Check eligibility Find treatment options The science behind ketamine

Frequently asked

Can I get ketamine for depression while pregnant?

No. Ketamine's safety for the developing fetus hasn't been established, so pregnancy is exclusionary for at-home ketamine. The appropriate treatments during pregnancy are therapy first, certain SSRIs when needed after a careful risk-benefit discussion, and ECT for severe cases.

Is it safe to leave depression untreated during pregnancy?

Not necessarily — untreated antenatal depression carries real risks, including poorer prenatal care, preterm birth, and a high chance of postpartum depression. "Doing nothing" isn't a safe default. The goal is to weigh treatment options against the risks of untreated illness, with your obstetric and psychiatric team.

What treats depression during pregnancy?

Psychotherapy (CBT, interpersonal therapy) is first-line and involves no fetal medication exposure. When symptoms are moderate-to-severe, certain SSRIs are used after a careful discussion, and ECT is an option with an established pregnancy safety record for severe cases.

Could I do ketamine after the baby is born?

Possibly — once you're no longer pregnant, ketamine may become an option for ongoing or postpartum depression, with breastfeeding decisions discussed separately. We're glad to have that conversation when it's clinically appropriate. During pregnancy, though, it's off the table.

References

Yonkers KA et al. 2009, General Hospital Psychiatry — ACOG/APA report on the management of depression during pregnancy, framing the treatment risk-benefit balance. (PMID 19703633)
Fabiano N et al. 2025, Molecular Psychiatry — Umbrella review of the safety of psychotropic medications in pregnancy. (PMID 39266712)

Last reviewed by Dr. Ben Soffer, DO on June 2, 2026. This page is educational and not a substitute for clinical evaluation. A physician determines whether ketamine therapy is appropriate for your specific situation.