During the reproductive years, depression is common in women, and many face treatment decisions during pregnancy. Possible risks of untreated maternal depression include increased risk of relapse and postpartum depression, all the serious risks associated with the untreated disorder in nonpregnant women, and obstetrical complications. Data on teratogenic risks of antidepressant use are inconsistent, but these risks should be taken into consideration. Overall, treatment should be individually tailored, and nonpharmacologic options may be appropriate.