A systematic review and meta-analysis published in The Lancet Psychiatry on May 14 synthesizes 37 high-quality observational studies encompassing over 648,000 antidepressant-exposed pregnancies and nearly 25 million unexposed ones, finding no causal link between SSRI or other antidepressant use before or during pregnancy and increased risks of autism spectrum disorder or ADHD once maternal mental health, genetics, and family environment are properly controlled. Unlike randomized controlled trials, which are ethically infeasible here, this evidence draws from large cohort and sibling-comparison designs that reveal the initial crude associations largely vanish, pointing instead to underlying parental depression and shared familial factors as the drivers. The original Healthline coverage accurately summarizes these null findings but underplays how paternal antidepressant use during the partner's pregnancy similarly correlates with offspring neurodevelopmental outcomes, a detail that further implicates genetic heritability over medication effects. Broader context reveals persistent myths amplified by recent U.S. health official statements, despite ACOG data showing depression affects 10% of pregnancies and untreated illness raises risks of preterm birth, low birth weight, and maternal suicide. Synthesizing this with a 2023 JAMA Pediatrics meta-analysis of sibling-controlled studies and a 2021 Lancet review on perinatal depression outcomes confirms that withholding antidepressants often harms both parent and child more than any hypothetical exposure risk. Conflicts of interest appear minimal in the registered PROSPERO protocol, though observational data inherently limits causal certainty compared to RCTs. These results demand updated clinical guidance prioritizing evidence-based pharmacotherapy alongside therapy rather than stigma-driven avoidance.