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While antidepressants are routinely prescribed to manage depression and anxiety, their long-term ramifications on reproductive health and the well-being of offspring are still shrouded in ambiguity. This review meticulously sifted through clinical trials pinpointing antidepressant usage among individuals of childbearing potential, highlighting safety concerns regarding reproductive health and the subsequent effects on offspring. We delved into studies spanning from January 1, 2000, to December 30, 2023, inclusively analysing randomized controlled trials, cohort studies, and case-control studies. Our synthesis illuminates a concerning correlation between antidepressant intake and an array of sexual dysfunction. Among pregnant users, an alarming connection was noted with heightened incidences of miscarriage, preterm births, postpartum haemorrhage and gestational diabetes mellitus. Newborns subjected to antidepressant exposure were at an elevated risk of low birth weight, necessitated more frequent admissions to neonatal intensive care units, small for gestational age, malformation and other adverse outcomes in newborns. The underpinning mechanisms triggering these adverse outcomes seem to intertwine with GABA receptor interactions, induced oxidative stress, and disruptions in mitotic spindle assembly. The surfacing evidence of antidepressants' potential reproductive toxicity underscores the need for circumspection in their prescribing practices. It becomes crucial to not only clearly communicate these risks to patients but also to tailor treatment decisions to meticulously balance individual needs against potential risks. Looking ahead, future endeavours should pivot towards a deeper understanding of the detrimental effects antidepressants may harbour on reproductive health and offspring vitality. This necessitates devising innovative strategies that mitigate these risks, thereby safeguarding treatment efficacy for generations to come.