Stopping antidepressants during pregnancy ups risk of mental health emergencies

Most women on antidepressant therapy discontinue their medications during pregnancy despite guideline recommendations against doing so, and this practice results in more mental health emergencies, according to new research.

In a cross-sectional analysis of a state-based private insurance database, women who stopped taking their antidepressant medications after conception had a higher rate of emergency visits for mental health conditions compared with those who stayed on their medications, reported lead study author Dr Kelly Zafman from the University of Pennsylvania in Philadelphia, Pennsylvania, US.

The rates were especially pronounced in the first trimester (month 2: 58 vs 37 per 1,000 patients; p=0.027) and in the late third trimester of pregnancy (month 9: 59 vs 29 per 1,000 patients; p<0.001). In the later postpartum periods, the rates continued to be higher among women who discontinued their medications. [SMFM 2026, abstract 16]

In absolute terms, women who discontinued their medications had 562 more unscheduled emergency visits for a mental health indication between the start of pregnancy to about 8 months postpartum compared with those who continued taking their medications—a difference corresponding to a nearly twofold risk increase.

Zafman noted in the months before conception, there were no significant differences in the rates of outpatient and emergency visits for mental health indications between women who discontinued vs continued their antidepressant medications. “This suggests that disease control was similar between the two groups prior to pregnancy.”

High discontinuation rates

“Although all medications are not without risk, the risks of untreated mental health disorders significantly outweigh the theoretical risks in pregnancy,” Zafman said.

The American College of Obstetricians and Gynecologists (ACOG) recommends against withholding or discontinuing medications for mental health conditions due to pregnancy or lactation status alone. This recommendation is supported by the SMFM. [Obstet Gynecol 2023;141:1262-1288; https://www.smfm.org/news/smfm-statement-on-ssris-and-pregnancy]

However, in the study cohort, only 17.6 percent of women took their antidepressants without interruption throughout their pregnancy. On the other hand, 64.6 percent had a >60-day gap in their prescription fills and 17.8 percent had not filled their prescriptions at all.

The rates of antidepressant discontinuation were similar across the trimesters of pregnancy (fist: 29.7 percent; second: 31.6 percent; third: 38.6 percent). Meanwhile, the rates significantly differed by prescriber specialty, with discontinuation least likely among women who had received antidepressant prescriptions from an OBGYN (p<0.001).

Treatment continuity a must

“These findings … are so important to consider for maternal health policy,” Zafman said.

She emphasized the need to take pregnant women’s mental health seriously. “The full range of treatment options [should be offered], including medications when clinically appropriate.”

Additionally, clinician-level intervention is needed, given that pregnant women receiving antidepressant prescriptions from non-OBGYN providers are more likely to discontinue treatment, she said.

The most important takeaway is that “treatment for mental health conditions should not be withheld during pregnancy,” according to Zafman.

“Untreated and under-treated mental health disorders increase the risk of many adverse maternal and neonatal outcomes, including preeclampsia, preterm birth, growth restriction, and adverse neurodevelopmental outcomes for children. Most importantly, untreated mental health disorders are a significant contributor to maternal deaths,” she noted.

The next step in the research is to continue to explore both patient and clinician barriers and facilitators to medication continuation in pregnancy, Zafman said. The evidence generated from such work will help inform strategies to promote medication continuation in appropriate patients, she added.

Study details

The analysis included 1,462 women (mean age 33.2 years, 88 percent White) who delivered newborns between 2023 and 2024. These women had a diagnosis of depression/anxiety prior to pregnancy and an active prescription for a selective serotonin reuptake inhibitor or serotonin norepinephrine reuptake inhibitor 3 months before conception.  

Anxiety was the most common mental health diagnosis (74 percent), followed by depressive disorder (29.7 percent), adjustment disorder (5.9 percent), and ADHD (19.2 percent).