Stopping antidepressants in pregnancy tied to more mental health emergencies

Clinical takeaway: Review antidepressant use early in pregnancy, address refill gaps, and plan mental health follow-up after delivery. Discuss treatment benefits and risks individually. ACOG recommends against discontinuing psychiatric medications solely because of pregnancy or lactation.

Pregnancy can prompt patients to reconsider antidepressant treatment, making continuity of mental health care an important part of prenatal planning. A new study found that antidepressant discontinuation was common and associated with more mental health–related emergency department (ED) visits during pregnancy and after delivery.

Researchers analyzed Pennsylvania private insurance claims for patients who delivered in 2023–2024. The study included 1,462 patients with preexisting depression or anxiety and an active prescription for a selective serotonin reuptake inhibitor (SSRI) or serotonin–norepinephrine reuptake inhibitor (SNRI) in the three months before pregnancy.

During pregnancy, 17.8% had no antidepressant fills, and 64.6% had a treatment gap exceeding 60 days. Among patients with these gaps, discontinuation occurred most often in the first trimester, followed by the third trimester.

Before pregnancy, patients who continued and those who discontinued treatment had similar rates of outpatient and emergency mental health visits. During pregnancy, however, ED visit rates were higher among those who discontinued, with notable differences in the second month (58 versus 37 per 1,000) and ninth month (59 versus 29 per 1,000).

The association persisted after delivery. Within eight months postpartum, mental health–related ED visit rates were 32 per 1,000 among patients who discontinued treatment during pregnancy versus 21 per 1,000 among those who continued.

The findings highlight opportunities to identify treatment interruptions during routine prenatal care and maintain support beyond delivery.

“In this cohort of privately insured patients with preexisting depression or anxiety, antidepressant discontinuation during pregnancy was common and was associated with increased risk of mental health–related ED visits,” the authors concluded.

Source: Zafman KB, et al. (2026 Oct 27) Obstet Gynecol. Antidepressant discontinuation during pregnancy and risk of mental health–related emergencies