Antidepressant discontinuation in pregnancy tied to higher mental health emergency risk

Mental health disorders are the leading contributor to maternal mortality in the United States, yet many patients discontinue antidepressants during pregnancy. A new cross-sectional analysis of a state-based private insurance database suggests that discontinuation is common and associated with a markedly increased risk of mental health emergencies during pregnancy.¹

“The initial sort of impetus for doing this study was really in my day to day taking care of patients who stop their antidepressants for a variety of reasons in pregnancy,” said Kelly B. Zafman, MD, MSCR, a maternal-fetal medicine fellow at the Hospital of the University of Pennsylvania, Philadelphia. “And then, unfortunately, we see that they really suffer in terms of their mental health during pregnancy and postpartum.”

Zafman and colleagues partnered with Independence Blue Cross in Pennsylvania to examine contemporary patterns of antidepressant use. The study included patients who delivered between January 1, 2023, and December 31, 2024, had a preexisting diagnosis of depression or anxiety, and had an active prescription for a selective serotonin reuptake inhibitor (SSRI) or serotonin norepinephrine reuptake inhibitor (SNRI) in the 3 months prior to pregnancy.

Of 3983 patients with depression or anxiety, 1462 (36.7%) entered pregnancy with an active SSRI or SNRI prescription. Discontinuation was defined as no medication fills during pregnancy or a gap greater than 60 days. Overall, 260 patients (17.8%) had no fills during pregnancy, and 945 (64.6%) had a gap exceeding 60 days. “Only about 17% of patients continued their treatment uninterrupted throughout the pregnancy,” Zafman said. “So [a] really, really high number of discontinuation was happening.”

Rates of discontinuation were similar across trimesters—29.7% in the first, 31.6% in the second, and 38.6% in the third. However, discontinuation was associated with worse mental health outcomes. Although patients who continued and discontinued medications had similar rates of outpatient and emergency visits for mental health indications prior to pregnancy, those who discontinued were significantly more likely to experience a mental health emergency during pregnancy.

Peaks were observed in the first and ninth months. In the first month, mental health emergencies occurred at a rate of 58 per 1000 among those who discontinued, compared with 37 per 1000 among those who continued (P=.02). In the ninth month, rates were 59 per 1000 versus 29 per 1000, respectively (P<.01). “We saw that especially in the beginning of pregnancy and toward the end of pregnancy, there was a much higher rate of patients presenting for mental health emergency to an emergency room,” Zafman said.

In total, “In this database, we saw it was more than 500 emergency room visits more for patients who stopped compared to those who continued their antidepressants in pregnancy,” she noted.

The timing of these peaks may reflect both physiologic stressors and medication changes. “We saw that the majority of antidepressant discontinuation happened in the first trimester, where you also see that peak in emergency room visits,” Zafman said. “And then similarly, again, in the third trimester, we saw a peak which corresponds to that same discontinuation of antidepressants.”

She emphasized that pregnancy recognition, first-trimester symptoms, delivery planning, and anticipation of postpartum life may compound the effects of medication withdrawal. “It’s the discontinuation of antidepressants in addition to the stressors that those points in pregnancy bring for patients,” she said.

The findings underscore the study’s central message. “Treatment for mental health conditions should not be withheld during pregnancy,” Zafman said, adding that promoting treatment continuation should be “an urgent public health priority” in efforts to address the maternal mortality crisis.

Reference:

1. Zafman KB, Zhu Y, Kornfield S, Smith-McLallen A, Srinivas SK. Contemporary patterns and outcomes of antidepressant discontinuation in pregnancy. Presented at: Society for Maternal-Fetal Medicine 2026 Pregnancy Meeting. February 8-13, 2026. Las Vegas, Nevada. Abstract 16. Accessed February 12, 2026