Key takeaways:
- Of 1462 pregnant patients entering pregnancy on an SSRI or SNRI, 82.4% discontinued or had a significant treatment gap, with rates distributed across all three trimesters.
- Discontinuation was associated with nearly twofold higher rates of mental health emergencies, peaking in the first and ninth months of pregnancy.
- Patients who stopped antidepressants were more likely to have had their medications prescribed by a non-OB/GYN, highlighting an opportunity for cross-specialty coordination and preconception counseling.
A standardized, patient-completed screening protocol for antidepressant use in pregnancy was associated with a sharp rise in treatment discontinuation and a nearly twofold increase in mental health emergencies, according to findings from a large retrospective cohort study using a state-based private insurance database.1
The study, which was presented at the 2026 Society for Maternal-Fetal Medicine Annual Pregnancy Meeting, evaluated 3983 patients with a diagnosis of depression or anxiety prior to pregnancy who delivered between January 2023 and December 2024. Investigators examined SSRI and SNRI prescribing patterns among patients who entered pregnancy with an active antidepressant prescription, comparing outcomes between those who continued and those who discontinued therapy.
"One of the most important things that we can do in a conversation with the patient is really frame it as a risk-risk situation," said Kelly B. Zafman, MD, MSCR, the study's lead investigator. "Of course, no medications are without risk in pregnancy, and that's true of antidepressants as well. But the part of the conversation that's equally important is talking to patients about the risks of stopping their medications."
Of the 1462 patients who entered pregnancy on an active SSRI or SNRI, 17.8% had no medication fills during pregnancy and 64.6% had a treatment gap exceeding 60 days. Discontinuation was distributed across all 3 trimesters, occurring in 29.7%, 31.6%, and 38.6% of patients per trimester, respectively.
Patients who stopped their medications were significantly more likely to experience a mental health emergency during pregnancy, with rates peaking in the first month (58 vs. 37 per 1000; P = 0.02) and the ninth month (59 vs. 29 per 1000; P < 0.01) compared with those who continued treatment.
Zafman noted that the mechanism underlying the increased emergency visits likely reflects multiple overlapping processes. "It may be a combination of all three," she said, referring to relapse of prior illness, withdrawal effects, and progression to more severe disease. "In any case, it certainly seems like stopping antidepressants for a large percentage of this population did mean that they had a rebound in depressive or anxiety symptoms that landed them in the emergency department."
The stakes extend beyond acute psychiatric care. Suicide remains one of the leading contributors to maternal mortality in the United States, and undertreated mental illness directly amplifies that risk. "Making sure that patients understand that this could destabilize their mental health in pregnancy if they're stopping medications," Zafman said, is an essential part of prenatal counseling.
A notable finding was that patients who discontinued were more likely to have their antidepressants prescribed by a non-OB/GYN provider, pointing to a gap in coordinated counseling. Zafman described a common scenario: "Some patients were prescribed their antidepressant by a really well-meaning primary care provider or psychiatrist but may not have necessarily gotten counseling before they were pregnant about what to do with their medications. And suddenly the patient finds themselves pregnant and they're not sure what to do."
She urged clinicians to probe beyond a simple medication question at prenatal intake. "Many times patients say, ‘Yes, I have a history of depression or anxiety’—they're asked, are you on medications?—and they may just say no, but really what they mean is that they were on medications and stopped them."
Zafman is extending this work through a mixed-methods study of both clinicians and patients, with the goal of developing targeted communication tools—potentially deployed before patients arrive for their first prenatal visit.
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, NV. Abstract 16.
