Association Between Antidepressant Discontinuation During Pregnancy and Risk of Mental Health Emergencies
Importance
Up to 20% of pregnant women experience mood or anxiety disorders. Although selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly prescribed, concerns about fetal safety may prompt treatment discontinuation. The clinical consequences of antidepressant discontinuation during pregnancy remain a critical maternal health issue.
Objective
To evaluate the association between discontinuation of SSRIs or SNRIs during pregnancy and the risk of mental health emergencies.
## Design, Setting, and Participants
Cross-sectional study using de-identified data from 3,983 women who delivered in 2023 or 2024. All participants had a documented diagnosis of anxiety or depression prior to pregnancy and an active SSRI or SNRI prescription within 3 months before conception.
## Exposure
Antidepressant discontinuation during pregnancy, defined as either (1) no medication fills during pregnancy or (2) a gap of more than 60 days between prescription fills.
## Main Outcomes and Measures
Mental health emergencies during pregnancy, including emergency department visits for psychiatric indications such as psychosis or substance overdose. Rates were compared between women who continued vs discontinued antidepressant therapy.
## Results
Among 3,983 women (mean age not reported), 36.7% entered pregnancy with an active SSRI or SNRI prescription. During pregnancy, 17.8% had no medication fills and 64.6% experienced a refill gap. Discontinuation rates were 29.7% in the first trimester, 31.6% in the second trimester, and 38.6% in the third trimester.
Prepregnancy emergency and outpatient mental health visit rates were similar between continuation and discontinuation groups. However, women who discontinued antidepressant therapy during pregnancy had nearly twice the risk of experiencing a mental health emergency compared with those who continued treatment. The association was strongest in the first month (P = .02) and ninth month (P < .01) of pregnancy.
Conclusions and Relevance
In this cross-sectional analysis, discontinuation of SSRIs or SNRIs during pregnancy was associated with a substantially increased risk of acute mental health emergencies. These findings suggest that routine discontinuation of antidepressants during pregnancy may pose significant maternal risks and underscore the importance of individualized risk-benefit counseling and policies that support continued treatment when clinically appropriate.
