New research suggests that when pregnant women stop taking their antidepressants they are nearly twice as likely to have a mental health emergency as those who continue to take their medication.
The research, which was presented at the annual conference of the Society for Maternal-Fetal Medicine, used private insurance and pharmacy claims data from Pennsylvania to examine the medical histories of more than 1,400 women who had a baby in 2023 or 2024. Each of the women had been diagnosed with anxiety or depression and were already taking an antidepressant before becoming pregnant.
The data, which has not yet been peer-reviewed, showed that a majority of women stopped taking their antidepressants during pregnancy. Those who discontinued their medication had, in total, over 500 more emergency department visits for behavioral health reasons than those who kept taking the drugs. Before pregnancy, the number of mental health emergency visits was similar between the two groups of women.
Dr. Kelly B. Zafman, a maternal fetal medicine fellow at the Hospital of the University of Pennsylvania and the lead researcher, called the results “staggering.”
“We emphasize medication risks in pregnancy a lot,” she said. But the part that the medical establishment doesn’t do a good job of explaining, she added, “is that there are really significant risks of stopping medications.”
An estimated 10 to 20 percent of women in the United States experience depressive symptoms during pregnancy. And many of them receive conflicting information, often from medical providers or social media, about the safety of using antidepressants while trying to conceive or while pregnant.
A panel convened by the Food and Drug Administration last year that debated the safety of antidepressant use during pregnancy drew criticism from the American College of Obstetricians and Gynecologists, which called it “alarmingly unbalanced,” especially given how little time was devoted to discussing the dangerous effects of untreated mental illness.
We dug through the research and contacted top experts in maternal mental health to help explain the facts about one of the most commonly prescribed antidepressants, selective serotonin reuptake inhibitors, or S.S.R.I.s, and pregnancy.
Do S.S.R.I.s work for perinatal mood disorders?
S.S.R.I.s have been prescribed for decades to perinatal women, meaning women who are pregnant or who have recently given birth. The medications have also been researched in these populations more often than any other type of antidepressant has. These studies have found that S.S.R.I.s can be effective in treating depression, anxiety and other mood disorders, particularly among women who have more severe cases of these illnesses.
“The medicine often provides the floor so that people aren’t plummeting into major depression,” said Dr. Helen Kim, a perinatal and reproductive psychiatrist who is the medical director of the Redleaf Center for Family Healing in Minneapolis.
Although there are no randomized controlled trials of women using S.S.R.I.s during pregnancy, robust observational data from hundreds of thousands of patients show that antidepressants are generally safe during pregnancy and that the risks of untreated depression are significant.
Serotonin-norepinephrine reuptake inhibitors, or S.N.R.I.s, and bupropion are considered comparably safe to S.S.R.I.s, said Dr. Misty C. Richards, a child and reproductive psychiatrist at the University of California, Los Angeles. However, there is less data on their use during pregnancy.
As with any medication, it’s important to consult a doctor to weigh the risks and benefits of taking an antidepressant and to discuss any potential side effects, Dr. Richards added. But if a pregnant patient comes to her who is already stable on an antidepressant, “the golden rule is: Don’t interfere with that,” she said.
Although the research presented at the Society for Maternal-Fetal Medicine conference was not nationally representative, it mirrors the results of an earlier study of Medicaid patients, which also found that it was common for women to discontinue their psychotropic medications, starting in the first trimester. A 2022 study that examined data from Denmark found that stopping antidepressants during pregnancy was associated with increased incidence of psychiatric emergency.
Sarah Bynum, 34, a mother of four who lives in Brookhaven, Pa., has been on antidepressants since she was a teenager. When she first became pregnant, she decided to stop taking her medication and then developed severe anxiety.
In her subsequent pregnancies, she chose instead to stick with her antidepressant while also receiving talk therapy.
“I needed to not have these anxieties weigh me down,” she said. “I needed to be able to focus on having a healthy pregnancy and caring for my toddler.”
Are there risks to the baby?
Persistent pulmonary hypertension of the newborn, or P.P.H.N., is a rare but life-threatening condition that affects one to two infants per 1,000 births in the general population. The condition interferes with blood flow to the pulmonary artery. As a result, the baby’s blood doesn’t have enough oxygen.
The F.D.A. announced in 2011 that “it is premature to reach any conclusion about a possible link between S.S.R.I. use in pregnancy and P.P.H.N.” Earlier research had suggested that the babies of women who took S.S.R.I.s during pregnancy had a higher risk of developing the condition. But subsequent studies found either no association between S.S.R.I. use in late pregnancy and persistent pulmonary hypertension of the newborn, or a much smaller risk than previously reported.
Up to 30 percent of babies exposed to S.S.R.I.s in the third trimester may experience what’s called poor neonatal adaptation. Though it can lead to symptoms such as jitters, restlessness, irritability and rapid breathing, these typically resolve on their own, often within a few days.
What about the risks of miscarriage, autism and other issues?
Because S.S.R.I.s cross the placental barrier, passing from the mother’s bloodstream into the baby’s blood, researchers have investigated whether S.S.R.I.s could affect a baby’s cognitive and behavioral development or increase the risks of birth defects or miscarriage.
Some studies suggested a potential link between S.S.R.I. use during pregnancy and autism, but they did not take into account that a mother’s psychiatric disorder is itself associated with an increased risk that a baby will develop autism. Other studies that controlled for maternal psychiatric illness, however, did not find an association between S.S.R.I.s and autism.
Similarly, S.S.R.I. use during pregnancy does not result in an increased risk of miscarriage, according to several large meta-analyses, including one from 2024. Earlier studies did suggest that S.S.R.I. use could increase the risk of miscarriage, but it remains unclear whether that risk was because of the medication, the depression itself or other factors associated with depression, like substance use or poor nutrition.
Finally, S.S.R.I.s are not typically associated with an increase in the risk of neurodevelopmental disorders or birth defects. The exception is paroxetine (Paxil), which has been associated with a small increased risk of cardiac malformations, Dr. Kim said. For this reason, she added, paroxetine is not typically considered a first-line antidepressant in pregnancy.
What are the risks of not treating depression during pregnancy?
When pregnant women aren’t adequately treated for depression, there can be big consequences for both the mother and the baby.
Research has found that depression in pregnancy can put newborns at risk for preterm birth, low birth weight, and increase the likelihood of neonatal intensive care admission. Untreated depression can also raise the risk that the mother will develop pre-eclampsia, a high-risk condition during pregnancy that is characterized by sudden high blood pressure and often by protein in the urine.
In 2020, an analysis of four studies found that pregnant women with severe depression had a higher risk of their symptoms returning compared with women who had milder depression after stopping their antidepressant medication.
Women experiencing depression may also be more likely to self-medicate by drinking alcohol or using illegal drugs. And some have difficulty bonding with their newborn, which may affect the child’s I.Q. and development.
Some depressed mothers die by suicide. In the United States, it contributes to more than 8 percent of pregnancy-related deaths.
“If I hadn’t gotten treatment, there’s a good chance I wouldn’t have been here anymore,” said Paige Bellenbaum, 52, a clinical social worker whose mental illness after the birth of her son inspired her to become a perinatal mental health expert.
Her depression and anxiety, which had resurfaced during pregnancy, only intensified after her son was born, and she began having suicidal thoughts. So she took a cab to a women’s clinic and started taking an S.S.R.I.
What can you do aside from taking medication?
S.S.R.I.s are just one way to treat mood disorders. Studies show that talk therapy, getting sufficient sleep, eating nutritious food and exercising can help relieve symptoms of depression and anxiety. Support groups, or a strong support system, have also been shown to improve mood.
Shawnnae Anderson, 27, who lives in Queens, N.Y., decided to stop taking psychiatric drugs when she found out that she was pregnant.
Her symptoms were not severe, so she found it sufficient to lean on her therapist and a postpartum peer coach. This, combined with meditation, keeping a journal and yoga, allowed her to manage her emotions.
Ms. Anderson, who had her baby eight months ago, has not restarted the drugs and said she is doing well.
But if her current strategies weren’t working, she added, she would return to her prescriptions.
“I need to be well to take care of my baby,” she said.
Christina Caron is a Times reporter covering mental health.
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